Primary care service utilisation pattern in dementia: a 10-year longitudinal population-based study.
Primary care service utilisation pattern in dementia: a 10-year longitudinal population-based study.
Where did the research take place?
The study site has not been established. Author addresses may differ from where the research occurred.
London, GB · Author affiliation
King's College London - Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, Denmark Hill Campus, London, SE5 8AF, United Kingdom of Great Britain and Northern Ireland.Location evidence
DK · Author affiliation · country only
King's College London - Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, Denmark Hill Campus, London, SE5 8AF, United Kingdom of Great Britain and Northern Ireland.Location evidence
IE · Author affiliation · country only
King's College London - Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, Denmark Hill Campus, London, SE5 8AF, United Kingdom of Great Britain and Northern Ireland.Location evidence
Singapore, SG · Author affiliation
National University of Singapore - Department of Japanese Studies, Faculty of Arts and Social Sciences, 10 Kent Ridge Crescent, Singapore 119260, Singapore.Location evidence
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Original abstract
BackgroundPrimary care services play a key role in dementia care, yet activity may vary between subtypes.ObjectiveTo investigate longitudinal determinants of primary care contact across Alzheimer's disease (ad), vascular dementia (VD), dementia with Lewy bodies (DLB), and Parkinson's disease dementia (PDD) 5 years pre-and-post-diagnosis, encompassing clinical, cognitive, functional, and sociodemographic factors.DesignRetrospective cohort study.MethodsData on 4384 individuals with first dementia diagnoses (2008-2023) were obtained from a South London catchment linking dementia services with primary care records. Linear mixed-effects models were run on 3-month interval counts (up to 40 intervals per individual, 20 pre-and-post-diagnosis). Separate pre-and-post-diagnosis models assessed longitudinal trends, adjusted for age, sex, and antidepressant use, with subgroup analyses by dementia subtype and cognitive status.ResultService utilisation increased over time, with VD showing a steeper pre-diagnosis rise and PDD moderate post-diagnosis increases compared to ad. Across both periods, worse cognitive impairment and antipsychotic receipt were associated with lower contacts, while older age and Black/British Black ethnicity were associated with higher contact. Pre-diagnosis, agitation, depressed mood, relationship and living conditions problems were linked to lower contact, whereas hallucinations were associated with higher use. Post-diagnosis, hypnotic/anxiolytic use predicted lower contact, while acetylcholinesterase inhibitor receipt, comorbidities, daily living difficulties, and mixed ethnicity were associated with increased utilisation.ConclusionPerson-centred care pathways should anticipate subtype-specific and individual patterns, providing targeted support for those with reduced pre-diagnosis contact who may have unmet needs, while considering early intervention for groups anticipated to require increased service use after diagnosis.