gms | German Medical Science

Introduction: The number of individuals with dementia is expected to increase in Germany in the future. Appropriate care of dementia patients will become increasingly important, as dementia coexists with other morbidities. Recent research on healthcare patterns of people with dementia has often focused on single-dimensional transitions, such as from home to hospital or long-term care. Little attention has been drawn to the heterogeneity of utilization after the initial diagnosis of dementia across various healthcare dimensions over time. This study aims to investigate the heterogeneity of multidimensional healthcare patterns by finding distinct groups along the dimensions of long-term care utilization, inpatient and outpatient medical care, and pharmacological and non-pharmacological treatment. Additionally, all-cause five-year mortality among dementia patients based on distinct groups of multidimensional healthcare patterns two years after diagnosis were examined.

Methods: German health claims data from 2004-2019 was used to analyze 19,867 individuals aged 75 and above who were diagnosed with dementia. Multichannel state sequence analysis (MSSA) and cluster analysis were used to identify long-term care, inpatient/outpatient medical care, and pharmacological/non-pharmacological treatment patterns two years after the initial dementia diagnosis. The association between the identified groups with sex, age at baseline and morbidities were analyzed by using multinomial logistic regression. Five-year mortality risk of the groups was assessed using a Cox proportional hazards model adjusted for age, sex and morbidities.

Results: MSSA and cluster analysis revealed six distinct groups of healthcare patterns: “Low utilization” (42.1%), “Comprehensive utilization” (7.6%), “Transition to nursing home and care” (8.8%), “Nursing home residency” (14.0%), “Deterioration to death” (11.0%) and “Last year of life” (16.6%). In the regression model, age- and sex-specific differences between the groups could be identified. In the Cox model, individuals with a “Transition to nursing home and care” had the highest mortality risk (HR=1.77, 95% confidence interval: [1.66-1.89]), followed by those with “Nursing home residency” (1.53 [1.45-1.62]), compared to those with “Low utilization”. There was no significant difference in the mortality risk for dementia patients with “Comprehensive utilization” compared to dementia patients with “Low utilization”.

Conclusion: This study identified distinct groups of healthcare patterns among newly diagnosed dementia patients in Germany, with the majority not receiving long-term care or comprehensive medical care and treatment. There was no difference in five-year all-cause mortality between those with comprehensive and low healthcare utilization.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.