Dementia Comorbidity and the Use of General and Mental Health Services Among Middle-Aged and Other Americans

Background and Purpose: An estimated 5.3 million Americans were living with dementia in 2016. Dementia is marked by the loss of cognitive ability and it is a significant and growing public health problem because rates are predicted to increase with the aging population. The existence of dementia is related to a higher likelihood of comorbid chronic-medical-conditions, and an increase in the incidence of premature mortality, particularly, if the chronic-medical-condition is cardiovascular disease or cancer. Theoretically, a dementia diagnosis should increase the use of mental health services, but it is not known how having both conditions impact use of mental health services, general services, or both. Dementia and chronic-medical-conditions may hold significant health and societal consequences for the aging population; however, little information exists for the comorbidity of dementia and chronic-medical-conditions regarding treatment by different types of providers. The objective of this study was to investigate associations between comorbid dementia and chronic-medical-conditions with past year visits to general providers, mental health providers, both, and neither.

Methods: The analysis sample included 7,802 respondents from the 2007 National Health Interview Series data, a cross-sectional study. Use of general and mental health services, the categorical dependent variable with three categories, was classified as (both general and mental services, either, and neither). Independent determinates included, comorbid dementia and chronic-medical-conditions which were defined as the presence of both conditions, sociodemographic factors (age, race/ethnicity, sex, marital status, education, nativity, and poverty), and health factors (common chronic medical conditions, functional limitation, and insurance coverage). Multinomial logistic regression was used to estimate relative risk ratios. Reference category for all the equations was neither.

Results: The results suggest a significant association of comorbid dementia and chronic-medical-conditions with the use of services. For respondents with dementia or chronic-medical-conditions relative to those who were healthy, the relative risk for visiting a general provider or a mental health professional relative to not seeing a doctor, increased by a factor of 3.39 (P<0.000). For respondents with dementia and chronic-medical-conditions relative to those who were healthy, the relative risk for visiting a general provider or a mental health professional relative to not seeing a doctor, increased by a factor of 3.37 (P<0.000). For respondents with dementia or chronic-medical-conditions relative to those who were healthy, the relative risk for visiting a general provider and a mental health professional relative to not seeing a doctor increased by a factor of 3.86 (P<0.000). For respondents with dementia and chronic-medical-conditions relative to those who were healthy, the relative risk for visiting a general provider and a mental health professional relative to not seeing a doctor, increased by a factor of 12.22 (P<0.000). Important control variables included: age, race, sex, insurance, functional limitations.

Conclusions and Implications:  Findings revealed important treatment seeking behavioral differences among respondents with and without comorbid dementia and chronic-medical-conditions. As the average age of the population rises, understanding how to care effectively for older people with these conditions is among the most important challenges that the health care system will need to address.