title: Use and cost of hospitalization in dementia: longitudinal results from a community-based study.
abstract: OBJECTIVE
  The aim of this study is to examine the relative contribution of functional impairment and cognitive deficits on risk of hospitalization and costs.
  
  
  METHODS
  A prospective cohort of Medicare beneficiaries aged 65 and older who participated in the Washington Heights-Inwood Columbia Aging Project (WHICAP) were followed approximately every 18 months for over 10 years (1805 never diagnosed with dementia during study period, 221 diagnosed with dementia at enrollment). Hospitalization and Medicare expenditures data (1999-2010) were obtained from Medicare claims. Multivariate analyses were conducted to examine (1) risk of all-cause hospitalizations, (2) hospitalizations from ambulatory care sensitive (ACSs) conditions, (3) hospital length of stay (LOS), and (4) Medicare expenditures. Propensity score matching methods were used to reduce observed differences between demented and non-demented groups at study enrollment. Analyses took into account repeated observations within each individual.
  
  
  RESULTS
  Compared to propensity-matched individuals without dementia, individuals with dementia had significantly higher risk for all-cause hospitalization, longer LOS, and higher Medicare expenditures. Functional and cognitive deficits were significantly associated with higher risks for hospitalizations, hospital LOS, and Medicare expenditures. Functional and cognitive deficits were associated with higher risks of for some ACS but not all admissions.
  
  
  CONCLUSIONS
  These results allow us to differentiate the impact of functional and cognitive deficits on hospitalizations. To develop strategies to reduce hospitalizations and expenditures, better understanding of which types of hospitalizations and which disease characteristics impact these outcomes will be critical.
authors.affiliation: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.|James J Peters VA Medical Center, Bronx, NY, USA.
authors.forename: Carolyn W
authors.initials: CW
authors.lastname: Zhu
authors.affiliation: Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, and Department of Neurology, Columbia University Medical Center, New York, NY, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Cosentino
authors.affiliation: The Samuel Bronfman Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Ornstein
authors.affiliation: Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, and Department of Neurology, Columbia University Medical Center, New York, NY, USA.
authors.forename: Yian
authors.initials: Y
authors.lastname: Gu
authors.affiliation: Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Andrews
authors.affiliation: Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, and Department of Neurology, Columbia University Medical Center, New York, NY, USA.
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Stern
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000191:economics; D015897:Comorbidity; D003704:Dementia / Q000191:economics* / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006304:Health Status; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology
keywords: dementia; healthcare expenditures; hospitalization; longitudinal follow-up