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Emergency and post‐emergency care of older adults with Alzheimer's disease/Alzheimer's disease related dementias

Hill, Jacob D. ; Schmucker, Abigail M. ; Siman, Nina ; Goldfeld, Keith S. ; Cuthel, Allison M. ; Chodosh, Joshua ; Bouillon‐Minois, Jean‐Baptiste ; Grudzen, Corita R.

Journal of the American Geriatrics Society (JAGS), 2022-09, Vol.70 (9), p.2582-2591 [Periódico revisado por pares]

Hoboken, USA: John Wiley & Sons, Inc

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  • Título:
    Emergency and post‐emergency care of older adults with Alzheimer's disease/Alzheimer's disease related dementias
  • Autor: Hill, Jacob D. ; Schmucker, Abigail M. ; Siman, Nina ; Goldfeld, Keith S. ; Cuthel, Allison M. ; Chodosh, Joshua ; Bouillon‐Minois, Jean‐Baptiste ; Grudzen, Corita R.
  • Assuntos: Aged ; Aged, 80 and over ; Alzheimer Disease - therapy ; Alzheimer's disease ; Chronic Disease ; Chronic illnesses ; Dementia ; Dementia disorders ; Emergency medical care ; Emergency Medical Services ; emergency medicine ; Female ; geriatrics ; Health care ; Health services utilization ; healthcare utilization ; Hospice Care ; Hospitalization ; Humans ; Medicare ; Mortality ; Neurodegenerative diseases ; Older people ; Patients ; United States - epidemiology
  • É parte de: Journal of the American Geriatrics Society (JAGS), 2022-09, Vol.70 (9), p.2582-2591
  • Notas: Funding information
    A subset of the material in this paper was presented at the American Geriatrics Society 2021 Virtual Annual Meeting, May 14, 2021.
    National Institute on Aging, Grant/Award Number: UG3/UH3 AT009844; National Center for Complementary & Integrative Health of the National Institutes of Health, Grant/Award Numbers: UH3AT009844, 3UH3AT009844‐03S1
    ObjectType-Article-1
    SourceType-Scholarly Journals-1
    ObjectType-Feature-2
    content type line 23
    JDH: Study concept and design, interpretation of data, preparation of manuscript
    NS: Acquisition of data, data analysis, interpretation of data, preparation of manuscript
    KG: Study concept and design, data analysis, interpretation of data, preparation of manuscript
    JBBM: Interpretation of data, preparation of manuscript
    JC: Interpretation of data, preparation of manuscript
    CRG: Study concept and design, interpretation of data, preparation of manuscript, obtained funding
    AMS: Interpretation of data, preparation of manuscript
    Author Contributions
    AC: Interpretation of data, preparation of manuscript
  • Descrição: Background The emergency department (ED) is a critical juncture in the care of persons living with dementia (PLwD), as they have a high rate of hospital admission, ED revisits, and subsequent inpatient stays. We examine ED disposition of PLwD compared with older adults with non‐dementia chronic disease as well as healthcare utilization and survival. Methods Medicare claims data were used to identify community‐dwelling older adults 66+ years old from 34 hospitals with either Alzheimer's disease/Alzheimer's disease related dementias (AD/ADRD) or a non‐AD/ADRD chronic condition between January 1, 2014, and December 31, 2018. We compared ED disposition at the index visit, as well as healthcare utilization and mortality in the 12 months following an index ED visit, and adjusted for age, gender, and risk of mortality. Results There were 29,626 patients in the AD/ADRD sample, and 317,046 in the comparison sample. The AD/ADRD sample was older (82.4 years old [SD: 8.2] vs. 76.0 years old [SD: 7.7]) and had more female patients (59.9% vs. 54.7%). The AD/ADRD sample was more likely to experience ED disposition to acute care (OR 1.039, p < 0.001, 95% CI 1.029–1.050), to have an ED revisit (OR 1.077, p < 0.001, 95% CI 1.066–1.087), and an inpatient stay in the subsequent 12 months (OR 1.085, p < 0.001, 95% CI 1.075–1.095). ED disposition to hospice was low in both samples (0.2%). AD/ADRD patients had a higher risk of mortality (OR 1.099, p < 0.001, 95% CI 1.091–1.107) and high short‐term mortality (31.9% within 12 months) than those without AD/ADRD (15.3% within 12 months). Conclusions PLwD who visit the ED have high short‐term mortality. Despite this, disposition to acute care, ED revisits, and inpatient stays, rather than hospice, remain the predominant mode of care delivery. Transition directly from the ED to hospice for PLwD is rare.
  • Editor: Hoboken, USA: John Wiley & Sons, Inc
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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