Home Care Services Use in Older Adults Living with Severe Mental Illness: Care Patterns Variations Before and After an Incident Dementia Diagnosis: Utilisation des services de soins à domicile chez les personnes âgées atteintes de troubles de santé mentale graves : Variation des modèles de soins avant et après un diagnostic de trouble neurocognitif.

Abstract

ObjectiveOlder adults with severe mental illness (SMI) represent a complex population with various healthcare needs, even more so when they subsequently develop dementia. While home care (HC) services are advocated for both patients with SMI and dementia, little is known regarding real-life practices, especially for individuals having both conditions. Therefore, we aimed to describe healthcare use and transitions in older adults with SMI across HC user profiles, before and after an incident dementia diagnosis.MethodWe used a retrospective cohort study drawn from Quebec health administrative data on individuals with SMI living in the community, aged 65 and older, and who received a first dementia diagnosis between 2013 and 2015. We described healthcare use 8 months prior and 2 years after the diagnosis, including hospital admissions, visits to the emergency department (ED), and long-term care (LTC) placement.ResultsA total of 3,713 individuals were included, 53% of whom were already receiving HC services before the diagnosis (Group 1), 28% received HC services only after the diagnosis (Group 2), and 19% did not receive any HC (Group 3). While Group 1 showed the highest overall healthcare use before the diagnosis, the most striking increase after the diagnosis was observed for Group 2, catching up with Group 1's levels for many indicators, and even surpassing them in some cases. HC was mainly introduced in the four months following the diagnosis in Group 2. Group 3, while showing the lowest healthcare use throughout the study period, had the second highest mortality rate after Group 1. Groups 2 and 3 were transferred to LTC and died at younger ages than Group 1, in average.ConclusionsThis study highlights potential missed opportunities for intervention, such as an earlier HC introduction which could contribute to prevent an increase in hospitalizations and ED visits, or any HC in Group 3 to mitigate mortality risk and postpone LTC placement.