A Cohort Study of Healthcare Utilization in Older Adults with Undiagnosed Dementia


We identified patients who developed dementia while enrolled in the Adult Changes in Thought (ACT) study, a prospective cohort study of older adults enrolled in Group Health (GH), an integrated healthcare system. ACT participants are assessed for dementia every 2 years, with abnormal results leading to a detailed diagnostic evaluation. For each of the 980 ACT participants who were diagnosed with dementia between 1994 and 2014, we examined GH electronic health data in the 2 years prior to diagnosis in ACT to determine whether dementia was recognized by their healthcare providers before diagnosis within the ACT research study. If a dementia diagnosis, memory complaint or dementia medication was found in the participant’s GH electronic health data prior to diagnosis in ACT, the participant was classified as having Bdiagnosed dementia^ (n = 544); otherwise, the participant was classified as having Bundiagnosed dementia^ (n = 436). For each undiagnosed case, we randomly selected three participants, matched on age, gender and date of ACT visit (±180 days), who did not develop dementia while in ACT to serve as our Bno dementia^ group (n = 1308). The number of outpatient visits, Bno-shows^ for scheduled outpatient visits, emergency department visits and hospitalizations were obtained from GH electronic utilization data for the 2-year period before the index ACT study dementia screening visit. We describe characteristics and healthcare utilization patterns of participants with diagnosed dementia, undiagnosed dementia and no dementia over 2 years. We used ageadjusted conditional logistic regression to formally compare participants with undiagnosed dementia and those without dementia.


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