Association of Sensory and Cognitive Impairment With Healthcare Utilization and Cost in Older Adults
Association of Sensory and Cognitive Impairment With Healthcare Utilization and Cost in Older Adults
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DOI：
10.1111/jgs.15891
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发表时间：
2019-08-01
影响因子：
6.3
通讯作者：
Whitson, Heather E.
中科院分区：
文献类型：
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作者：
Deardorff, William James;Liu, Phillip L.;Whitson, Heather E.
目的：研究自我报告的视力损害（VI）、听力损害（HI）和双重感觉损害（DSI）之间的相关性，按痴呆状态分层，住院、临终关怀使用和医疗费用。设计回顾性分析。1999年至2006年医疗保险现行受益人调查。参与者社区居住的医疗保险受益人的旋转面板，年龄65岁及以上（N = 24 009）。测量VI和HI通过自我报告确定。痴呆状态通过自我报告或索赔数据中的诊断代码确定。主要结果包括2年内的任何住院患者，2年内的临终关怀使用，年度医疗保险服务费用和总医疗费用（包括医疗保险索赔数据和其他自我报告的支付信息）。结果30.2%（n = 263/871）的痴呆患者和17.8%（n = 4112/23138）的非痴呆患者存在自我报告的DSI。在多变量logistic回归模型中，HI、VI或DSI通常与住院和临终关怀使用的几率增加相关，而与痴呆状态无关。在一个根据人口统计学调整的广义线性模型中，与没有痴呆的DSI患者相比，DSI和痴呆患者的年度总医疗费用更高（分别为28875美元和3340美元）。任何感觉障碍的存在通常与更高的医疗费用相关。在调整人口统计学，医疗补助状态和慢性疾病的模型中，DSI与无感觉障碍相比，无痴呆症患者的总医疗支出差异较小，但具有统计学意义（1151美元vs 1056美元; P < .001），但痴呆症患者的差异不明显（11303美元vs 10466美元; P = .395）。结论：有感觉和认知障碍的老年人构成了一个特别普遍和脆弱的人群，他们住院的风险增加，并导致更高的医疗费用。J Am Geriatr Soc 67：1617-1624，2019
OBJECTIVES To examine the association between self-reported vision impairment (VI), hearing impairment (HI), and dual-sensory impairment (DSI), stratified by dementia status, on hospital admissions, hospice use, and healthcare costs. DESIGN Retrospective analysis. SETTING Medicare Current Beneficiary Survey from 1999 to 2006. PARTICIPANTS Rotating panel of community-dwelling Medicare beneficiaries, aged 65 years and older (N = 24 009). MEASUREMENTS VI and HI were ascertained by self-report. Dementia status was determined by self-report or diagnosis codes in claims data. Primary outcomes included any inpatient admission over a 2-year period, hospice use over a 2-year period, annual Medicare fee-for-service costs, and total healthcare costs (which included information from Medicare claims data and other self-reported payments). RESULTS Self-reported DSI was present in 30.2% (n = 263/871) of participants with dementia and 17.8% (n = 4112/23 138) of participants without dementia. In multivariable logistic regression models, HI, VI, or DSI was generally associated with increased odds of hospitalization and hospice use regardless of dementia status. In a generalized linear model adjusted for demographics, annual total healthcare costs were greater for those with DSI and dementia compared to those with DSI without dementia ($28 875 vs $3340, respectively). Presence of any sensory impairment was generally associated with higher healthcare costs. In a model adjusted for demographics, Medicaid status, and chronic medical conditions, DSI compared with no sensory impairment was associated with a small, but statistically significant, difference in total healthcare spending in those without dementia ($1151 vs $1056; P < .001) but not in those with dementia ($11 303 vs $10 466; P = .395). CONCLUSION Older adults with sensory and cognitive impairments constitute a particularly prevalent and vulnerable population who are at increased risk of hospitalization and contribute to higher healthcare spending. J Am Geriatr Soc 67:1617-1624, 2019