title: Acute care utilization by dementia caregivers within urban primary care practices.
abstract: BACKGROUND
  Caring for an individual with Alzheimer's dementia (AD) is stressful, and studies show that this stress has an impact on both the physical and mental health of the caregiver. However, many questions remain about the characteristics of AD patients and their caregivers that contribute to this stress and how it impacts caregivers' use of healthcare resources.
  
  
  OBJECTIVE
  To study the impact of stress on the physical and mental health of the caregiver.
  
  
  METHODS
  Patients underwent extensive testing to allow description of their degree of cognitive impairment, behavioral and psychological symptoms, medical comorbidities, and functional abilities. Caregivers were assessed for depressive symptoms and also for emergency department (ED) use and hospitalizations in the previous six months. Multivariate logistic regression was used to evaluate impact of patients' dementia symptoms on caregivers' acute care utilization.
  
  
  METHODS
  One hundred and fifty-three AD patients and their caregivers attending two large, urban, university-affiliated primary care practices were enrolled in a cross-sectional study to examine the facets of dementia caregiving that impact caregiver acute health care utilization.
  
  
  RESULTS
  Twenty-four percent of the caregivers had at least one ED visit or hospitalization in the six months prior to enrollment. After adjusting for caregiver age, gender, and education, our logistic regression model found that the caregivers' acute care utilization was associated with their depression as measured by the PHQ-9 (OR 1.09, 95% CI 1.00-1.18), the patients' behavioral and psychological symptoms as measured by the NPI (OR 1.04, 95% CI 1.01-1.08), and the patients' functional status as measured by the ADCS-ADL (OR 1.05, 95% CI 1.01-1.09).
  
  
  CONCLUSIONS
  To improve the health of AD caregivers, a primary care system needs to reallocate resources to manage the functional, behavioral, and psychological symptoms related to the care-recipients suffering from AD.
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Cathy C
authors.initials: CC
authors.lastname: Schubert
authors.forename: Malaz
authors.initials: M
authors.lastname: Boustani
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Callahan
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Perkins
authors.forename: Siu
authors.initials: S
authors.lastname: Hui
authors.forename: Hugh C
authors.initials: HC
authors.lastname: Hendrie
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000628:therapy*; D003863:Depression / Q000209:etiology*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011788:Quality of Life; D014505:Urban Population