Chapter 5Results from the Cognitive Functioning and Ageing Studies analysis

Dementia and comorbidity compared with dementia

Approximately one-third of individuals with dementia and no target condition used hospital services in the last 12 months. In comparison, between 45% and 58% of individuals with dementia and one of the target health conditions used hospital services, with the highest use seen in those with dementia and stroke (see Figure 6). This was mainly driven by the use of inpatient services, as day patient and outpatient service use was largely the same in both groups (see Figure 7). Those with dementia and stroke used inpatient services more than those with only dementia; this was also the case for those with dementia and either diabetes or VI, but the level of service use was not quite as high as it was for those with dementia and stroke (see Appendix 5).

As with hospital use, the use of services in the previous 4 weeks was higher for those with dementia and one of the target health conditions than for those with dementia alone (see Figure 6). For those with dementia but none of the target health conditions, six out of 10 people used some form of service in the last 4 weeks, whereas, for those with dementia and one of the target health conditions, around eight out of 10 people used some form of service in the last 4 weeks. Use of services was higher for those with dementia and stroke because of home care assistant, chiropodist and day centre use (see Appendix 5). The use of any nursing service and chiropodists was the reason for higher service use in the previous 4 weeks for those with dementia and diabetes and this was also the case for those with dementia and VI (see Appendix 5).

Around one-quarter of people with dementia and none of the target conditions used day-to-day services. This compared with more than one-third of those with dementia and diabetes and almost half of those with either dementia and stroke or dementia and VI (see Figure 6). Those with dementia and stroke had day-to-day help from a care worker a considerable amount more than those with dementia alone. Although this was also true for those with dementia and either diabetes or VI, it was not of the same magnitude (see Appendix 5).

Unpaid care was common, with over two-thirds of people with dementia alone reporting use of informal help from family and friends. Use of unpaid care was even higher for individuals with dementia and one of the target health conditions, with around eight out of 10 people reporting informal help (see Figure 7).

Dementia and comorbidity compared with comorbidity alone

When comparing those with dementia and a target health condition with those with just the health condition, hospital use mostly does not change (see Appendix 5). The only case in which there is a difference is for those with dementia and stroke, with use of inpatient services being higher than for those with stroke alone. The use of a home care assistant and a day centre in the previous 4 weeks was higher for those with dementia and the target health condition than for those with the target health condition alone. Of all of the day-to-day services, the use of a care worker was higher for those with dementia and a target health condition than for those with the target health condition alone. Unpaid care was also used more by those with dementia and any of the target health conditions than by those with the health condition alone. However, caution should be exercised when interpreting these results as the estimates have broad CIs because of instability introduced by having a small reference group (the target health condition).

Overall service use

Box 3 shows the key messages relating to overall service use.

BOX 3

Key messages Hospital service use has increased in the last decade for those with dementia alone and those with dementia and stroke.

Figure 8 gives the overall grouped service use for individuals with dementia and one of the target health conditions. Additional details of differences in service use between CFAS I and CFAS II comparing dementia alone with dementia plus a target condition are provided in Appendix 5. One of the limitations was that hospital use data were collected for a different time period from that for day patient or outpatient service use data. For example, for day patient and outpatient services participants were asked if they had used them in the previous few months but for inpatient services participants were asked if they had been admitted in the last year. However, it is clear that hospital use increased between CFAS I and CFAS II for those with dementia alone and for those with dementia and stroke.

FIGURE 8

Percentage of grouped service use in CFAS I and CFAS II with 95% CIs by those with dementia alone and dementia with each of the target comorbidities. (a) Dementia and no target comorbidity; (b) dementia and stroke; (c) dementia and diabetes; and (d) dementia (more...)

Although hospital service use increased for those with only dementia, the use of day-to-day services and service use in the 4 weeks before interview decreased slightly between CFAS I and CFAS II. Day-to-day service use decreased between CFAS I and CFAS II for all those with dementia and a target condition. Apart from day-to-day service use, those with dementia and stroke had similar service use in CFAS I and CFAS II. This was also the case for those with dementia and diabetes, although there was a slight increase in the use of unpaid care in CFAS II. More change was seen for those with dementia and VI: there was an increase in the use of unpaid care and services in the 4 weeks before interview between CFAS I and CFAS II as well as the decrease in day-to-day service use. Unfortunately, because of non-response this could not be tested formally.

Across all target conditions in CFAS I and CFAS II there was an increased use of unpaid care compared with those having dementia alone.

Separate service use

Box 4 shows the key messages relating to separate service use.

BOX 4

Key messages There was an increase in the use of unpaid care for those with dementia and either diabetes or VI.

More detailed results on separate services are provided in Figure 9. For those with dementia but none of the target health conditions the overall increase in hospital use resulted from an increase in the use of all hospital services but mainly from an increase in day patient and outpatient admissions. The large increase in day patient service use was also present for those with dementia and stroke. Although hospital service use overall increased for people with dementia and stroke, reductions in inpatient and outpatient admissions were observed between CFAS I and II. These decreases were also observed in those with dementia and VI but not in those with dementia and diabetes.

FIGURE 9

Percentage of individual service use in CFAS I and CFAS II with 95% CIs by those with dementia alone and dementia with each of the target comorbidities. (a) Dementia and no target comorbidity; (b) dementia and stroke; (c) dementia and diabetes; and (d) (more...)

For people with dementia and without any of the target conditions, decreases in service use in the 4 weeks before interview were mainly driven by decreases in chiropodist and social worker use. Increases in day centre use were mirrored in people with dementia and either stroke or VI and there was also an increase in the use of nursing services by those with dementia and stroke. For people with dementia and VI, the overall increase in service use in the 4 weeks before interview was mainly driven by an increase in chiropodist use and GP visits, as well as greater use of day centres. A reduction in the use of meals on wheels was observed across all groups.

Differences in the proportion of people using care workers, paid help or home help on a day-to-day basis accounted for the majority of the change in overall use of day-to-day services across groups. For people with dementia and no target condition, reductions in the use of daily care workers and home help accounted for the majority of the reduction in day-to-day services. Decreases in the use of meals on wheels and care workers accounted for the overall decrease in use of day-to-day services seen for people with dementia and either stroke or VI.

Separate services within each condition

Although overall hospital service use remained similar in CFAS I and CFAS II for those with dementia and stroke, there was a decrease in inpatient and outpatient admissions, which was balanced out by an increase in day patient admissions. Between CFAS I and CFAS II those with dementia and stroke used more speech therapists, occupational therapists and social workers, whereas use was low in CFAS I. For this group, there was also an increase in the use of day hospitals and day centres, GPs, chiropodists and nursing services. There was a decrease in the use of physiotherapists, meals on wheels and home help by those with dementia and stroke during this time. The use of day-to-day services decreased for those with dementia and stroke. This was mainly because of a reduction in the use of care workers, home help, paid help and meals on wheels. The use of unpaid care remained similar between CFAS I and CFAS II.

For those with dementia and diabetes there was only a slight increase in the use of outpatient services between CFAS I and CFAS II. Overall, the use of services in the 4 weeks before interview was similar between CFAS I and CFAS II but there were increases in the use of speech therapists, social workers and chiropodists, which were mainly offset by the decrease in the use of meals on wheels. The decrease in day-to-day service use seen in those with dementia and diabetes was the result of a decrease in the use of care workers, wardens and paid help, although increases were seen in the use of community nurses and home help. The use of unpaid care increased substantially between CFAS I and CFAS II for those with dementia and diabetes.

All service use apart from day-to-day service use increased between CFAS I and CFAS II for individuals with dementia and VI. For hospital service use this resulted from an increase in day patient admissions although decreases were also seen in inpatient and outpatient admissions. There was a decrease in the use of physiotherapists, meals on wheels and home help in the 4 weeks before the interview between CFAS I and CFAS II but large increases in visits to chiropodists, GPs and day centres. For day-to-day service use, all service use decreased between CFAS I and CFAS II apart from use of wardens and community nurses. The use of unpaid care increased between CFAS I and CFAS II.