Healthcare and long-term care for people with cognitive impairment in the US: A latent transition analysis

Abstract

AbstractIMPORTANCEPeople with cognitive impairment often have complex care needs. Both healthcare and long-term care are crucial to the well-being of people with mild cognitive impairment (MCI) or dementia.OBJECTIVETo understand the clustering patterns of healthcare and long-term care use in people with MCI or dementia and the relationships between changes in cognitive functioning and transitions of care.DESIGNThis cohort study used longitudinal data from three recent waves of the Health and Retirement Study (HRS) collected between 2014 and 2018.SETTINGHRS is a nationally representative biennial survey of older persons aged 50 years and over in the US.PARTICIPANTSThe study cohort included 4,469 people with MCI or dementia in 2014. The same participants were followed until 2018. The total sample size across the three waves was 10,155.EXPOSUREChanges in cognitive functioning based on the Langa-Weir Classifications.MAIN OUTCOMES AND MEASURESThe outcome measures included five types of healthcare and three types of long-term care services. Latent transition analyses were conducted to identify the clustering patterns of healthcare and long-term care use and map out the transition pathways between different care classes over time. Multilevel regression models were estimated to investigate the relationships between changes in cognitive functioning status and care transitions. Sociodemographic, health, and socioeconomic factors before care transitions were controlled for.RESULTSThree user groups were identified: high healthcare and low long-term care (MM-LC, 56%, n=5,657), medium healthcare and high long-term care (HM-HC, 37%, n=3,743), and low healthcare and low long-term care (LM-LC, 7%, n=736). The progression of cognitive impairment was associated with a higher probability of transitioning from MM-LC to HM-HC class (β= 0.070; p<0.001). An improvement in cognitive functioning was associated with a higher probability of transitioning from HM-HC to MM-LC class (β =0.042, p<0.05).CONCLUSIONPeople with MCI or dementia use specific combinations of services to meet their complex care needs, which underscores the importance of integration between healthcare and long-term care. Changes in cognitive functioning are useful indicators that can assist policymakers and practitioners with early care planning, resource allocation, and care coordination from diverse care providers.Key PointsQuestionsHow is the use of healthcare and long-term care services clustered in people with cognitive impairment? Are changes in cognitive functioning associated with transitions in service clusters?FindingsThree classes of healthcare and long-term care services were identified in the latent transition analyses. The progression of cognitive impairment was associated with transitioning to a class characterized by more use of healthcare and long-term care services, whereas an improvement in cognitive improvement was associated with transitioning to a class characterized by less use of care in both sectors.MeaningThe findings underscore the importance of integration between the healthcare and long-term care sectors and point to the value of using cognitive functioning to guide resource allocation and coordinate care planning.