Get started
Work

Regional dementia diagnostic intensity and healthcare use among older U.S. adults living with Alzheimer’s disease and other related dementias

Year: 2023
Type: article
Study design: Observational Study
Abstract: Background Recent studies have demonstrated that the diagnosis of Alzheimer’s disease and other related dementias (ADRD) varies across the U.S. Residing in an area of high ADRD identification may be associated with better care; yet, healthcare use according to regional ADRD diagnosis intensity has not be examined. Method We conducted a cross‐sectional study using a 20% sample of 2018 Fee‐For‐Service Medicare older Americans (age≥65). Diagnosis codes were to identify those who received a new ADRD diagnosis (incident cohort) and those who died with an ADRD diagnosis (decedent cohort). An established measure of ADRD diagnostic intensity across the 306 U.S. Hospital Referral Regions was used and collapsed into terciles. We constructed measures of healthcare use (e.g., outpatient visits, inpatient use) in the first year following diagnosis and the last six months of life. Measures of preventable hospitalizations among those newly diagnosed and measures on life‐prolonging treatment among ADRD decedents were also constructed. Mixed models were used to adjust for sociodemographic characteristics and comorbidity and account for clustering within region of residence. Result We identified 158,908 older Americans who received a new ADRD diagnosis and 97,431 ADRD decedents in 2018. The mean age of the incident ADRD cohort was 82.8 (SD = 8.0) and 85.9 (SD = 7.8) among the decedent cohort. Across both cohorts, approximately 61% were female and 83% were While older adults. In adjusted analyses among the incident cohort, the only two differences across tercile of ADRD diagnostic intensity were mean No. of home health days (from 26.4 in T1 (lowest) to 40.3 in T3 (highest), p‐value<0.001) and mean No. of inpatient days, p‐value = 0.01 (Table 1). After adjusting for differences, outpatient, inpatient, and life‐prolonging treatment did not vary across tercile of ADRD diagnostic intensity among ADRD decedents – except for mean No. of home health days, p‐value< 0.001, hospice use in the last year of life, p‐value = 0.03, and ‘other inpatient’ as a place of death, p‐value = 0.02 (Table 2 and Figure 1). Conclusion Across the disease course of ADRD, regional ADRD diagnostic intensity is not associated with worse healthcare (e.g., ED use, preventable hospitalization) but is associated with home healthcare and higher hospice use.
DOI: 10.1002/alz.077129
Language: English
Field: Medicine
Open Access status: bronze
OpenAlex ID: W4390192513
FWCI:
Cites:
Cited by:
Related to: 10