title: Caring for dementia: a population-based study examining variations in guideline-consistent medical care.
abstract: BACKGROUND
  Evidence indicates that early detection and management of dementia care can improve outcomes. We assess variations in dementia care based on processes outlined in clinical guidelines by the BC Ministry of Health.
  
  
  METHODS
  A population-based retrospective cohort study of community-dwelling seniors using patient-level administrative data in British Columbia, Canada. Guidelines measured: laboratory testing, imaging, prescriptions, complete examination, counseling, and specialist referral.
  
  
  RESULTS
  Older patients were less likely to receive guideline-consistent medical care. Patients in higher income categories had higher odds of receiving counseling (confidence interval or CI 1.13-153) and referrals (15.1 CI 1.18-1.95) compared with those of lower income. Over a quarter of the cohort received an antipsychotic (28%) or nonrecommended benzodiazepine (26%). Individuals living within "rural" health authorities or of low income were more likely to receive antipsychotic treatment.
  
  
  CONCLUSIONS
  Patterns of inequality by age and income may signal barriers to care, particularly for management of dementia care processes.
authors.affiliation: UBC Centre for Health Services and Policy Research, School of Population and Public Health, Vancouver, BC, Canada. Electronic address: ssivananthan@chspr.ubc.ca.
authors.forename: Saskia N
authors.initials: SN
authors.lastname: Sivananthan
authors.affiliation: UBC Centre for Health Services and Policy Research, School of Population and Public Health, Vancouver, BC, Canada.
authors.forename: M Ruth
authors.initials: MR
authors.lastname: Lavergne
authors.affiliation: UBC Centre for Health Services and Policy Research, School of Population and Public Health, Vancouver, BC, Canada.
authors.forename: Kimberlyn M
authors.initials: KM
authors.lastname: McGrail
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000592:standards / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000592:standards / Q000627:therapeutic use; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D018672:Community Health Planning; D003695:Delivery of Health Care / Q000379:methods* / Q000592:standards*; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D059906:Neuroimaging; D010808:Physical Examination
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents
keywords: Dementia care; Elderly; Health service utilization; Inequality; Population-level; Variation