Physician outpatient contacts and hospitalizations among cognitively impaired elderly.
BACKGROUND
This study examined how physician contacts and hospitalizations vary in relation to cognitive function level among community-residing older adults.


METHODS
Analysis of the 1998 wave of the Health and Retirement Survey (HRS) was conducted to create three levels of cognitive function among 6,991 older adults by using direct measures for self-respondents and proxy evaluations. Ordinary least square regression analyses were used to estimate the probability of physician outpatient contacts, number of hospitalizations, and nights hospitalized during the last 2 years.


RESULTS
Lower cognitive function level was found to be associated with decreasing levels of physician contacts and increasing levels of hospitalizations as well as nights hospitalized. In addition, lower cognitive function levels were consistently related to a variety of comorbidities. Moreover, many older adults with low cognitive function levels reported or were reported by their proxies as not having a diagnosis of a memory-related disease (MRD). Finally, having a diagnosis of an MRD was found to be associated with more physician contacts but fewer hospital nights compared with those who had never received such a diagnosis.


CONCLUSIONS
The findings suggest the need for increased outreach targeted at identification of community-dwelling older adults with decline in cognitive function who are in need of care but are underdiagnosed, underutilize physician care, and are overhospitalized.
Caspi
Eilon
E
Gerontology Institute and Department, McCormack Graduate School of Policy Studies, University of Massachusetts Boston, Boston, MA, USA. eiloncaspi@yahoo.com
Silverstein
Nina M
NM
Porell
Frank
F
Kwan
Ngai
N
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology / Q000628:therapy; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D003072:Cognition Disorders / Q000453:epidemiology* / Q000628:therapy*; D003159:Community-Institutional Relations; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D016852:Housing for the Elderly; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000453:epidemiology / Q000628:therapy; D010820:Physicians / Q000706:statistics & numerical data*; D015995:Prevalence; D012720:Severity of Illness Index