Does Dementia Status Impact Fragmentation of Care During Last Year of Life?

During the last year of life, researchers found older adults (OAs) with dementia had lower use of health care services and less fragmented outpatient care when compared to OAs suffering from serious illness not related to dementia.

Study authors analyzed National Health and Aging Trends Study data and focused on adults aged 65 years or older who died and were linked to Medicare fee-for-service claims for 12 months or more prior to death between 2011 and 2017.

OAs were categorized into 3 groups: serious illness due to dementia, nondementia serious illness, or no serious illness. The Bice-Boxerman continuity of care index (COC) was calculated for outpatient fragmentation and measured the known provider of care index (KPC) and care concentration.

The number of hospitals and emergency departments visited were divided by the total number of visits for acute care fragmentation.

The study included 1793 OAs and results showed 42% had dementia, 53% experienced nondementia serious illness, and 5% had no serious illness.

“OAs with dementia had fewer hospitalizations than older adults with nondementia serious illness but more than older adults without serious illness (mean 1.9 vs 2.3 vs 1, P = 0.002),” wrote researchers.

“In adjusted models, compared to OAs with nondementia serious illness, those with dementia had significantly less fragmented care across all quantiles of COC (range 0.016-0.110) but a lower predicted 90th percentile of KPC, meaning more older adults with dementia had extremely fragmented care on the KPC measure.”

No significant different was observed in acute care fragmentation.

“More research is needed to understand the consequences of fragmentation of care in the last year of life on care quality and the end-of-life care experience from the perspective of older adults and families,” concluded study authors.

Reference:
Nothelle S, Kelley AS, Zhang T, Roth DL, Wolff JL, Boyd C. Fragmentation of care in the last year of life: does dementia status matter? J Am Geriatr Soc. Published online April 30, 2022. doi:10.1111/jgs.17827