Utilization of long-term care resources for people with dementia in Taiwan: a three-year cohort study

This study aims to assess the utilization of long-term care (LTC) resources among patients with dementia (PWD) and their caregivers, and to analyze various factors influencing the use of these services. This three-year cohort study enrolled 1281 patients and their caregivers from the Dementia Center of Changhua Christian Hospital. The care team performed face-to-face interviews about every six months since a diagnosis of dementia was made. The main outcomes were the percentages of different LTC resources utilized and the factors associated with their use among patients and caregivers. Longitudinal data were analyzed using generalized estimating equations. The proportion of PWD using any LTC resources increased significantly from 34% at baseline to 44% three years later ( p = 0.006). The most commonly used resources were personal and professional care services (18% at baseline and 20% at year 3), followed by assistive devices and home modification (14% at baseline and 19% at year 3). The proportion of PWD using community aging care centers also increased significantly, from 6.8% at baseline to 13% three years later ( p = 0.001). PWD of older age (OR = 1.04, 95% CI = 1.02 ~ 1.06, p = < 0.001), poor activity of daily living (ADL) function (OR = 1.08, 95% CI = 1.06 ~ 1.11, p < 0.001), higher caregiver education (OR = 1.05, 95% CI = 1.02 ~ 1.08, p < 0.001), being cared for by a solo informal caregiver (OR = 1.98, 95% CI = 1.36 ~ 2.88, p < 0.001), and higher Zarit caregiver burden scores (OR = 1.01, 95% CI = 1.0 ~ 1.02, p = 0.001) were associated with greater use of LTC resources; while male patients (OR = 0.71, 95% CI = 0.55 ~ 0.91, p = 0.008) and those hiring a foreign caregiver (OR = 0.67, 95% CI = 0.46 ~ 1.00, p = 0.05) were less likely to use these resources. The demand for LTC resources among PWD is high. Tailored support strategies are essential for both PWD and their caregivers to ensure adequate resource provision. Educational programs targeting caregivers, particularly those with lower educational levels, may help improve resource utilization.