{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T05:05:19Z","timestamp":1776229519373,"version":"3.50.1"},"reference-count":43,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100012665","name":"Institute for Clinical Evaluative Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012665","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100025092","name":"Ministry of Health, Ontario","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100025092","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100025090","name":"Ministry of Long-Term Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100025090","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To measure the association between initiating palliative care using the combined criteria of short survival expectations and increased care needs with acute healthcare utilization among community\u2010dwelling people living with dementia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A population\u2010level propensity\u2010based overlap\u2010weighted cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Ontario, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>50,961 community\u2010dwelling people living with dementia between 2010 and 2023, with 1\u2010year follow\u2010up until 2024. We used moderate to severe dementia and the initiation of homecare services as proxies for short survival expectations and increased care needs, respectively. We used linked health administrative data with propensity\u2010based overlap weighting on sociodemographic and clinical factors to address confounding by the indication to receive palliative care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Receipt of home\u2010based palliative care within 30\u2009days of homecare initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcome Measures<\/jats:title>\n                    <jats:p>Individual 1\u2010year cause\u2010specific hazards of emergency department (ED) use, hospitalization, and intensive care unit (ICU) admission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Palliative care was associated with a higher risk of hospitalization in the first 90 days (e.g., hazard ratio (HR) 1.43 at 30 days; 95% confidence interval (CI) 1.25\u20131.64), which was driven predominantly by hospitalization with palliative intent, but was no longer significantly different beyond 180 days, compared to not receiving palliative care. [Correction added on 31 January 2026, after first online publication: The preceding sentence has been revised in this version.] At 90\u2009days, the cumulative incidence of hospitalization, death, or admission to a nursing home was approximately 20% among those receiving palliative care, compared to 15% in those not receiving palliative care. Although the overall absolute rate of\n                      <jats:styled-content style=\"fixed-case\">ICU<\/jats:styled-content>\n                      admission was low (0.01 \u00b1\u20090.1 admissions per month), palliative care initiation was associated with a 186% higher risk in the first 30\u2009days (\n                      <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>\n                      2.86; 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      1.75\u20134.69) but not beyond 90\u2009days. Palliative care was not associated with\n                      <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>\n                      use over the following year (\n                      <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>\n                      1.02; 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      0.72\u20131.45).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The current approach to delivering palliative care services for community\u2010dwelling people living with dementia in Canada may paradoxically increase early acute care use, likely reflecting system gaps and unmet needs. Given the high prevalence of dementia, there is an urgent need to re\u2010examine homecare delivery models.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70282","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T16:29:46Z","timestamp":1767976186000},"page":"964-974","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association of Palliative Care Initiation With Acute Healthcare Utilization Among Community\u2010Dwelling Adults Living With Dementia"],"prefix":"10.1111","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1681-5170","authenticated-orcid":false,"given":"Kieran L.","family":"Quinn","sequence":"first","affiliation":[{"name":"Department of Medicine and Institute of Health Policy, Management and Evaluation University of Toronto  Toronto Ontario Canada"},{"name":"Department of Medicine Sinai Health System  Toronto Ontario Canada"},{"name":"ICES  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