Table 3.
The relationship of significant psychosis or agitation and associated informant distress with utilization and Medicare costs among ADAMS participants with dementia
| Model 1 (unadjusted) | Model 2a | Model 3b | |||||||
|---|---|---|---|---|---|---|---|---|---|
|
| |||||||||
| Outcomec | 95% CI | p-value | Outcomec | 95% CI | p-value | Outcomec | 95% CI | p-value | |
| Emergency Department visits | |||||||||
|
| |||||||||
| Significant psychosis or agitationd | |||||||||
| No (ref.) | 1.00 | – | – | 1.00 | – | – | 1.00 | – | – |
| Yes | 0.56 | 0.31–1.00 | 0.05 | 0.57 | 0.32–1.02 | 0.06 | 0.39 | 0.25–0.61 | <0.001 |
| Associated informant distresse | |||||||||
| None (ref.) | 1.00 | – | – | 1.00 | – | – | 1.00 | – | – |
| Low | 1.32 | 0.64–2.73 | 0.43 | 1.68 | 0.90–3.13 | 0.10 | 2.31 | 1.24–4.31 | 0.01 |
| High | 2.10 | 1.11–3.95 | 0.02 | 2.30 | 1.24–4.28 | 0.01 | 3.03 | 1.98–4.63 | <0.001 |
|
| |||||||||
| Acute inpatient hospitalization | |||||||||
|
| |||||||||
| Significant psychosis or agitation | |||||||||
| No (ref.) | 1.00 | – | – | 1.00 | – | – | 1.00 | – | – |
| Yes | 0.88 | 0.42–1.86 | 0.73 | 1.06 | 0.55–2.02 | 0.86 | 0.63 | 0.36–1.09 | 0.09 |
| Associated informant distress | |||||||||
| None (ref.) | 1.00 | – | – | 1.00 | – | – | 1.00 | – | – |
| Low | 0.50 | 0.26–0.98 | 0.04 | 0.54 | 0.29–1.01 | 0.05 | 0.78 | 0.37–1.62 | 0.49 |
| High | 1.71 | 0.86–3.41 | 0.12 | 1.81 | 0.98–3.32 | 0.06 | 2.78 | 1.73–4.46 | <0.001 |
|
| |||||||||
| Medicare expenditures | |||||||||
|
| |||||||||
| Significant psychosis or agitation | |||||||||
| No (ref.) | 1.00 | – | – | 1.00 | – | – | 1.00 | – | – |
| Yes | 1.23 | 0.62–2.44 | 0.54 | 1.69 | 0.79–3.58 | 0.17 | 0.88 | 0.43–1.80 | 0.72 |
| Associated informant distress | |||||||||
| None (ref.) | 1.00 | – | – | 1.00 | – | – | 1.00 | – | – |
| Low | 0.65 | 0.37–1.16 | 0.14 | 0.77 | 0.52–1.12 | 0.16 | 1.17 | 0.73–1.87 | 0.51 |
| High | 1.89 | 0.74–4.81 | 0.17 | 1.43 | 0.63–3.25 | 0.38 | 2.00 | 1.12–3.59 | 0.02 |
adjusted for age, age2, gender, race/ethnicity, education, nursing home residency, and informant coresidency.
adjusted for Model 2 covariates as well as Charlson comorbidity score and dementia severity.
for emergency department and acute inpatient hospitalization, the outcome is incidence rate ratio; for Medicare expenditures, the outcome is relative cost ratio.
“Yes” means ADAMS participant had significant BPSD (domain score ≥4) on at least one of the following domains: delusions, hallucinations, agitation/aggression. Participants in the “No” group had no significant BPSD in any of those three domains. The models did not otherwise adjust for the severity of BPSD, only whether clinically significant symptoms were present.
Summed Neuropsychiatric Inventory informant distress score for domains of delusions, hallucinations, and agitation/aggression (total range 0–15), trichotomized as: none (score 0, n=231 [74.5%]), low (score 1–3, n=59 [13.2%]), and high (score ≥4, n=42 [12.4%]).