Health Services/Policy
Primary care follow-up visits after discharge from hospital among older adults with dementia Derek Manis* Derek Manis Manis Manis Manis Manis Manis Manis Manis Arizona State University
Older adults with dementia have fragmented health service use, particularly after discharge from hospital. This population-based, retrospective cohort study used linked, individual-level health system administrative data in Ontario, Canada to examine the time to a primary care physician (PCP) follow-up visit among older adults (≥ 66 years) with a previous physician-diagnosed dementia billing claim who were discharged from the emergency department and/or a hospital admission between July 1, 2018 and June 30, 2023; these older adults were followed until March 31, 2024. Older adults who were residents of licensed assisted living facilities were compared to community-dwelling home care recipients. Stabilized inverse probability (IP) weighted pooled logistic regression models were used to graph marginal cumulative incidence curves that were standardized by each exposure status at each day of follow-up from the hospital discharge date. There were 3,144 older adults from licensed assisted living facilities (Mean [SD] age = 88.0 [6.4] years, 72% female) and 25,046 home care recipients (Mean [SD] age = 84.5 [7.4] years, 60% female) who were discharged from hospital (N = 29,190; 1,538,936 person-days). The mean of the stabilized IP weights was 0.99. There were 44 (95% CI [11, 77]), 47 (95% CI [13, 81]), and 26 (95% CI [-5, 58]) additional visits with a PCP per 1,000 older adults if all older adults were residents of assisted living facilities at the 7-, 14-, and 30-days of follow-up after discharge from hospital. The risk of a visit with a PCP was 1.13 (95% CI [1.03, 1.24]), 1.10 (95% CI [1.03, 1.17]), and 1.04 (95% CI [0.99, 1.09]) times higher if all older adults were residents of assisted living facilities at the 7-, 14-, and 30-days of follow-up after discharge from hospital. These population-level findings of follow-up PCP visits likely signal that residency in a licensed assisted living facility can better support the health service needs of older adults with dementia.