Long-term Healthcare Transition Pathways Among Community Dwelling Adults with Dementia in Alberta, Canada; A retrospective cohort analysis

Abstract

In Canada, one in five adults over the age of 80 have dementia. Dementia negatively impacts other chronic conditions and is associated with a higher risk of death, frailty and higher health-care costs. Health care transitions are major events; the abrupt nature of transitions, are confusing and frustrating events for both patients and caregivers and there is increasing evidence that patient safety is jeopardized during transitions. Patient transition pathways through the health care system are complex and are inadequately captured by standard single outcome and transition models, so I developed a multi-state model to better reflect complex transition pathways. I did this by constructing a retrospective cohort of 10,287 older community-dwelling adults living with dementia, and the transitions they experienced over a two-year period, from administrative databases and electronic medical records. This data was summarized and then analyzed. I found that frequent transitions and complex pathways characterize long-term transition pathways for older adults living with dementia. Additionally, older age, being male, increased comorbidity and number of previous transitions increase the complexity of long-term transition pathways through the healthcare system.