Acute care utilization by dementia caregivers within urban primary care practices

Cathy C. Schubert, Malaz Boustani, Christopher Callahan, Anthony J. Perkins, Siu Hui, Hugh Hendrie

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

BACKGROUND: Caring for an individual with Alzheimer's dementia (AD) is stressful, and studies show that this stress has an impact on both the physical and mental health of the caregiver. However, many questions remain about the characteristics of AD patients and their caregivers that contribute to this stress and how it impacts caregivers' use of healthcare resources. OBJECTIVE: To study the impact of stress on the physical and mental health of the caregiver. DESIGN: Patients underwent extensive testing to allow description of their degree of cognitive impairment, behavioral and psychological symptoms, medical comorbidities, and functional abilities. Caregivers were assessed for depressive symptoms and also for emergency department (ED) use and hospitalizations in the previous six months. Multivariate logistic regression was used to evaluate impact of patients' dementia symptoms on caregivers' acute care utilization. PARTICIPANTS: One hundred and fifty-three AD patients and their caregivers attending two large, urban, university-affiliated primary care practices were enrolled in a cross-sectional study to examine the facets of dementia caregiving that impact caregiver acute health care utilization. RESULTS: Twenty-four percent of the caregivers had at least one ED visit or hospitalization in the six months prior to enrollment. After adjusting for caregiver age, gender, and education, our logistic regression model found that the caregivers' acute care utilization was associated with their depression as measured by the PHQ-9 (OR 1.09, 95% CI 1.00-1.18), the patients' behavioral and psychological symptoms as measured by the NPI (OR 1.04, 95% CI 1.01-1.08), and the patients' functional status as measured by the ADCS-ADL (OR 1.05, 95% CI 1.01-1.09). CONCLUSION: To improve the health of AD caregivers, a primary care system needs to reallocate resources to manage the functional, behavioral, and psychological symptoms related to the care-recipients suffering from AD.

Original languageEnglish
Pages (from-to)1736-1740
Number of pages5
JournalJournal of General Internal Medicine
Volume23
Issue number11
DOIs
StatePublished - Nov 2008

Fingerprint

Caregivers
Dementia
Primary Health Care
Alzheimer Disease
Behavioral Symptoms
Logistic Models
Psychology
Hospital Emergency Service
Mental Health
Hospitalization
Patient Acceptance of Health Care
Depression
Aptitude
Activities of Daily Living
Comorbidity
Cross-Sectional Studies
Delivery of Health Care
Education

Keywords

  • Caregiver
  • Dementia
  • ED visit
  • Health care utilization
  • Hospitalization

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Acute care utilization by dementia caregivers within urban primary care practices. / Schubert, Cathy C.; Boustani, Malaz; Callahan, Christopher; Perkins, Anthony J.; Hui, Siu; Hendrie, Hugh.

In: Journal of General Internal Medicine, Vol. 23, No. 11, 11.2008, p. 1736-1740.

Research output: Contribution to journalArticle

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