Center of Innovation in Long-Term Services and Supports, U.S. Department of Veterans Affairs Medical Center, Providence, Rhode Island, USA.
Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA.
J Am Geriatr Soc. 2023 Feb;71(2):538-545. doi: 10.1111/jgs.18207. Epub 2022 Dec 26.
Injuries are a leading cause of emergency department (ED) visits among older adults, and individuals with Alzheimer's disease and related dementias (ADRD) may be at particular risk. We compared injury-related ED use among assisted living (AL) residents with and without ADRD and assessed differences in the risk of injury-related ED visits among individuals with ADRD residing in ALs with memory care designation versus general AL.
Using Medicare claims, we identified a cohort of fee-for-service beneficiaries who lived in AL in 2018 and resided in one of 20 states with site-specific information on memory care designation (n = 116,754). Outcomes included all injury-related ED visits and injury-related ED visits resulting in hospitalization in the calendar year 2018. We fit multilevel models of the association between ADRD and outcomes, adjusting for resident demographic characteristics and chronic conditions, license type characteristics, and AL characteristics, with random intercepts at the AL and license type levels. Among residents with ADRD, we examined whether memory care licensure was associated with injury-related ED visits.
The adjusted risk of injury-related ED use during the year was 20.1% (95% CI: 19.6%, 20.6%) for residents with ADRD compared to 16.1% for residents without ADRD (95% CI: 15.7%, 16.5%; p < 0.001). The adjusted risk of injury-related ED use ending in hospitalization was 4.9% (95% CI: 4.6%, 5.1%) for AL residents with ADRD and 3.9% for residents without ADRD (95% CI: 3.8%, 4.1%; p < 0.001). There were no significant differences in injury-related ED visits between residents with ADRD in ALs with memory care designation and residents in general AL.
Injury-related ED visits are common among AL residents with ADRD and residents in memory care, but residents in memory care AL experienced similar risks of injury as those in general AL. Further research should identify modifiable factors that can prevent injury among AL residents with ADRD.
伤害是导致老年人前往急诊部（ED）就诊的主要原因，而患有阿尔茨海默病和相关痴呆症（ADRD）的个体可能面临特别高的风险。我们比较了有和没有 ADRD 的辅助生活（AL）居民之间与伤害相关的 ED 使用情况，并评估了在 AL 中居住且有记忆护理指定的 ADRD 个体与一般 AL 个体之间与伤害相关的 ED 就诊风险的差异。
使用医疗保险索赔，我们确定了一个在 2018 年居住在 AL 并在 20 个州之一居住的服务付费受益人队列，这些州有关于记忆护理指定的特定地点信息（n=116754）。结果包括 2018 年日历年内所有与伤害相关的 ED 就诊和导致住院的与伤害相关的 ED 就诊。我们使用多水平模型调整了居民人口统计学特征和慢性疾病、许可类型特征以及 AL 特征，在 AL 和许可类型级别上设有随机截距，对 ADRD 与结果之间的关系进行拟合。在有 ADRD 的居民中，我们检查了记忆护理许可是否与与伤害相关的 ED 就诊相关。
与没有 ADRD 的居民相比（95%CI：15.7%，16.5%；p<0.001），患有 ADRD 的居民在当年因与伤害相关的 ED 使用的调整风险为 20.1%（95%CI：19.6%，20.6%）。患有 ADRD 的 AL 居民因与伤害相关的 ED 使用而导致住院的调整风险为 4.9%（95%CI：4.6%，5.1%），而没有 ADRD 的居民为 3.9%（95%CI：3.8%，4.1%；p<0.001）。在有记忆护理指定的 AL 中患有 ADRD 的居民和普通 AL 中的居民之间，与伤害相关的 ED 就诊没有显著差异。
与伤害相关的 ED 就诊在患有 ADRD 的 AL 居民和记忆护理居民中很常见，但在记忆护理 AL 中的居民与普通 AL 中的居民的伤害风险相似。应进一步研究可预防 ADRD 居民在 AL 中受伤的可改变因素。
