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Use and cost of hospitalization in dementia: longitudinal results from a community‐based study
Author(s) -
Zhu Carolyn W.,
Cosentino Stephanie,
Ornstein Katherine,
Gu Yian,
Andrews Howard,
Stern Yaakov
Publication year - 2015
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.4222
Subject(s) - dementia , medicine , propensity score matching , ambulatory , gerontology , cognition , longitudinal study , multivariate analysis , cohort study , cohort , disease , alzheimer's disease , prospective cohort study , emergency medicine , psychiatry , pathology
Objectives The aim of this study is to examine the relative contribution of functional impairment and cognitive deficits on risk of hospitalization and costs. Methods A prospective cohort of Medicare beneficiaries aged 65 and older who participated in the Washington Heights‐Inwood Columbia Aging Project (WHICAP) were followed approximately every 18 months for over 10 years (1805 never diagnosed with dementia during study period, 221 diagnosed with dementia at enrollment). Hospitalization and Medicare expenditures data (1999–2010) were obtained from Medicare claims. Multivariate analyses were conducted to examine (1) risk of all‐cause hospitalizations, (2) hospitalizations from ambulatory care sensitive (ACSs) conditions, (3) hospital length of stay (LOS), and (4) Medicare expenditures. Propensity score matching methods were used to reduce observed differences between demented and non‐demented groups at study enrollment. Analyses took into account repeated observations within each individual. Results Compared to propensity‐matched individuals without dementia, individuals with dementia had significantly higher risk for all‐cause hospitalization, longer LOS, and higher Medicare expenditures. Functional and cognitive deficits were significantly associated with higher risks for hospitalizations, hospital LOS, and Medicare expenditures. Functional and cognitive deficits were associated with higher risks of for some ACS but not all admissions. Conclusions These results allow us to differentiate the impact of functional and cognitive deficits on hospitalizations. To develop strategies to reduce hospitalizations and expenditures, better understanding of which types of hospitalizations and which disease characteristics impact these outcomes will be critical. Copyright © 2014 John Wiley & Sons, Ltd.