Distress Associated with Dementia-Related Psychosis and Agitation in Relation to Healthcare Utilization and Costs.

TitleDistress Associated with Dementia-Related Psychosis and Agitation in Relation to Healthcare Utilization and Costs.
Publication TypeJournal Article
Year of Publication2017
AuthorsMaust, DT, Kales, HC, McCammon, RJ, Blow, FC, Leggett, AN, Langa, KM
JournalAmerican Journal of Geriatric Psychiatry
Date Published2017 Oct
ISSN Number1545-7214
KeywordsDementia, Depressive symptoms, Healthcare, Stress

OBJECTIVES: Explore the relationship between behavioral and psychological symptoms of dementia (BPSD; specifically, delusions, hallucinations, and agitation/aggression) and associated caregiver distress with emergency department (ED) utilization, inpatient hospitalization, and expenditures for direct medical care.

DESIGN/SETTING/PARTICIPANTS: Retrospective cross-sectional cohort of participants with dementia (N = 332) and informants from the Aging, Demographics, and Memory Study, a nationally representative survey of U.S. adults >70 years old.

MEASUREMENTS: BPSD of interest and associated informant distress (trichotomized as none/low/high) were assessed using the Neuropsychiatric Inventory (NPI). Outcomes were determined from one year of Medicare claims and examined according to presence of BPSD and associated informant distress, adjusting for participant demographics, dementia severity, and comorbidity.

RESULTS: Fifty-eight (15%) participants with dementia had clinically significant delusions, hallucinations, or agitation/aggression. ED visits, inpatient admissions, and costs were not significantly higher among the group with significant BPSD. In fully adjusted models, a high level of informant distress was associated with all outcomes: ED visit incident rate ratio (IRR) 3.03 (95% CI: 1.98-4.63; p < 0.001), hospitalization IRR 2.78 (95% CI: 1.73-4.46; p < 0.001), and relative cost ratio 2.00 (95% CI: 1.12-3.59; p = 0.02).

CONCLUSIONS: A high level of informant distress related to participant BPSD, rather than the symptoms themselves, was associated with increased healthcare utilization and costs. Effectively identifying, educating, and supporting distressed caregivers may help reduce excess healthcare utilization for the growing number of older adults with dementia.

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Alternate JournalAm J Geriatr Psychiatry
Citation Key9321
PubMed ID28754586
PubMed Central IDPMC5600647
Grant ListK08 AG048321 / AG / NIA NIH HHS / United States
P30 AG024824 / AG / NIA NIH HHS / United States
U01 AG009740 / AG / NIA NIH HHS / United States