Identifying Distinct Profiles of People with Dementia Based on their Healthcare Use in the Last Year of Life Using Routine Data (Sampson, 2023)

Yorganci E., Stewart R., Sampson E.L., Sleeman K.E.

Palliative Medicine 2023;37(1 Supplement): 191.

Background/aims: People with dementia can access multiple healthcare services for their care needs. Among those approaching end of life, access and use of healthcare services vary considerably. We aimed to characterise subgroups of people with dementia based on their healthcare use in the last year of life.

Method(s): Retrospective cohort study using mental healthcare data of decedents who were >= 50 years old at dementia diagnosis in South London and Maudsley Hospital, United Kingdom, linked with national hospital data (2006-2020). We used latent profile analysis to group the individuals according to their patterns of healthcare use (planned & unplanned hospital admissions, length of hospital stays, outpatient visits, emergency visits, community nurse & therapist visits, mental health appointments). We used multinomial logistic regression with multiple imputation to predict sociodemographic and illness characteristics, and the outcome of dying in hospital, based on individual's group membership.

Result(s): 11,209 decedents with dementia were grouped into four distinct healthcare profiles: 1. minimal healthcare users (n=2,728, 24%) 2. occasional hospital in-patients & mental health care input (n=4,909, 44%) 3. frequent hospital & emergency department visitors (n=1,242, 11%) 4. specialist care recipients who spend long periods in hospital (n=2,330, 21%). Having a non-Alzheimer's dementia diagnosis, not receiving a care package, being diagnosed with dementia at older age, female, Black, Asian and other minority ethnicity were all associated with higher relative odds of being in group 2,3 or 4 compared to group 1. Compared to group 1, all other three groups had over four times higher relative odds of dying in hospital (p<0.000, CI 95% 4.3-5.1 for group 1 vs 3).

Conclusion(s): Distinct profiles of people with dementia exist based on their healthcare use in the last year of life. We identified policy targets for improving care, and need for exploring underlying mechanisms between sociodemographic factors, health and care use.