Health care utilisation among older persons with intellectual disability and dementia: a registry study

• Published in: Journal of intellectual disability research Vol. 60; no. 12; pp. 1165 - 1177
• Main Authors: Axmon, A., Karlsson, B., Ahlström, G.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.12.2016; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Comorbidity; Dementia; Dementia - epidemiology; Dementia - therapy; Disability; Disabled older people; Down syndrome; Female; Gender differences; Health Care Service and Management, Health Policy and Services and Health Economy; Health Needs; Health Sciences; Health services utilization; Hospitalisation; Humans; Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi; Hälsovetenskap; In-patient care; Intellectual disabilities; Intellectual Disability; Intellectual Disability - epidemiology; Intellectual Disability - therapy; Learning disabilities; Learning disability; Length of stay; Life expectancy; Longevity; Longitudinal Studies; Male; Medical and Health Sciences; Medical diagnosis; Medicin och hälsovetenskap; Mental retardation; Middle Aged; Older people; Out-patient care; Patient Acceptance of Health Care - statistics & numerical data; People with disabilities; Primary care; Registries - statistics & numerical data; Sweden - epidemiology; Unplanned; Visits; Out-patient care; In-patient care; Down syndrome; Learning disability; Mental retardation; Hospitalisation
• ISSN: 0964-2633; 1365-2788
• DOI: 10.1111/jir.12338

Background Both persons with intellectual disability (ID) and persons with dementia have high disease burdens, and consequently also high health care needs. As life expectancy increases for persons with ID, the group of persons with the dual diagnosis of ID and dementia will become larger. Method Through national registries, we identified 7936 persons who had received support directed to persons with ID during 2012, and an age‐ and gender‐matched sample from the general population. A national registry was also used to collect information on health care utilisation (excluding primary care) for the period 2002–2012. Health care utilisation was measured as presence and number of planned and unplanned in‐patient and out‐patient visits, as well as length of stay. Results In comparison with persons with ID but without dementia, persons with ID and dementia were more likely to have at least one planned out‐patient visit (odds ratio [OR] 8.07), unplanned out‐patient visit (OR 2.41), planned in‐patient visit (OR 2.76) or unplanned in‐patient visit (OR 4.19). However, among those with at least one of each respective outcome, the average number of visits did not differ between those with and without dementia. Persons with ID and dementia were less likely to have at least one planned out‐patient visit than persons with dementia in the general population sample (OR 0.40), but more likely to have at least one unplanned in‐patient visit (OR 1.90). No statistically significant differences were found for having at least one unplanned out‐patient or planned in‐patient visit. Nevertheless, among those with at least one unplanned out‐patient visit, the number of visits was higher in the general population sample. Conclusions Persons with ID and dementia are less likely to receive planned health care than persons with dementia in the general population. They have, however, higher levels of unplanned health care utilisation. This may be an indication that the current support system is not sufficient to meet the challenges of increased longevity among persons with ID.