Abstract

Objective: Research on help-seeking in dementia has mainly focused on characteristics affecting the timeliness and pathway to care. The type of service use before gaining access to a diagnostic service is less well research, despite its potential implication on triage system design, public education strategies, and resources allocation. We aim to investigate the pre-diagnosis service utilization in people with suspected dementia seeking help from an Early Detection Service provided by the Hong Kong Alzheimer’s Disease Association.

Method: We collected service utilization data in the past 30 days in 110 people with suspected dementia and their carers who sought help from the Early Detection Service. Services were categorised as: 1) emergency and inpatient service; 2) outpatient clinic visit; 3) community care service; 4) caregiver support and domestic helper’s assistance. Participant characteristics were included in a logistic regression model to identify predictors for pre-diagnosis service utilization.

Results: The first-line of help-seeking in this group was mainly the Early Detection Service itself, or contact with other NGOs/governmental agencies. Among the 110 help-seekers, 20.0% had not used any service in the 30 days before the assessment; while 45.5% had turned to multiple service providers. Over 60% had visited an outpatient clinic, 33.6% used community care service, 30.0% of the patients’ caregivers have turned to caregiver support service or hired a stay-over or hourly domestic helper, and 13.6% of had contacted A&E services or had been hospitalised. Outpatient clinic visit in the past 30 days was mainly predicted by depressive symptoms of the person with suspected dementia and worse self-rated health of the carer. With one score increase in CSDD, the probability of making outpatient clinic visit increases by 6.8%. Community care service use during this period can be predicted by greater carer burden and carer perceiving a better relationship with the person with suspected dementia. A carer who scores one more point in ZBI-Short is 3.3% more likely to make use of the community care services.

Conclusion: The pathway to care in people seeking help from dementia service is varied. Pre-diagnostic service use is also diverse before these families reach a dementia assessment service. Our preliminary findings suggest that before a diagnosis is available, people with suspected dementia and their carers may already have service needs, as reflected in their use of other services. Further analyses are needed to understand the impact of a more direct care pathway on services utilization in people with suspected dementia without a diagnosis, and the effect on patient and carer outcomes.