Institute of Gerontology, Wayne State University, Detroit, Michigan, USA.
Department of Neurosciences and Shiley-Marcos Alzheimer's Disease Research Center, University of California San Diego School of Medicine, San Diego, California, USA.
Gerontologist. 2022 Jul 15;62(6):911-922. doi: 10.1093/geront/gnab160.
The evidence base on health services use and cost burdens associated with transition to severe cognitive impairment (SCI) and dementia is underdeveloped. We examine how the change in cognitive impairment status influences nursing home use, hospitalizations, and out-of-pocket (OOP) expenditures.
We use prospective data from the Health and Retirement Study (2007/2008-2015/2016) on adults 70 years and older meeting research criteria for cognitive impairment not dementia (CIND) at baseline (unweighted n = 1,692) to fit 2-part models testing how reversion to normal cognition, stability (CIND maintenance), and transition into SCI/dementia influence change in yearly nursing home use, hospitalizations, and OOP expenditures.
Over 8 years, 5.9% reverted, 15.9% remained CIND, 14.9% transitioned to SCI/dementia, and 63.3% died. We observed substantial increases in the propensity of any nursing home use which were particularly pronounced among those who transitioned or died during follow-up and similar but less pronounced differences in patterns of inpatient hospitalizations. Average baseline OOP spending was similar among reverters ($1156 [95% confidence interval = 832-1,479]), maintainers ($1,145 [993-1,296]), and transitioners ($1,385 [1,041-1,730]). Individuals who died during follow-up spent $2,529 (2,101-2,957). By the eighth year of follow-up, spending among reverters increased to $1,402 (869-1,934) and $2,188 (1,402-2,974) and $8,988 (5,820-12,157) for maintainers and transitioners, respectively. Average spending at the wave preceding death was $7,719 (4,345-11,094). Estimates were only partly attenuated through adjustment to covariables.
A better understanding of variations in health services use and cost burdens among individuals with mild cognitive impairment can help guide targeted care and financial planning.
关于与严重认知障碍（SCI）和痴呆相关的过渡期间的卫生服务使用和费用负担的证据基础尚不完善。我们研究了认知障碍状态的变化如何影响疗养院的使用、住院和自付费用（OOP）支出。
我们使用前瞻性数据，对参加健康与退休研究（2007/2008 年至 2015/2016 年）的年龄在 70 岁及以上、基线时符合认知障碍而非痴呆（CIND）研究标准的成年人（未加权 n = 1,692）进行拟合两部分模型测试，以检验认知恢复正常、稳定（CIND 维持）和转变为 SCI/痴呆如何影响每年疗养院使用、住院和 OOP 支出的变化。
在 8 年期间，5.9%的人恢复正常认知，15.9%的人保持 CIND，14.9%的人转变为 SCI/痴呆，63.3%的人死亡。我们观察到任何疗养院使用的倾向都有了实质性的增加，尤其是在随访期间发生转变或死亡的人群中更为明显，而住院治疗模式的差异则相似但不那么明显。恢复者（1156 美元[95%置信区间=832-1479]）、维持者（1145 美元[993-1296]）和转变者（1385 美元[1041-1730]）的基线 OOP 支出基本相似。随访期间死亡的人支出 2529 美元（2101-2957）。到第八年随访时，恢复者的支出增加到 1402 美元（869-1934）和 2188 美元（1402-2974），维持者和转变者的支出分别为 8988 美元（5820-12157）。在死亡前的那一波中，平均支出为 7719 美元（4345-11094）。通过对协变量进行调整，估计值仅部分减弱。
更好地了解轻度认知障碍患者的卫生服务使用和费用负担的变化，可以帮助指导有针对性的护理和财务规划。
