Health Services Utilization Associated With Cognitive Impairment and Dementia in Older Patients Undergoing Post-Acute Rehabilitation

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• 作者：Laurence Seematter-Bagnoud ; MD ; MSc^a ; ^b ; ^{Laurence.Seematter-Bagnoud@chuv.ch} ; Estelle Martin ; PhD^a ; Christophe J. Bü ; la ; MD^a
• 关键词：Elderly ; dementia ; health service utilization
• 刊名：Journal of the American Medical Directors Association
• 出版年：2012
• 出版时间：October, 2012
• 年：2012
• 卷：13
• 期：8
• 页码：692-697
• 全文大小：269 K

文摘

Objective

To investigate the relationship between levels of cognitive impairment and health services utilization in older patients undergoing post-acute rehabilitation.

Design

Cross-sectional study.

Setting

Post-acute rehabilitation facility.

Participants

Patients (N?= 1764) aged 70 years and older admitted over 3 years.

Measurements

Sociodemographic, medical, and functional data were collected upon admission. Based on discharge diagnoses, patients were classified as cognitively intact, cognitively impaired with no dementia (CIND), and demented.

Results

Dementia and CIND were diagnosed in 425 (24.1 % ) and 301 (17.1 % ) patients, respectively. Gradients from cognitively intact to cognitively impaired to demented patients were observed in median length of stay (19, 22, and 25 days, P < .001), and institutionalization rates at discharge (4.2 % , 7.6 % , and 28.8 % , P < .001). Among patients discharged home, similar gradients were observed in utilization of home care (68.2 % , 79.7 % , and 83.3 % , P < .001) and day care (3.1 % , 7.1 % , and 14.3 % , P < .001). After adjustment, compared with cognitively intact patients, only those with dementia still had longer stays (+2.7 days) and increased odds of institutionalization (adjOR 6.1, 95 % CI 4.0-9.3, P < .001). Among patients discharged home, use of home and day care remained higher in those with dementia (adjOR 1.8, 95 % CI 1.2-2.7, P?= .005, and adjOR 1.8, 95 % CI 1.2-2.7, P?= .005, respectively), while CIND patients had higher odds of using home care (adjOR 1.6, 95 % CI 1.1-2.4, P?= .028).

Conclusion

Among patients undergoing post-acute rehabilitation, those with dementia had increased use of both institutional and community care, whereas those with CIND had increased use of home care services only. Future studies should investigate specific strategies susceptible to reduce the related burden on health care systems.