• Andrea Gruneir, Erik Youngson, Bonnie Dobbs, Adrian Wagg, Tyler Williamson, Kim Duerksen, Stephanie Garies, Boglarka Soos, Brian Forst, Jeff Bakal, Donna P Manca, and Neil Drummond.
• Associate Professor in the Department of Family Medicine at the University of Alberta in Edmonton. gruneir@ualberta.ca.
• Can Fam Physician. 2023 Feb 1; 69 (2): 114124114-124.

ObjectiveTo characterize transitions to acute and residential care and identify variables associated with specific transitions among community-based persons living with dementia (PLWD).DesignRetrospective cohort study using primary care electronic medical record data linked with health administrative data.SettingAlberta.ParticipantsAdults aged 65 years or older living in the community who had been diagnosed with dementia and who saw a Canadian Primary Care Sentinel Surveillance Network contributor between January 1, 2013, and February 28, 2015.Main Outcome MeasuresAll emergency department visits, hospitalizations, residential care (supportive living and long-term care) admissions, and deaths within a 2-year follow-up period.ResultsIn total, 576 PLWD were identified who had a mean (SD) age of 80.4 (7.7) years; 55% were female. In 2 years, 423 (73.4%) had at least 1 transition and, of these, 111 (26.2%) had 6 or more. Emergency department visits, including multiple visits, were common (71.4% had ≥1, 12.1% had ≥4). Of those hospitalized (43.8%), nearly all were admitted from the emergency department; the average (SD) length of stay was 23.6 (35.8) days, and 32.9% had at least 1 alternate level of care day. In total, 19.3% entered residential care, most admitted from hospital. Those admitted to hospital and those admitted to residential care were older and had greater historical health system use, including home care. One-quarter of the sample did not have any transitions (or die) during follow-up; they were typically younger and had limited historical health system use.ConclusionOlder PLWD experienced frequent, and frequently compound, transitions that have implications for them, their family members, and the health system. There was also a large proportion without transitions suggesting that appropriate supports enable PLWD to do well in their own communities. The identification of PLWD who are at risk of or who make frequent transitions may allow for more proactive implementation of community-based supports and smoother transitions to residential care.Copyright © 2023 the College of Family Physicians of Canada.

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