Table 1.
All women with dementia (N = 3,717) | Care pattern HC onlyb (N = 1,179; 31.7%) | Care pattern HC > RC (N = 1,340; 36.1%) | Care pattern RC only (N = 1,014; 27.3%) | Other care pattern (N = 184; 5.0%) | p Valuec | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Characteristics | N/mean | Percentage/(CI) | N/mean | Percentage/(CI) | N/mean | Percentage/(CI) | N/mean | Percentage/(CI) | N/mean | Percentage/(CI) | |
Demographic | |||||||||||
Aged | 83.5 | (83.3, 83.7) | 83.1 | (82.7, 83.4) | 83.3 | (82.9, 83.7) | 84.4 | (84.0, 84.8) | 83.5 | (82.5, 84.4) | <.001 |
% 85 or olderd | 1,728 | 46.5% | 518 | 43.9% | 599 | 44.7% | 533 | 52.6% | 78 | 42.4% | <.001 |
High school or higher | 1,656 | 46.7% | 511 | 44.8% | 611 | 47.1% | 453 | 48.7% | 81 | 45.0% | .325 |
Low income (supplement)e | 1,642 | 44.9% | 599 | 52.5% | 606 | 45.5% | 329 | 32.8% | 108 | 59.3% | <.001 |
Living alone | 1,454 | 39.6% | 445 | 38.2% | 547 | 40.9% | 354 | 35.9% | 108 | 59.3% | <.001 |
Marital status | <.001 | ||||||||||
Married | 972 | 26.5% | 333 | 28.6% | 404 | 30.2% | 208 | 21.1% | 27 | 14.9% | |
Widowed | 2,319 | 63.2% | 707 | 60.7% | 809 | 60.5% | 669 | 67.8% | 134 | 74.0% | |
Separated | 49 | 1.3% | 20 | 1.7% | 15 | 1.1% | 12 | 1.2% | 2 | 1.1% | |
Divorced | 215 | 5.9% | 69 | 5.9% | 67 | 5.0% | 65 | 6.6% | 14 | 7.7% | |
Never married | 107 | 2.9% | 32 | 2.7% | 40 | 3.0% | 31 | 3.1% | 4 | 2.2% | |
Other | 7 | 0.2% | 4 | 0.3% | 2 | 0.1% | 1 | 0.1% | 0 | 0.0% | |
Location of residencef | <.001 | ||||||||||
Rural | 399 | 10.7% | 156 | 13.2% | 157 | 11.7% | 73 | 7.2% | 13 | 7.1% | |
Suburban | 1,336 | 35.9% | 408 | 34.6% | 501 | 37.4% | 367 | 36.2% | 60 | 32.6% | |
Urban | 1,982 | 53.3% | 615 | 52.2% | 682 | 50.9% | 574 | 56.6% | 111 | 60.3% | |
Health | |||||||||||
Falls riskg | .023 | ||||||||||
Low | 2,003 | 54.4% | 647 | 55.5% | 755 | 56.3% | 501 | 50.3% | 100 | 54.9% | |
Medium | 881 | 23.9% | 293 | 25.2% | 292 | 21.8% | 253 | 25.4% | 43 | 23.6% | |
High | 799 | 21.7% | 225 | 19.3% | 293 | 21.9% | 242 | 24.3% | 39 | 21.4% | |
ADLh | 1.4 | (1.4, 1.5) | 0.9 | (0.9, 1.0) | 1.1 | (1.0, 1.1) | 2.6 | (2.5, 2.7) | 0.6 | (0.4, 0.7) | <.001 |
CPSi | 2.4 | (2.4, 2.5) | 2.1 | (2.1, 2.2) | 2.3 | (2.2, 2.4) | 3.1 | (3.0, 3.1) | 1.7 | (1.6, 1.8) | <.001 |
Depressionj | 1.7 | (1.6, 1.8) | 1.6 | (1.5, 1.8) | 1.9 | (1.7, 2.0) | 1.6 | (1.4, 1.7) | 1.7 | (1.3, 2.0) | .016 |
Medical frailty (CHESS score)k | 1.3 | (1.3, 1.4) | 1.2 | (1.1, 1.3) | 1.4 | (1.3, 1.4) | 1.5 | (1.4, 1.5) | 1.2 | (1.1, 1.4) | <.001 |
PAINl | 0.9 | (0.9, 1.0) | 1.0 | (1.0, 1.1) | 0.9 | (0.9, 1.0) | 0.8 | (0.7, 0.9) | 1.0 | (0.8, 1.1) | <.001 |
Number of chronic conditionsm | 2.7 | (2.6, 2.7) | 2.8 | (2.7, 2.9) | 2.6 | (2.5, 2.7) | 2.5 | (2.4, 2.6) | 3.2 | (2.9, 3.4) | <.001 |
Incontinencen | 1,423 | 38.7% | 380 | 32.6% | 439 | 32.8% | 559 | 56.2% | 45 | 24.7% | <.001 |
Aggressiono | 600 | 16.3% | 135 | 11.6% | 220 | 16.4% | 238 | 23.9% | 7 | 3.8% | <.001 |
Died within study period | 1,116 | 30.0% | 251 | 21.3% | 420 | 31.3% | 409 | 40.3% | 36 | 19.6% | <.001 |
Primary caregiverp | <.001 | ||||||||||
Spouse | 685 | 18.8% | 224 | 19.2% | 311 | 23.2% | 137 | 14.4% | 13 | 7.1% | |
Child/child-in-law (live with) | 893 | 24.5% | 358 | 30.7% | 318 | 23.8% | 181 | 19.0% | 36 | 19.8% | |
Child/child-in-law (not live with) | 1,588 | 43.7% | 439 | 37.7% | 538 | 40.2% | 497 | 52.2% | 114 | 62.6% | |
Other (relative, friend, neighbor) | 437 | 12.0% | 136 | 11.7% | 160 | 12.0% | 122 | 12.8% | 19 | 10.4% | |
No primary caregiver | 35 | 1.0% | 8 | 0.7% | 11 | 0.8% | 16 | 1.7% | 0 | 0.0% | |
Hours of informal care weeklyp | 19.4 | (18.7, 20.1) | 21.8 | (20.6, 23.0) | 22.5 | (21.2, 23.8) | 13.3 | (12.0, 14.5) | 12.0 | (10.3, 13.6) | <.001 |
Service use | |||||||||||
Total days in long-term care | 752.5 | (738.0, 767.1) | 624.9 | (600.6, 649.3) | 923.7 | (900.8, 946.6) | 654.2 | (626.6, 681.8) | 866.0 | (807.7, 924.3) | <.001 |
Total hospitalizationsq | 2.1 | (2.0, 2.1) | 1.9 | (1.8, 2.0) | 2.3 | (2.2, 2.4) | 1.8 | (1.7, 1.9) | 2.8 | (2.5, 3.2) | <.001 |
0 | 843 | 22.7% | 341 | 28.9% | 283 | 21.1% | 180 | 17.8% | 39 | 21.2% | <.001 |
1 | 1,020 | 27.4% | 299 | 25.4% | 324 | 24.2% | 363 | 35.8% | 34 | 18.5% | |
2 | 671 | 18.1% | 198 | 16.8% | 241 | 18.0% | 204 | 20.1% | 28 | 15.2% | |
3+ | 1,183 | 31.8% | 341 | 28.9% | 492 | 36.7% | 267 | 26.3% | 83 | 45.1% | |
Total hospital days | 40.1 | (38.5, 41.7) | 25.4 | (23.2, 27.7) | 43.4 | (40.6, 46.2) | 52.6 | (49.5, 55.7) | 41.6 | (33.8, 49.3) | <.001 |
Note: ANOVA = analysis of variance; CI = confidence interval; HC = home care; LTC = long-term care; RC = residential care.
aBased on demographic and RAI assessment values closest to the start of LTC—baseline.
bCare patterns based on first and last service records.
cSignificance testing (p value) compares differences across all pattern groups using either chi square or one-way ANOVA, as appropriate.
dAge as of the start of initial long-term care service.
eReceipt of Guaranteed Income Supplement provided to older adults below minimum income threshold.
fBased on geocoded location of first three digits of residential postal code. For residential care clients, this should represent last known home address.
gClinical Assessment Protocol to represent risk of future falls.
hActivities of Daily Living based on ADL Self-Performance Hierarchy Scale; range 0 = independent to 6 = total dependence.
iCognitive Performance Scale; range 0 = intact to 6 = very severe impairment.
jDepression Rating Scale, range 0–14, with higher values indicating more numerous and/or frequent symptoms of depression.
kChanges in Health, End-Stage Disease and Signs and Symptoms (CHESS), range 0 = no instability to 5 = highest level of instability.
lPain scale, range 0 = no pain to 3 = severe daily pain.
mBased on chronic conditions common to both the home care and residential care assessment instruments, range 0–10.
nEvidence of either bladder and/or bowel incontinence.
oEvidence of minimum one item associated with Aggressive Behaviour Scale, including verbal abuse, physical abuse, inappropriate behavior, and resisting care.
pPrimary caregiver and informal care information is included on the RAI-HC instrument only. Clients without a home care assessment will be missing for these items.
qHospitalizations with a discharge date more than 365 days prior to the start of LTC have been excluded from the analysis of hospital variables.
Sources: Analysis utilized anonymized linked administrative data from long-term care clients in the Fraser Health Authority in British Columbia, Canada, including client demographic and service utilization records, Resident Assessment Instruments (inter-RAI) for Residential Care (RAI-MDS 2.0) and for Home/Community Care (RAI-HC), Canadian Versions, and Discharge Abstract Database (DAD) hospital discharge records. All clients received long-term care services between January 1, 2008 and December 31, 2011.