Incident Care Trajectories for Older Adults With and Without Dementia[Hospital readmission among older adults who return home with unmet need for ADL disability]

ObjectiveDespite cross-sectional evidence that persons living with dementia receive disproportionate hours of care, studies of how care intensity progresses over time and differs for those living with and without dementia have been lacking.MethodWe used the 2011–2018 National Health and Aging Trends Study to estimate growth mixture models to identify incident care hour trajectories (“classes”) among older adults (N = 1,780).ResultsWe identified 4 incident care hour classes: “Low, stable,” “High, increasing,” “24/7 then high, stable,” and “Low then resolved.” The high-intensity classes had the highest proportions of care recipients with dementia and accounted for nearly half of that group. Older adults with dementia were 3–4 times as likely as other older adults to experience one of the 2 high-intensity trajectories. A substantial proportion of the 4 in 10 older adults with dementia who were predicted to be in the “Low, stable” class lived in residential care settings.DiscussionInformation on how family caregiving is likely to evolve over time in terms of care hours may help older adults with and without dementia, the family members, friends, and paid individuals who care for them, as well as their health care providers assess and plan for future care needs.