Use of non-admitted geriatric and allied health services by people living with dementia in community and residential aged care

Introduction Post-diagnostic care guidelines for people with dementia recommend supports such as physiotherapy, occupational therapy, speech therapy, psychology and memory clinics. There is evidence that healthcare pathways differ between people living in the community and aged care. Methods Retrospective matched cohort study was carried out using linked mortality, admitted and non-admitted data. Study participants were residents living in a regional area, aged 65 or older with a first inpatient diagnosis of dementia. Transition from community to aged care (where applicable) was estimated using mode of separation, transfers to/from facility IDs, source of referral and type of usual accommodation. Time in study was censored for deaths and hospital admissions. A propensity matched cohort (admission date, socio-demographics, admission characteristics and comorbidities but without history of dementia) was used to compare rates of service use by setting. Results The study cohort included 4,786 people with a total of 4,937 person-years observed in the community and 3,734 in aged care. Non-admitted geriatric services 0.91 per year in the community compared to 0.35 in aged care. Non-admitted services involving an occupational therapist 0.61 per year in the community in contrast to 0.13 in aged care, involving a physiotherapist 0.84 per year in the community in contrast to 0.14 in aged care. The matched cohort included 4,909 people with a total of 7,205 person-years observed in the community and 3,251 in aged care. Non-admitted geriatric services 0.16 per year in the community compared to 0.12 in aged care. Non-admitted services involving an occupational therapist 0.51 per year in the community in contrast to 0.26 in aged care, involving a physiotherapist 0.88 per year in the community in contrast to 0.41 in aged care. Implications Despite having a similar demographic and clinical profile, people living with dementia in aged care received less support occupational therapy and physiotherapy than people without dementia.