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Use and cost of hospitalization of patients with AD by stage and living arrangement

CERAD XXI

From the Center for the Study of Aging and Human Development (Dr. Fillenbaum, A.L. Weiman), the Division of Neurology (Dr. Heyman), and the Division of Biometry (Drs. Peterson and Pieper), Duke University, Durham, NC.

Address correspondence and reprint requests to Dr. G. Fillenbaum, Box 3003, Duke University Medical Center, Durham, NC 27710.

OBJECTIVE: To determine the probability, frequency, length of stay, and Medicare costs of hospitalization of institutionalized and noninstitutionalized patients with AD at various stages of dementia.

METHODS: The authors analyzed the 1991 to 1995 Medicare records of 420 CERAD patients with AD, a group which, at entry, had no serious comorbidities. They were geographically distributed across the United States and observed for a median of 2.5 years. Repeated measures logistic regression and generalized estimating equations were used to model the probability of hospitalization. Among those hospitalized, the general linear mixed model was used to determine number of admissions, length of stay, and Medicare cost. Demographic characteristics and calendar date were controlled in all analyses.

RESULTS: As dementia worsened, the probability of hospitalization increased among patients living at home, but decreased among those who were institutionalized. Number of admissions, length of stay, and cost also decreased significantly as stage worsened among the institutionalized patients, but the stage of dementia had no effect in non-institutionalized patients.

CONCLUSION: The hospitalization experience of patients with AD living at home differs from that of patients with AD living in institutions. Residential setting appears to be an important determinant of hospitalization in patients with AD.

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