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Studies of mild cognitive impairment (MCI) utilize stringent inclusion/exclusion criteria which may impact the generalizability of findings to the broader clinical population. We compared characteristics of MCI patients in a Canadian memory clinic in Calgary to MCI research participants in published Canadian studies to assess the representativeness of research samples. Clinic participants included 555 MCI patients from the Prospective Study for Persons with Memory Symptoms registry. Research participants included 4,981 individuals with MCI retained from a systematic literature review of 112 peer-reviewed empirical Canadian studies. Clinic patients and research participants were diagnosed with MCI using similar diagnostic criteria (i.e., from the NIA-AA, or Petersen criteria). Both samples were compared on baseline demographic variables, medical and psychiatric comorbidities, and global cognitive performance using chi-square tests and t-tests with weighted means. Diverse presumed causes were noted among clinic patients. Clinic patients were younger, more likely to be male, and more educated than research participants (ds: 0.22-0.98). Psychiatric disorders, traumatic brain injury, and sensory impairments were common in clinic patients (up to 83%), but participants with these conditions were excluded from approximately 80% of studies in the systematic review. Clinic patients performed significantly worse on two global cognitive assessments (ds: 0.53 – 1.27). Stringent eligibility criteria such as used in Canadian MCI research studies would exclude a considerable subset of MCI patients seen in our referral clinic. This may have contributed to the disparities between the clinical and research cohorts in the cognitive measures examined. The implications of these findings will be discussed.

Health systems strive to enable persons with Alzheimer’s and related dementias to remain at home to maximize their quality of life. There is limited evidence describing long-term trajectories of health system use by persons with dementia as they remain in the community over time. A cohort of 62,622 community-dwelling older adults was followed for seven years and matched to persons without dementia (controls) based on age, sex and comorbidities. Overall, persons with dementia were more likely than controls to use health services, particularly home care and hospitalizations with discharge delay; and were more likely to be admitted to a nursing home. As they remained in the community over time, persons with dementia used home care at an increasingly intensive rate. Our approach to examine trajectories of health system use among persons with dementia is of particular value to capacity planning initiatives to anticipate future health service needs of this population.

Background Cognitive function is important for healthy aging. Social support availability (SSA) may modify cognitive function. We descriptively examined the association between SSA and cognitive function in a population-level sample of middle- and older-aged adults. Methods We analyzed the tracking dataset of the Canadian Longitudinal Study on Aging. Participants aged between 45 and 85 years answered questions about SSA and performed three cognitive tests (Rey Auditory Verbal Learning Test, Animal Fluency Test and Mental Alternation Test) via telephone. We divided global SSA and global cognitive function scores into tertiles and generated contingency tables for comparisons across strata defined by sex, age group, region of residence, urban vs. rural residence and education. Results The proportion of participants with low global cognitive function was often greater among persons who reported low global SSA. The proportion of persons with high cognitive function was greater in participants with high SSA. The findings were most pronounced for females, 45- to 54-year olds, all regions (especially Québec) except Atlantic Canada, urban dwellers and persons with less than high school education. Conclusions Our results can help public health officials focus on providing social supports to subgroups of the population who would benefit the most from policy interventions.

As populations worldwide are living longer, the impact of neurodegenerative diseases on health resource utilization is expected to increase. Providing care to older adults with neurodegenerative diseases is challenging, and requires adequate supports across multiple health sectors including community, acute care and nursing home settings to allow individuals to maximize their quality of life. The Ontario Neurodegenerative Disease Research Initiative (ONDRI) is a collaborative research program that aims to improve diagnosis, treatment and management of neurodegenerative diseases including Alzheimer’s disease and related dementias, Parkinson’s disease, Amyotrophic Lateral Sclerosis (ALS), and Vascular Cognitive Impairment. Using population-based linked health administrative and clinical databases--covering over 14 million individuals residing in the province of Ontario, Canada-- the ONDRI health services research platform will address knowledge gaps regarding the health service utilization and outcomes of older adults with neurodegenerative diseases and impacts on family and care partners. Access to over two decades of historical health administrative data on a large population of older individuals uniquely positions our collaborative to examine trajectories of health system use as well as rare neurodegenerative diseases which have been previously understudied. The health services research platform is embedded within a larger ONDRI network of biomedical researchers, provincial decision-makers and health system stakeholders. Our research findings will inform health system planning and interventions to support older adults to live independently in the community. This session will explore how health administrative databases may be used to address knowledge gaps regarding health service utilization and outcomes in older persons with neurodegenerative diseases.

Assisted living (AL) has emerged as a popular residential care option for older adults in Canada. Similar to the U.S. experience, its introduction has raised concerns about regulatory oversight, eligibility criteria, staffing levels and quality of care. The Alberta Continuing Care Epidemiological Studies (ACCES) is the first prospective cohort study in Canada to examine AL residents’ health and social needs and healthcare outcomes. ACCES included 1,089 older (65+) residents from 59 AL residences and 1,000 residents from 54 nursing homes (NHs) across Alberta. In both settings, dementia was the most common diagnosis (58% AL, 71% NH). Despite being less impaired, AL residents exhibited an annual incidence of hospitalization 3-times higher than NH residents (38.9% vs. 13.7%). They also showed an annual incidence of NH placement of 18.3%. Key drivers of both outcomes included AL resident characteristics (health and social vulnerability) and residence factors (size, staffing levels and oversight).

This presentation will summarize evidence arising from a multi-year population-based study of over 6 Million people in Ontario, Canada who have one of 17 common chronic conditions, and particularly the more than 2.5 Million individuals with multiple chronic conditions. Aside from the expected increases in health care utilization, adverse outcomes and health care costs associated with an increasing number of conditions, the results highlight several novel insights. For example: there are very few patterns of clustering of multiple chronic conditions; the increasing effect of additional conditions on health care use is attenuated for those aged 65 or over; the gradient in mortality associated with socio-economic status is not apparent after controlling for the number of chronic conditions that a person has. Results also indicate modifiable factors: having greater than median continuity of care was equivalent to having one less chronic condition in terms of hospitalization outcomes.