Health care utilisation among older persons with intellectual disability and dementia: a registry study.
Older adults with both ID and dementia get more emergency care yet less routine care than other seniors with dementia.
01Research in Context
What this study did
van Timmeren et al. (2016) pulled health-registry records for older adults who have both intellectual disability and dementia. They compared how often these adults use planned versus emergency care with seniors in the general population who only have dementia.
The team counted hospital stays, specialist visits, and same-day surgeries. They used existing data, so no one was asked to change treatment.
What they found
Adults with both ID and dementia had more unplanned hospital visits than other seniors with dementia. Yet they received fewer planned check-ups and routine procedures.
The pattern points to a service gap: the system reacts to crises but does not prevent them.
How this fits with other research
Dall et al. (1997) first showed that dementia in adults with ID brings extra physical illness and lower daily-living skills. van Timmeren et al. (2016) now links those same health burdens to higher emergency use, extending the 1997 warning into real-world service numbers.
Lin et al. (2006) found that 18% of Taiwanese adults with ID visited an emergency room in only seven months. van Timmeren et al. (2016) mirror this high acute-use rate in a Nordic registry, showing the problem crosses countries and lasts into old age.
Chiviacowsky et al. (2013) showed that adults with ID living in rural or low-income areas face more preventable hospital stays. van Timmeren et al. (2016) add dementia as another clear driver of unplanned care, so the two studies stack rather than clash.
Why it matters
If you support aging clients with ID, schedule proactive medical reviews before small issues become crises. Flag any signs of memory loss and fast-track dental, vision, and cardio checks. A quick call to the primary-care team each quarter can swap an ambulance ride for a clinic visit.
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02At a glance
03Original abstract
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.
Journal of intellectual disability research : JIDR, 2016 · doi:10.1111/jir.12338