Distress Associated with Dementia-Related Psychosis and Agitation in Relation to Healthcare Utilization and Costs
Male
Aging
Hallucinations
Clinical Sciences
Clinical sciences
Stress
Medicare
Delusions
Clinical and health psychology
Hospital
Clinical Research
Health Services and Systems
Health Sciences
Behavioral and Social Science
Acquired Cognitive Impairment
80 and over
Health services and systems
Humans
caregiver
Psychomotor Agitation
Aged
Retrospective Studies
Aged, 80 and over
Emergency Service
behavioral and psychological symptom
Neurosciences
healthcare utilization
Health Care Costs
Health Services
16. Peace & justice
United States
Brain Disorders
3. Good health
Aggression
Hospitalization
Mental Health
Good Health and Well Being
Cross-Sectional Studies
Caregivers
Geriatrics
Public Health and Health Services
Psychological
Cognitive Sciences
Dementia
Female
Emergency Service, Hospital
Stress, Psychological
DOI:
10.1016/j.jagp.2017.02.025
Publication Date:
2017-05-25T07:17:24Z
AUTHORS (6)
ABSTRACT
Explore the relationship between behavioral and psychological symptoms of dementia (BPSD; specifically, delusions, hallucinations, and agitation/aggression) and associated caregiver distress with emergency department (ED) utilization, inpatient hospitalization, and expenditures for direct medical care.Retrospective cross-sectional cohort of participants with dementia (N = 332) and informants from the Aging, Demographics, and Memory Study, a nationally representative survey of U.S. adults >70 years old.BPSD of interest and associated informant distress (trichotomized as none/low/high) were assessed using the Neuropsychiatric Inventory (NPI). Outcomes were determined from one year of Medicare claims and examined according to presence of BPSD and associated informant distress, adjusting for participant demographics, dementia severity, and comorbidity.Fifty-eight (15%) participants with dementia had clinically significant delusions, hallucinations, or agitation/aggression. ED visits, inpatient admissions, and costs were not significantly higher among the group with significant BPSD. In fully adjusted models, a high level of informant distress was associated with all outcomes: ED visit incident rate ratio (IRR) 3.03 (95% CI: 1.98-4.63; p < 0.001), hospitalization IRR 2.78 (95% CI: 1.73-4.46; p < 0.001), and relative cost ratio 2.00 (95% CI: 1.12-3.59; p = 0.02).A high level of informant distress related to participant BPSD, rather than the symptoms themselves, was associated with increased healthcare utilization and costs. Effectively identifying, educating, and supporting distressed caregivers may help reduce excess healthcare utilization for the growing number of older adults with dementia.
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