Alzheimer’s dementia, the most common type of dementia, afflicts more than 6 million Americans. More than 80 percent of people living with dementia (PLWD) live in the community, either with caregivers or alone. As cognitive impairment becomes more severe, behavioral and psychological symptoms of dementia (BPSD) become more difficult to manage, and those with severe or dangerous BPSD may need to be treated in an inpatient psychiatric facility (IPF). The immediate goal of an IPF stay is to stabilize patients in a psychiatric crisis. IPFs primarily serve people with serious mental illness and substance use disorders, whose care needs may overlap with but also differ from the needs of PLWD.
Little is known about PLWD who use IPFs. The goal of this RAND research was to conduct exploratory analyses focused on PLWD who use IPFs to (1) characterize the population and compare them with IPF users without dementia, (2) examine characteristics and utilization patterns for different services and settings that may be associated with IPF stays, and (3) analyze outcomes following IPF stays.
The authors used Medicare fee-for-service data to conduct descriptive analyses characterizing beneficiaries with dementia who experienced an IPF stay in 2018 and compare them with beneficiaries without dementia. The research team used regression analyses to explore predictors of IPF use and service use and outcomes after IPF discharge.
Key Findings
- In 2018, approximately 205,000 Medicare fee-for-service beneficiaries had at least one IPF stay; more than 40 percent of these IPF users had dementia.
- The typical beneficiary admitted to an IPF had a high level of illness burden. In addition to schizophrenia, bipolar disorder, major depressive disorder, and dementia, multiple physical health comorbidities were common, including rheumatoid arthritis, ischemic heart disease, and chronic kidney disease.
- Consistent with their older age, PLWD were frailer compared with those without dementia among IPF users.
- Among PLWD, key predictors of IPF admission include long-term nursing home residence, frailty, serious mental illness or substance use disorder, emergency department visit in the first quarter prior to IPF admission, prior IPF stays in the past year, and use of antipsychotic medications in the first quarter prior to IPF admission.
- While PLWD with antipsychotic medication use in the first quarter prior to IPF admission were more likely to have IPF admission, those with use in two to four quarters prior were less likely to have an IPF admission, suggesting that new antipsychotic medication use in the one quarter prior may be a precursor to IPF admission.
- Compared with people not living with dementia, PLWD were more likely to use skilled nursing facilities and less likely to use outpatient services in the 30 days following IPF discharge.
- Death and admission to long-term nursing homes sooner after discharge from an IPF were more likely for PLWD compared with those without dementia.
– Mark J. Sorbero, Yaou Flora Sheng, Swad Komanduri, Jodi L. Liu, Published courtesy of RAND.
