Grant: CIHR Fellowship

As the number and proportion of seniors continue to grow in Canada, the burden of dementia has become a national concern. This stems from the observation that the incidence of dementia is strongly associated with increasing age. In the 2010 report commissioned by the Alzheimer's Society of Canada - "Rising Tide: The Impact of Dementia on Canadian Society" - it has been predicted that dementia prevalence will more than double in the next 30 years and the cost of care will increase by ten-fold. As the prevalence of dementia increases, the need for home support and specialized housing to care for those living with the disease will likely rise in tandem. Given its implications on health care spending, as well as the health outcomes of older adults with dementia, transitions between care settings is often used as a measure of health system performance. For frail seniors, poor transitional care and multiple transitions are associated with adverse events, low satisfaction with care, and higher re-hospitalization rates. The severe cognitive deficits and responsive behaviours of older adults with dementia further increase the burden of transitions for patients and their families. Despite these issues, no previous studies have examined the full care trajectory of those with dementia, by following these patients from being in a healthy state to disease diagnosis, need for home care, admission into nursing homes, and death. In this study, we will examine transitions across health states and care settings among older adults with dementia. Results from this study will aid the development of provincial and national dementia planning models, and for the first time, to consider transitions to dementia from preventable risks and patients' progression through our health care system. This knowledge will be critical to the designs of provincial and national dementia care strategies currently under consideration.