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Cited by 17Frailty in Older AdultsDementia and Cognitive Impairment ResearchGeriatric Care and Nursing Homes

Joint impact of dementia and frailty on healthcare utilisation and outcomes: a retrospective cohort study of long-stay home care recipients

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Maxwell, Colleen J, Mondor, Luke, Hogan, David B, Campitelli, Michael A, Bronskill, Susan E, Seitz, Dallas P, Wodchis, Walter P·2019·BMJ Open
DOI 10.1136/bmjopen-2019-029523PMC PMC6596979
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Abstract

Objectives: To examine the associations between dementia and 1-year health outcomes (urgent hospitalisation, long-term care (LTC) admission, mortality) among long-stay home care recipients and the extent to which these associations vary by clients’ frailty level. Design: A retrospective cohort study using linked clinical and health administrative databases. Setting: Home care in Ontario, Canada. Participants: Long-stay (≥60 days) care clients (n=153 125) aged ≥50 years assessed between April 2014 and March 2015. Main outcome measures: Dementia was ascertained with a validated administrative data algorithm and frailty with a 66-item frailty index (FI) based on a previously validated FI derived from the clinical assessment. We examined associations between dementia, FI and their interactions, with 1-year outcomes using multivariable Fine-Gray competing risk (urgent hospitalisation and LTC admission) and Cox proportional hazards (mortality) models. Results: Clients with dementia (vs without) were older (mean±SD, 83.3±7.9 vs 78.9±11.3 years, p<0.001) and more likely to be frail (30.3% vs 24.2%, p<0.001). In models adjusted for FI (as a continuous variable) and other confounders, clients with dementia showed a lower incidence of urgent hospitalisation (adjusted subdistribution HR (sHR)=0.84, 95% CI: 0.83 to 0.86) and mortality rate (adjusted HR=0.87, 95% CI: 0.84 to 0.89) but higher incidence of LTC admission (adjusted sHR=2.60, 95% CI: 2.53 to 2.67). The impact of dementia on LTC admission and mortality was significantly modified by clients’ FI (p<0.001 interaction terms), showing a lower magnitude of association (ie, attenuated positive (for LTC admission) and negative (for mortality) association) with increasing frailty. Conclusions: The strength of associations between dementia and LTC admission and death (but not urgent hospitalisation) among home care recipients was significantly modified by their frailty status. Understanding the public health impact of dementia requires consideration of frailty levels among older populations, including those with and without dementia and varying degrees of multimorbidity.

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  • Differences observed between dementia populations and those without dementia are likely attributable to differences in dementia severity as well as other important risk factors such as frailty.

    “Differences observed between dementia populations and those without dementia are likely attributable to differences in dementia severity as well as other important risk factors such as frailty.27–29”

    From Trajectories of health system use and survival for community-dwelling persons with dementia: a cohort study (2020) · cites this paper as [27]

    The Discussion (page unavailable) reports that clients with dementia were more likely to be frail and that frailty modified the differences in long-term care admission and mortality between clients with and without dementia. The paper does not establish that those differences are attributable to dementia severity; it identifies dementia by diagnosis rather than measuring severity. Its findings are also limited to long-stay home care recipients. (LLM, conf=0.84)

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Research works printed but not linked: 29

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Authors
Maxwell, C. J., Mondor, L., Hogan, D. B., Campitelli, M. A., Bronskill, S. E., Seitz, D. P., & Wodchis, W. P.
Affiliations
  • University of Waterloo (CA)
  • Institute for Clinical Evaluative Sciences (CA)
  • University of Calgary (CA)
  • University of Toronto (CA)
  • Queen's University (CA)
Corresponding author
Maxwell, Colleen J
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2019-06
Volume
9
Issue
6
Pages
e029523
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2019-029523
PMC
PMC6596979
OpenAlex
W2949549720
Cited by
17
References
5
Citations by year
2026: 3 · 2025: 4 · 2023: 3 · 2022: 4 · 2021: 2 · 2020: 1
FWCI
0.92
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • Ontario Ministry of Health and Long-Term Care
  • ICES
Topics
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
Keywords
dementia, frailty, frailty index, long-term care admission, mortality, health care utilization, older adults, competing risks, interaction effects
MeSH terms
Aged, Aged, 80 and over, Dementia, Female, Home Care Services, Hospitalization, Humans, Long-Term Care, Male, Ontario, Patient Acceptance of Health Care, Retrospective Studies, Frail Elderly

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