Dementia care in Ontario, Canada: evidence of more timely diagnosis among persons with dementia receiving care at home compared with residential facilities. (January 2016)

• Record Type: Journal Article
• Authors: Bartfay, Emma; Bartfay, Wally J.; Gorey, Kevin M.
• Is Part Of: Public health. Volume 130(2016)
• Page Start: 6
• Page End: 12
• Publication Date: 2016-01
• Subjects: Dementia diagnosis -- Residential care -- Home care -- Cognitive status -- Functional status -- Activities of daily living; Public health -- Periodicals; Public health -- Periodicals; Electronic journals; 362.1
• DOI: 10.1016/j.puhe.2015.10.002
• Languages: English
• ISSNs: 0033-3506

Abstract

Abstract: Objective: Home care (HC) has been promoted as an efficient alternative to residential care (RC). However, little is known about the individuals who receive HC. This study compared the cognitive and functional statuses of persons with dementia receiving HC or RC at the time of diagnosis with dementia. It was hypothesized that persons with dementia receiving RC would have declined further, both cognitively and functionally. Study design: Population-based secondary data analysis. Methods: Data from the Canadian Institute for Health Information's Continuing Care Reporting System and the Home Care Reporting System, 2009–2011, were used. Respective populations of 39, 604 and 21, 153 persons with dementia who received either RC or HC were included. Cognitive and functional statuses were measured using a cognitive performance scale (CPS) and an activities of daily living (ADL) scale, respectively. Results: The mean CPS score was higher for the RC group (3.2 vs 2.5). The proportion of individuals diagnosed when impairment was moderate to very severe (CPS ≥ 4) was higher in the RC group (32.0% vs 13.3%). The mean ADL score was also higher for the RC group (3.5 vs 1.6). The proportion of individuals diagnosed when they required extensive assistance or were totally dependent (ADL ≥ 3) was markedly higher in the RC group (72.3% vs 27.3%). All findings were statistically significant ( P < 0.0001). Multivariable analysis suggested that RC clients were nearly four times more likely than HC clients to be diagnosed at a later stage (odds ratio = 3.74, 95% confidence interval 3.54–3.95). Conclusions: Persons with dementia in RC facilities in Ontario are diagnosed when their cognitive and functional statuses have declined more than those of their HC counterparts. Highlights: We compared welfare of persons with dementia receiving home or residential care. We examined cognitive and functional statuses at time of dementia diagnosis. Residential care clients had poorer cognition at time of dementia diagnosis. Residential care clients had worse functional status at time of dementia diagnosis. Residential care clients were four times as likely to experience later diagnoses.