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

BackgroundHealthcare and long-term care are crucial to the well-being of people with mild cognitive impairment (MCI) or dementia. This study investigates 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. MethodsThe study used longitudinal data from three recent waves of the Health and Retirement Study (HRS 2014-2018, N=10,152). MCI and dementia were measured based on the Langa-Weir Classifications. The 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 care use and map out the transition pathways between different care classes over time. Multilevel regression analyses were conducted to investigate the relationships between changes in cognitive functioning and care transitions. ResultsWe identified three user groups: medium healthcare and low long-term care (MM-LC, 56%, n=5,653), high 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 ({beta}=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 ({beta}=0.039, p<0.05). ConclusionsOur findings underscore the importance of integration between healthcare and long-term care. Changes in cognitive functioning are useful indicators for care planning, resource allocation, and care coordination from diverse care providers. Key pointsO_LIThree classes of healthcare and long-term care services were identified in the latent transition analyses. C_LIO_LIThe progression of cognitive impairment was associated with transitioning to a class characterized by more use of healthcare and long-term care services, C_LIO_LIAn improvement in cognitive functioning was associated with transitioning to a class characterized by less use of care in both sectors. C_LI