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O3‐01‐05: Resident and facility predictors of hospitalization among older adults with dementia residing in assisted living facilities
Author(s) -
Amuah Joseph,
Maxwell Colleen,
CepoiuMartin Monica,
Soo Andrea,
Gruneir Andrea,
Hogan David,
Patten Scott,
LeClair Ken,
Wilson Kimberly,
Strain Laurel
Publication year - 2012
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2012.05.1144
Subject(s) - medicine , staffing , gerontology , aging in place , cumulative incidence , long term care , incidence (geometry) , dementia , proportional hazards model , emergency medicine , disease , nursing , cohort , physics , optics , surgery , pathology
expenditures as a result of their comorbidities. This study assessed the risk of potentially avoidable hospitalizations (PAHs) that might be prevented with good outpatient management among ADRD patients. Methods: We examined the proportions of subjects with PAHs among Medicare beneficiaries with and without ADRD using data from 2007-2008 Medicare claims files. We used logistic regression to calculate propensity scores of having ADRD, matching cases (n1⁄4195,024) and an equal number of controls based on age, sex, race, Medicare-Medicaid dual eligibility, residence in a metropolitan statistical area, and number of comorbidities. We defined PAHs as admissions for: serious short-term complications of diabetes, serious long-term complications of diabetes, COPD or asthma, hypertension, and heart failure, based on the Medicare Ambulatory Care Indicators for the Elderly. We used logistic regression to investigate patient characteristics associated with PAHs. Results: Approximately one in five (20.2%) beneficiaries with ADRD and concurrent COPD/asthma had a PAH directly related to COPD/asthma. Corresponding proportions of patients with PAHs were 11.7% for heart failure, 2.8% for diabetes long-term complications, 1.3% for diabetes short-term complications, and 0.5% for hypertension. Compared to propensity-matched non-ADRD subjects, ADRD beneficiaries were more likely to have PAHs for diabetes shortterm complications (OR1⁄41.43; 95% CI1⁄41.31-1.57), diabetes long-term complications (OR1⁄41.08; 95% CI1⁄41.02-1.14), and hypertension (OR1⁄41.22; 95% CI1⁄41.08-1.38), but less likely to have PAHs for COPD/ asthma (OR1⁄40.85; 95% CI1⁄40.82-0.87) and heart failure (OR1⁄40.89; 95% CI1⁄40.86-0.92). Among ADRD patients, the risk of PAHs increased with comorbidity burden and the presence of medical complications associated with late-stage ADRD (ulcers, feeding disorders and malnutrition, aspiration pneumonia, and incontinence). Conclusions: A substantial proportion of Medicare beneficiaries with ADRD had preventable hospital admissions related to uncontrolled comorbidities. For some conditions, such as diabetes and hypertension, ADRD patients had a higher risk of condition-related PAHs compared to matched controls without dementia. Future ADRD management programs should improve care coordination between ambulatory, inpatient, and post-acute care, and these efforts should target high-risk patients, especially patients with multiple chronic conditions.