Seniors living in the community who have dementia are more likely to be hospitalized and visit the emergency department than those who do not have dementia, according to a new study by researchers at RTI International.
However, the research showed there was little difference in the number of hospitalizations among nursing home residents with and without dementia.
"The aging population makes it likely that more people will have Alzheimer's disease or experience other dementias in the coming years," said Zhanlian Feng, Ph.D., senior research public health analyst in the Aging, Disability, and Long-Term Care program at RTI and co-author of the study. "Our research underlines the challenges and importance of providing adequate community-based medical care and long-term services and supports to reduce the amount of hospitalizations and emergency department use among older adults, especially those with dementia. Doing so could improve quality of life, avoid unnecessary hospitalizations, and save money."
The study, published in the April issue of Health Affairs, examined Medicare claims linked to the Health and Retirement Study data to examine hospital and emergency department use, both potentially avoidable and overall, among Medicare beneficiaries with and without dementia across community and institutional settings.
The researchers found significant differences in the likelihood of these events among elderly fee-for-service Medicare beneficiaries in the community, with 26.7 percent of adults with dementia versus 18.7 percent of adults without dementia experiencing hospitalization, and 34.5 percent versus 25.4 percent experiencing an emergency department visit each year.
In contrast, researchers found only a small difference in hospital and emergency department use between nursing home residents with and without dementia. The study found 45.8 percent of nursing home residents with dementia versus 41.9 percent of non-dementia residents experienced hospitalization, and 55.3 percent compared to 52.7 percent experienced an emergency department visit annually.
However, the study found hospitalization and emergency department visits increased significantly for both community and nursing home residents in the last year of life, whether or not they had dementia.
The research suggests that the high rate of hospitalization and emergency department use among community residents may be attributable to factors such as deficiencies in primary and other medical care available to these patients, and fewer programs designed to reduce these events among community residents with dementia. In comparison, nursing home providers may be more equipped to provide care to patients with dementia due to the high prevalence of dementia in nursing homes.
"Our research also suggests that a significant amount of hospitalizations and emergency department visits for patients with dementia both before and during the last year of life were potentially avoidable," Feng said. "This is a policy concern and potential opportunity to reduce spending for Medicare and other payers."
To help reduce avoidable hospital-based care, the study recommends that policymakers consider providing more supportive services and advance care planning and promoting alternative end-of-life options, including hospice, to Medicare beneficiaries.
- Z. Feng, L. A. Coots, Y. Kaganova, J. M. Wiener. Hospital And ED Use Among Medicare Beneficiaries With Dementia Varies By Setting And Proximity To Death. Health Affairs, 2014; 33 (4): 683 DOI: 10.1377/hlthaff.2013.1179
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