The final year for community-dwelling older adults with dementia in an Asian setting: admissions, interventions, and...

Current understanding of the last year of life with dementia is disproportionately informed by studies conducted in western contexts, primarily within long-term care settings. This study examines the last year of life experience for community-dwelling older adults and their caregivers in an Asian setting.

Using prospective longitudinal cohort data from 125 family caregivers to older adults who have died during the study, we estimate separate random effects regression models to identify factors associated with hospital admissions, medical interventions, care experience, and informal caregiving hours. We also estimate costs associated with informal caregiving hours.

Nearly half (48%) of older adults experienced an inpatient admission, and nearly all (92%) experienced a potentially burdensome intervention. Urinary tract infections were the strongest predictor of hospital admissions (adjusted odds ratio [AOR] = 10.42, p = .00) and medical interventions (AOR = 9.61, p = .02). Pneumonia (AOR = 8.40, p = .05) and febrile episodes (AOR = 3.94, p = .03) were associated with increased odds of intervention, whereas caregivers who prioritized comfort care only were associated with reduced interventions (AOR = 0.28, p = .04) and increased admissions (AOR = 3.20, p = .04). Family caregivers provided 42 hours of care per week on average, and 30% gave up their employment to care for the older adult during the older adult's final year.

Community-dwelling older adults in Singapore experienced similar clinical problems and potentially more burdensome interventions, including feeding tubes and physical restraints, than described previously in other contexts, highlighting the need for a palliative approach not apparent in the frequent acute care utilization, interventions, and caregiving burden observed.