The Dynamic Impacts of Dementia on Preventive Care Utilization

Background Dementia can greatly affect individuals’ decision‐making and wellbeing; and impose substantial burdens on individuals, families, and society. Identifying earlier signals of dementia risk may offer people more time to prepare for the future, helping to delay the onset or slow the progression of dementia. However, lack of evidence documenting the impacts of dementia and its early signs on health care utilization largely limits our understanding of early presentation of the disorder. To fill the gap, this study investigates the short‐term and long‐term impacts of dementia on preventive care decisions, discovering early signs of the disorder and facilitating disease early diagnosis. Method Data were obtained from Health and Retirement Study, a nationally representative longitudinal study of Americans 50 or older. Individuals’ dementia status were assessed in 1995‐2018. 3,488 persons with incidence of dementia were identified and 22,619 consecutive person‐waves before and after the incidence of dementia were included. To quantify the short‐term effects of dementia, for each individual with an incidence of dementia, we examined the changes in preventive care utilization around the first occurrence of dementia relative to his/her own behaviors when he/she is non‐demented. To examine the long‐term effects of dementia, we further compared the dynamic changes of behavioral outcomes between individuals who developed dementia and those who never developed the disorder, covering up to 18 years before and 6 years after the incidence of dementia. Result Incidental dementia was associated with significant reductions in preventive care utilization, including cholesterol test, flu shot, mammogram, and prostate test, relative to individuals’ own behaviors before the disorder. Moreover, the impact tended to increase over time, with significant larger effects in waves after the onset of dementia compared to incidental changes. Our long‐term dynamic estimation further corroborated the findings. In particular, consistent and growing declines were observed in preventive care utilization 4‐6 years before the incidence of dementia. The effects of dementia were strong and robust across types of preventive care, population groups, and model specifications. Conclusion Our findings highlight the salient impact of dementia risk on preventive care utilization, which may increase individuals’ vulnerability to health shocks, exacerbating the deterioration of cognitive function.