Impact of Dementia on Health Service Use in the Last 2 Years of Life for Women with Other Chronic Conditions

Abstract

Objectives: To assess the impact of dementia on the use of health and community services in the last 2 years of life by women who also had other major chronic conditions.

Design: Matched groups of women with a chronic condition who did or did not also have dementia, and who died or did not die for at least another 2 years.

Setting and participants: Participants in the Australian Longitudinal Study on Women's Health who were born from 1921-1926. These women were from a random, nationally representative sample of 12,432 recruited in 1996 with follow-up until 2014.

Methods: Repeated survey data and linked administrative records were used to identify women with heart disease, chronic lower respiratory tract disease, and dementia. Use of aged care services, medical visits, and hospital admissions were compared among the matched groups.

Results: Women with dementia were more likely to move into residential aged care, especially in the months and years before death. Consequently, they made less use of community-based services. Numbers of general practitioner visits were similar for women with or without dementia, increasing substantially in the last 4 months of life. In contrast, women with dementia were less likely to see medical specialists and slightly less likely to be admitted to hospital, even in the last 4-6 months of life when hospitalization was more common. The findings were similar whether the comorbid condition was heart disease or chronic lower respiratory tract disease.

Conclusions and implications: Use of other services is affected by use of residential aged care, so the comprehensive care of people with dementia requires understanding connections between sectors.

Keywords: Dementia; community services; comorbidity; health service use; last 2 years of life; older women.