Abstract

Purpose: Alzheimer’s disease affected approximately 4.7 million Americans age 65 or older in 2010. This study examines the effect of dementia on hospital and emergency department (ED) use for people living in the community, nursing homes, and residential care facilities (such as assisted living facilities) in the United States.

Data: Two datasets were used in this study. To analyze the impact of dementia for people living in the community and in nursing homes, we used longitudinal data from the Health and Retirement Study linked with Medicare claims over 2000–2008. This part of the study examined fee-forservice Medicare beneficiaries age 65 or older. Second, to assess the impact of dementia for people living in residential care facilities, we analyzed the 2010 National Survey of Residential Care Facilities. This part of the study examined people age 65 and older.

Results: First, prevalence of dementia differed by residential setting. Approximately 12% of community-dwelling Medicare beneficiaries had dementia, in contrast with 84% of those in nursing homes and 51% of people in residential care facilities. Second, the impact of dementia on hospital and ED use varied by residential setting. Among community-dwelling beneficiaries, individuals with dementia were significantly more likely than those without dementia to be hospitalized and to have ED visits annually, both overall and for potentially avoidable conditions, after adjusting for demographic, socioeconomic, and healthrelated risk factors. For example, 27% of Medicare fee-for-service beneficiaries with dementia had a hospitalization annually, compared with 19% of beneficiaries without dementia. Moreover, 8% of beneficiaries with dementia had a potentially avoidable hospitalization, compared with 5% of people without dementia. In terms of ED visits, 35% of beneficiaries with dementia had ED visits, compared with 25% of beneficiaries without dementia. Third, in contrast, among nursing home and residential care facility residents, there were no significant differences in hospitalization by dementia status. Although people with dementia in nursing homes did not have higher rates of hospitalizations or potentially avoidable hospitalizations than people without dementia, the absolute rates of hospitalization were quite high (46% for those with dementia and 42% for those without dementia). Older people living in residential care facilities did not have exceptionally high rates of hospitalizations (about 24% annually). On most measures of ED use by nursing home and residential care residents, there were no differences by dementia status.

Conclusions: High rates of hospitalizations and ED use among community-dwelling people with dementia, both overall and for potentially avoidable conditions, may be attributable to multiple factors, such as challenges in providing adequate ambulatory care for this vulnerable population. In comparison, most nursing homes are equipped to provide medical and nursing care for many conditions that would be difficult to manage in community settings. People with dementia in nursing homes and residential care facilities have hospital use rates similar to people without dementia, but the high nominal rates of hospitalizations for nursing home residents suggest the importance of reducing unnecessary use.

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