Hospitalizations and long-term care for older adults with Alzheimer's disease and related dementia: Differences across geographic regions of the United States

Abstract

Background

Alzheimer's disease and related dementia (ADRD) leads to adverse health outcomes, such as higher risk of hospitalizations and long-term institutionalization. However, little is known about differences in ADRD health outcomes for older adults in the Deep South compared to those in the rest of the United States (non-Deep South).

Objective

This study aims to examine the prevalence of hospitalization and long-term use of skilled nursing facilities (SNF) among older adults with ADRD, and factors influencing these healthcare utilization outcomes in the Deep South versus non-Deep South regions.

Methods

We conducted secondary analyses of claims data for 115,879 Medicare beneficiaries with ADRD in 2013–2015. Modified Poisson regression was used to examine the association of outcomes with individual and context-level factors for Deep South and non-Deep South separately.

Results

Hospitalization rates were slightly higher in the Deep South. Utilization of long-term SNF was similar across regions. In adjusted analyses, within each region, differences between non-Hispanic Black and White beneficiaries were not significant. Comorbidities, specialist visits, ADRD drug use, and Medicare/Medicaid dual eligibility were associated with more hospitalizations and SNF use for all beneficiaries in the Deep South. For beneficiaries in the non-Deep South region, context-level factors (limited availability of medical resources and poor population health) were significantly associated with healthcare utilization.

Conclusions

We identified differences across regions in the factors associated with hospitalizations and long-term SNF stays, with patient-level factors being relevant in the Deep South region and context-level factors in the non-Deep South region.