Rates of mechanical ventilation for patients with dementia in Ontario
CCCF ePoster library. Borjaille C. Nov 7, 2018; 234656; 36
Cristiana Borjaille
Cristiana Borjaille
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Abstract
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Introduction: The number of elderly patients with dementia receiving invasive mechanical ventilation (IMV) is increasing over time in the United States (US), even though intensive care interventions on this population may not improve quality of life and can be inconsistent with end of life care. However, it is unknown whether similar patterns in use of IMV in this population occur in countries with different financial models, such as the single-payer health system in Canada.



Objective: To determine the trends in rates of IMV use in elderly patients with dementia in Ontario and generate projections of these rates to 2030.



Methods: The cohort consisted of all patients older than 65 years who received IMV during hospitalization between 2005 and 2014, identified by Ontario Health Insurance Plan (OHIP) billing codes, and excluding patients who previously received chronic mechanical ventilation. We identified individuals with a prior diagnosis of dementia, using a previous validated algorithm. We assessed absolute numbers of patients with and without dementia who received IMV each year, as well as the percentage of all IMV patients with dementia. We then used population estimates from 2016 to 2030 and Poisson regression to generate projections of the numbers of elderly patients receiving IMV with and without dementia to 2030.



Results: The study included 199,016 patients age 65 and older who received IMV from 2005 to 2014. Of these, 17,065 (8.6%) had a previous diagnosis of dementia. The absolute number of hospitalizations with IMV increased 34% from 2005 (n=17,612) to 2014 (n=23,540), and the number of patients with dementia who received IMV almost doubled, from 1,181 in 2005 to 2,329 in 2014, at an annual growth rate of 7.9% (Figure 1). In 2005, elderly patients with dementia made up 6.7% of all patients with IMV, increasing to 9.9% in 2014. Projections suggest that by 2030 the absolute number of patients receiving IMV will be 44,337, two and a half times higher than the number in 2005 and double times the number in 2014. Patients with dementia will account for 20% of hospitalizations receiving IMV (Table 1).



Conclusion: In Ontario, Canada, the number of elderly patients with dementia receiving IMV is increasing over time at a slower rate than in the US. However, projections suggest a two and a half-fold increase in the absolute number of patients receiving of IMV in 2030 compared with 2005, and one in five elderly patients receiving IMV will have dementia.

 


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