Hospitalization in community-dwelling persons with Alzheimer's disease: frequency and causes.
OBJECTIVE
To examine the rates of and risk factors for acute hospitalization in a prospective cohort of older community-dwelling patients with Alzheimer's disease (AD).


METHODS
Longitudinal patient registry.


METHODS
AD research center.


METHODS
Eight hundred twenty-seven older persons with AD.


METHODS
Acute hospitalization after AD research center visit was determined from a Medicare database. Risk factor variables included demographics, dementia-related, comorbidity and diagnoses and were measured in interviews and according to Medicare data.


RESULTS
Of the 827 eligible patients seen at the ADRC during 1991 to 2006 (median follow-up 3.0 years), 542 (66%) were hospitalized at least once, and 389 (47%) were hospitalized two or more times, with a median of 3 days spent in the hospital per person-year. Leading reasons for admission were syncope or falls (26%), ischemic heart disease (17%), gastrointestinal disease (9%), pneumonia (6%), and delirium (5%). Five significant independent risk factors for hospitalization were higher comorbidity (hazard ratio (HR)=1.87, 95% confidence interval (CI)=1.57-2.23), previous acute hospitalization (HR=1.65, 95% CI=1.37-1.99), older age (HR=1.51, 95% CI=1.26-1.81), male sex (HR=1.27, 95% CI=1.04-1.54), and shorter duration of dementia symptoms (HR=1.26, 95% CI=1.02-1.56). Cumulative risk of hospitalization increased with number of risk factors present at baseline: 38% with zero factors, 57% with one factor, 70% with two or three factors, and 85% with four or five factors (P(trend) <.001).


CONCLUSIONS
In a community-dwelling population with generally mild AD, hospitalization is frequent, occurring in two-thirds of participants over a median follow-up time of 3 years. With these results, clinicians may be able to identify dementia patients at high risk for hospitalization.
Rudolph
James L
JL
Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA. jrudolph@partners.org
Zanin
Nicole M
NM
Jones
Richard N
RN
Marcantonio
Edward R
ER
Fong
Tamara G
TG
Yang
Frances M
FM
Yap
Liang
L
Inouye
Sharon K
SK
D000058:Accidental Falls / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000544:Alzheimer Disease / Q000453:epidemiology*; D015897:Comorbidity; D003693:Delirium / Q000453:epidemiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D013575:Syncope / Q000453:epidemiology