The association between an early diagnosis of dementia and secondary health service use: A retrospective cohort study using electronic health records: Epidemiology / Prevalence, incidence, and outcomes of MCI and dementia. (7th December 2020)

• Record Type: Journal Article
• Authors: Couch, Elyse; Mueller, Christoph; Perera, Gayan; Lawrence, Vanessa; Prina, Matthew
• Is Part Of: Alzheimer's & dementia. Volume 16(2020)Supplement 10
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-12-07
• Subjects: Alzheimer's disease -- Periodicals; Alzheimer Disease -- Periodicals; Dementia -- Periodicals; Démence; Maladie d'Alzheimer; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.83
• DOI: 10.1002/alz.041854
• Languages: English
• ISSNs: 1552-5260

Abstract

Abstract: Background: The frequent use of emergency services and unplanned hospitalisations is reflective of fractured dementia care. People living with dementia have a higher risk of hospitalisation and are more likely to use Accident and Emergency (A&E) services more than people of the same age without dementia. It has been proposed that diagnosing dementia early can reduce the risk of harmful hospital admissions or A&E attendances, however there is very little evidence to support this. A diagnosis of Mild Cognitive Impairment (MCI) before dementia can be a helpful proxy to explore early diagnosis. Therefore, the aim of this study was to investigate the association between an early diagnosis of MCI and hospitalisations and A&E attendances. Method: This study is a retrospective cohort study of electronic health care records from 15, 836 patients from a large secondary care database in South London, UK. Participants were divided into two groups: those with a diagnosis of MCI before dementia, to represent an early diagnosis, and those without. Cox regression models were used to compare risk of hospitalisation and A&E attendances after dementia diagnosis. Finally, negative binomial regression models were used to compare the average length of stay and average number of A&E attendances. All models were adjusted for age at diagnosis, gender, ethnicity, levels of comorbid physical conditions, prescription of acetylcholinesterase inhibitors (AChEIs) and, mini‐mental state exam (MMSE) scores at dementia diagnosis. Results: Participants with an early diagnosis were more likely to attend A&E after their diagnosis of dementia (HR=1.13), however they did not visit A&E more frequently compared to participants without an early diagnosis (IRR=1.01). There was no difference the risk of hospitalisation or length of stay between the groups. Conclusion: The findings of this study demonstrate that despite the widely held belief that an early diagnosis reduces the likelihood of potentially harmful A&E attendances, patients with an early diagnosis were more likely to visit A&E after their diagnosis. It is possible this may reflect their use of A&E services before dementia. An early diagnosis does not impact the risk of hospitalisation or the length of time spent in hospital.