title: Elevated Hospitalization Risk of Assisted Living Residents With Dementia in Alberta, Canada.
abstract: OBJECTIVE
  Assisted living (AL) is an increasingly used residential option for older adults with dementia; however, lower staffing rates and service availability raise concerns that such residents may be at increased risk for adverse outcomes. Our objectives were to determine the incidence of hospitalization over 1 year for dementia residents of designated AL (DAL) facilities, compared with long-term care (LTC) facilities, and identify resident- and facility-level predictors of hospitalization among DAL residents.
  
  
  METHODS
  Participants were 609 DAL (mean age 85.7 ± 6.6 years) and 691 LTC (86.4 ± 6.9 years) residents with dementia enrolled in the Alberta Continuing Care Epidemiological Studies. Research nurses completed a standardized comprehensive assessment of residents and interviewed family caregivers at baseline (2006-2008) and 1 year later. Standardized administrator interviews provided facility level data. Hospitalization was determined via linkage with the provincial Inpatient Discharge Abstract Database. Multivariable Cox proportional hazards models were used to identify predictors of hospitalization.
  
  
  RESULTS
  The cumulative annual incidence of hospitalization was 38.6% (34.5%-42.7%) for DAL and 10.3% (8.0%-12.6%) for LTC residents with dementia. A significantly increased risk for hospitalization was observed for DAL residents aged 90+ years, with poor social relationships, less severe cognitive impairment, greater health instability, fatigue, high medication use (11+ medications), and 2+ hospitalizations in the preceding year. Residents from DAL facilities with a smaller number of spaces, no chain affiliation, and from specific health regions showed a higher risk of hospitalization.
  
  
  CONCLUSIONS
  DAL residents with dementia had a hospitalization rate almost 4-fold higher than LTC residents with dementia. Our findings raise questions about the ability of some AL facilities to adequately address the needs of cognitively impaired residents and highlight potential clinical, social, and policy areas for targeted interventions to reduce hospitalization risk.
authors.affiliation: Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. Electronic address: colleen.maxwell@uwaterloo.ca.
authors.forename: Colleen J
authors.initials: CJ
authors.lastname: Maxwell
authors.affiliation: Health System Performance Branch, Canadian Institute for Health Information, Ottawa, Ontario, Canada.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Amuah
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Division of Geriatric Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: David B
authors.initials: DB
authors.lastname: Hogan
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Monica
authors.initials: M
authors.lastname: Cepoiu-Martin
authors.affiliation: Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Patten
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Soo
authors.affiliation: Division of Geriatric Psychiatry, Queen's University and Center for Studies in Aging and Health, Providence Care, Kingston, Ontario, Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Le Clair
authors.affiliation: Department of Family Relations and Applied Nutrition, University of Guelph, Macdonald Institute, Guelph, Ontario, Canada.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Wilson
authors.affiliation: Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada.
authors.forename: Brad
authors.initials: B
authors.lastname: Hagen
authors.affiliation: Department of Sociology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Strain
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities; D003704:Dementia / Q000523:psychology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010360:Patient Transfer; D036301:Qualitative Research; D018570:Risk Assessment
keywords: Dementia; assisted living; hospitalization; long-term care; predictors