Healthcare Service Utilisation of People Living With Non-Alzheimer's Dementia: A Systematic Review.

Abstract

IntroductionThe global rise in dementia presents significant challenges for healthcare systems. While Alzheimer's disease (AD) dominates dementia care, people with non-Alzheimer's dementias (non-AD), such as dementia with Lewy bodies (DLB), frontotemporal dementia (FTD), vascular dementia (VD), and Parkinson's disease dementia (PDD), often have distinct and unmet healthcare needs.AimThis systematic review aimed to summarise evidence on healthcare utilisation (HCU) patterns and factors affecting care among people living with non-AD dementias.MethodsFollowing a PROSPERO-registered protocol (CRD42024568391), comprehensive searches of Embase, Ovid MEDLINE, Global Health, PsycINFO, and PubMed were conducted in February and June 2024. Peer-reviewed English-language studies reporting on HCU or its determinants in DLB, FTD, VD, or PDD were included. Reviews, case reports, grey literature, and studies without subtype-specific data were excluded. Quality was assessed using the Newcastle-Ottawa Scale.ResultsThirty-one studies (16 cohort; 10 cross-sectional, 4 case-description, and 1 chart review) were included. HCU varied by dementia subtype and was influenced by sociodemographic, cognitive, and clinical factors. Compared with AD, non-AD dementias had higher healthcare use and costs. PDD showed the highest inpatient, outpatient, and skilled nursing care use, driven by severe cognitive decline. DLB was linked to unplanned hospital admissions and frequent ambulance use, often due to falls and pneumonia. FTD resulted in extended hospital stays related to behavioural symptoms, while VD incurred high costs due to chronic comorbidities and long-term care needs.ConclusionPeople with non-AD dementias have greater and distinct healthcare needs. Future research should develop standardised measures and tailored interventions to address their complex socioeconomic and clinical requirements.