Hospitalization in Community-Dwelling Persons with Alzheimer's Disease: Frequency and Causes

Authors

  • James L. Rudolph MD, SM,

    1. From the *Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts; Veterans Affairs Boston Healthcare System, Geriatric Research Education and Clinical Center, Boston, Massachusetts; §Boonshoft School of Medicine, Wright State University, Dayton, Ohio; #Division of General Medicine and Primary Care, **Department of Neurology, and Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; ††Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts.
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    • 1These authors contributed equally and have agreed to share first authorship.

  • 1 Nicole M. Zanin BA,

    1. From the *Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts; Veterans Affairs Boston Healthcare System, Geriatric Research Education and Clinical Center, Boston, Massachusetts; §Boonshoft School of Medicine, Wright State University, Dayton, Ohio; #Division of General Medicine and Primary Care, **Department of Neurology, and Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; ††Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts.
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    • 1These authors contributed equally and have agreed to share first authorship.

  • 1 Richard N. Jones ScD,

    1. From the *Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts; Veterans Affairs Boston Healthcare System, Geriatric Research Education and Clinical Center, Boston, Massachusetts; §Boonshoft School of Medicine, Wright State University, Dayton, Ohio; #Division of General Medicine and Primary Care, **Department of Neurology, and Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; ††Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts.
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  • Edward R. Marcantonio MD, SM,

    1. From the *Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts; Veterans Affairs Boston Healthcare System, Geriatric Research Education and Clinical Center, Boston, Massachusetts; §Boonshoft School of Medicine, Wright State University, Dayton, Ohio; #Division of General Medicine and Primary Care, **Department of Neurology, and Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; ††Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts.
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  • Tamara G. Fong MD, PhD,

    1. From the *Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts; Veterans Affairs Boston Healthcare System, Geriatric Research Education and Clinical Center, Boston, Massachusetts; §Boonshoft School of Medicine, Wright State University, Dayton, Ohio; #Division of General Medicine and Primary Care, **Department of Neurology, and Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; ††Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts.
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  • Frances M. Yang PhD,

    1. From the *Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts; Veterans Affairs Boston Healthcare System, Geriatric Research Education and Clinical Center, Boston, Massachusetts; §Boonshoft School of Medicine, Wright State University, Dayton, Ohio; #Division of General Medicine and Primary Care, **Department of Neurology, and Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; ††Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts.
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  • Liang Yap PhD,

    1. From the *Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts; Veterans Affairs Boston Healthcare System, Geriatric Research Education and Clinical Center, Boston, Massachusetts; §Boonshoft School of Medicine, Wright State University, Dayton, Ohio; #Division of General Medicine and Primary Care, **Department of Neurology, and Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; ††Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts.
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  • Sharon K. Inouye MD, MPH

    1. From the *Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts; Veterans Affairs Boston Healthcare System, Geriatric Research Education and Clinical Center, Boston, Massachusetts; §Boonshoft School of Medicine, Wright State University, Dayton, Ohio; #Division of General Medicine and Primary Care, **Department of Neurology, and Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; ††Massachusetts Alzheimer's Disease Research Center, Massachusetts General Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts.
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Address correspondence to James L. Rudolph, VABHS GRECC, 150 South Huntington Ave, Boston, MA 02130. E-mail: jrudolph@partners.org

Abstract

OBJECTIVES: To examine the rates of and risk factors for acute hospitalization in a prospective cohort of older community-dwelling patients with Alzheimer's disease (AD).

DESIGN: Longitudinal patient registry.

SETTING: AD research center.

PARTICIPANTS: Eight hundred twenty-seven older persons with AD.

MEASUREMENTS: Acute hospitalization after AD research center visit was determined from a Medicare database. Risk factor variables included demographics, dementia-related, comorbidity and diagnoses and were measured in interviews and according to Medicare data.

RESULTS: Of the 827 eligible patients seen at the ADRC during 1991 to 2006 (median follow-up 3.0 years), 542 (66%) were hospitalized at least once, and 389 (47%) were hospitalized two or more times, with a median of 3 days spent in the hospital per person-year. Leading reasons for admission were syncope or falls (26%), ischemic heart disease (17%), gastrointestinal disease (9%), pneumonia (6%), and delirium (5%). Five significant independent risk factors for hospitalization were higher comorbidity (hazard ratio (HR)=1.87, 95% confidence interval (CI)=1.57–2.23), previous acute hospitalization (HR=1.65, 95% CI=1.37–1.99), older age (HR=1.51, 95% CI=1.26–1.81), male sex (HR=1.27, 95% CI=1.04–1.54), and shorter duration of dementia symptoms (HR=1.26, 95% CI=1.02–1.56). Cumulative risk of hospitalization increased with number of risk factors present at baseline: 38% with zero factors, 57% with one factor, 70% with two or three factors, and 85% with four or five factors (Ptrend<.001).

CONCLUSION: In a community-dwelling population with generally mild AD, hospitalization is frequent, occurring in two-thirds of participants over a median follow-up time of 3 years. With these results, clinicians may be able to identify dementia patients at high risk for hospitalization.

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