Cognitive impairment and service use: The relationship between research and policy

Abstract

This thesis examines the association between healthcare service use and cognitive functioning in individuals aged 60 years and over. It examines the association between use of primary and secondary health care services, specifically general practitioners and hospitals, and cognitive impairment. This thesis uses secondary data from the ANU Personality and Total Health (PATH) Through life study. PATH is a longitudinal health study which examines three age-cohorts residing in the Australian Capital Territory and surrounding regions over 12 years. The PATH study also has a number of sub-studies, one of which is the Health and memory sub-study. This sub-study identifies individuals in the PATH sample who would be clinically classified as having mild cognitive disorder (MCD) or dementia. Data on health service use has been obtained by linking three administrative datasets to PATH. Data on primary health care usage was obtained from the Medicare Benefits Schedule. Data on secondary health care usage was obtained from the ACT Admitted Patient Care dataset and the ACT Emergency Department Information. From this linkage, we have information on number of general practitioner visits over a year, number of hospital admissions, length of hospital stay and number of emergency department presentations for each consenting participant. Analysis of general practitioners focused on the impact cognitive impairment had on use over the 12 years of study. Using negative binomial models this analysis found that individuals with MCD visited their general practitioner significantly more than individuals who were cognitively healthy. This use almost doubled when individuals had a comorbid condition of depression or arthritis. Analysis relating to hospitalisation also focused on the association between use and cognitive impairment longitudinally. This analysis found that individuals who were hospitalised had significant declines in particular cognitive tests compared to individuals who were not hospitalised. This thesis also examined factors which impacted on general practitioner, hospital and emergency department use. Predictors of use were examined for individuals with MCD or dementia compared with cognitively healthy individuals, based on the Andersen-Newman model of health behaviour. Analysis using logistic regression models found that individuals with MCD and dementia had higher usage of all three services compared to cognitively healthy individuals. This study also found that need variables were the strongest predictor of healthcare service use. However, the types of predisposing, enabling and need variables varied depending on the healthcare service (general practitioner, same day hospital, multiple day hospital or emergency department) and whether the individual had MCD, dementia or was cognitively healthy. The information and findings relating to cognitive impairment and health service use are important for policy and practice. Communication of research to policy makers for the development of policy, termed knowledge translation, is discussed in the thesis. Several important models of knowledge translation are outlined and there is a discussion about how to strengthen the relationship between researchers and policy makers. The thesis concludes with a discussion on future policies and practices to increase early detection and diagnosis of MCD and dementia through prevention and screening in healthcare services. Show more