title: Patterns of health service use in community living older adults with dementia and comorbid conditions: a population-based retrospective cohort study in Ontario, Canada.
abstract: Patients with dementia have increased healthcare utilization and often have comorbid chronic conditions. It is not clear if the increase in utilization is driven by dementia, the comorbidities or both. The objective of this study was to describe the number and types of comorbid conditions in a population-based cohort of older adults with dementia and how the level of comorbidity impacts dementia-related and non-dementia-related health service utilization.
  
  
  
  This study is a retrospective cohort study using multiple linked administrative databases to examine health service utilization and costs of 100,630 community-living older adults living with pre-existing dementia in Ontario, Canada. Comorbid conditions and health service utilization were measured using administrative data (physician visits, emergency department visits, hospitalizations, and homecare contacts).
  
  
  
  Nearly all, 96.3 %, had at least one comorbid condition, while 18.4 % had five or more comorbid conditions. The most common comorbid conditions were hypertension (77.8 %), and arthritis (66.2 %). All types of utilization increased consistently with the number of comorbid conditions. The average number of dementia-related services tended to be similar across all levels of comorbidity while the average number of non-dementia related visits tended to increase with the level of comorbidity.
  
  
  
  Comorbidities in community-living older adults with dementia are common and account for a substantial proportion of health service use and costs in this population. Our results suggest that comprehensive programs that take a holistic view to identify the needs of patients in the context of other comorbidities are required for persons with dementia living in the community.
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University, McMaster Innovation Park, 175 Longwood Road South, Hamilton, ON, L8P 0A1, Canada. griffith@mcmaster.ca.
authors: Lauren E
authors: 0000-0002-2794-9692
authors: LE
authors: Griffith
authors: Department of Family Medicine, 6-40 University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada.
authors: Andrea
authors: A
authors: Gruneir
authors: School of Nursing, McMaster University, Health Sciences Centre, 1280 Main Street West, Room 3N25B, Hamilton, ON, L8S 4K1, Canada.
authors: Kathryn
authors: K
authors: Fisher
authors: Women's College Research Institute, Women's College Hospital, 790 Bay St., 7th floor, Toronto, ON, M5G 1N8, Canada.
authors: Dilzayn
authors: D
authors: Panjwani
authors: Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
authors: Sima
authors: S
authors: Gandhi
authors: Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
authors: Li
authors: L
authors: Sheng
authors: Centre for Health Economics and Policy Analysis; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Room CRL-208, Hamilton, ON, L8S 4K1, Canada.
authors: Amiram
authors: A
authors: Gafni
authors: Department of Medicine, McMaster University, Health Sciences Centre, 1280 Main Street West, Room 3N25B, Hamilton, ON, L8S 4K1, Canada.
authors: Christopher
authors: C
authors: Patterson
authors: School of Nursing, McMaster University, Health Sciences Centre, 1280 Main Street West, Room 3N25B, Hamilton, ON, L8S 4K1, Canada.
authors: Maureen
authors: M
authors: Markle-Reid
authors: School of Nursing, McMaster University, Health Sciences Centre, 1280 Main Street West, Room 3N25B, Hamilton, ON, L8S 4K1, Canada.
authors: Jenny
authors: J
authors: Ploeg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003704:Dementia / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D009864:Ontario / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: Community-living older adults; Comorbidity; Dementia; Health service costs; Health service utilization