Distress associated with dementia-related psychosis and agitation in relation to healthcare utilization and costs
Open accessAbstract
Objectives Explore the relationship between behavioral and psychological symptoms of dementia (BPSD; specifically, delusions, hallucinations, and agitation/aggression) and associated caregiver distress with emergency department (ED) utilization, inpatient hospitalization, and expenditures for direct medical care.Design/setting/participants Retrospective cross-sectional cohort of participants with dementia (N = 332) and informants from the Aging, Demographics, and Memory Study, a nationally representative survey of U.S. adults >70 years old.Measurements BPSD of interest and associated informant distress (trichotomized as none/low/high) were assessed using the Neuropsychiatric Inventory (NPI). Outcomes were determined from one year of Medicare claims and examined according to presence of BPSD and associated informant distress, adjusting for participant demographics, dementia severity, and comorbidity.Results Fifty-eight (15%) participants with dementia had clinically significant delusions, hallucinations, or agitation/aggression. ED visits, inpatient admissions, and costs were not significantly higher among the group with significant BPSD. In fully adjusted models, a high level of informant distress was associated with all outcomes: ED visit incident rate ratio (IRR) 3.03 (95% CI: 1.98-4.63; p < 0.001), hospitalization IRR 2.78 (95% CI: 1.73-4.46; p < 0.001), and relative cost ratio 2.00 (95% CI: 1.12-3.59; p = 0.02).Conclusions A high level of informant distress related to participant BPSD, rather than the symptoms themselves, was associated with increased healthcare utilization and costs. Effectively identifying, educating, and supporting distressed caregivers may help reduce excess healthcare utilization for the growing number of older adults with dementia.
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Like people without dementia, those with dementia engage more in preferred activities, but require additional support to do so.
“Like people without dementia, those with dementia engage more in preferred activities, but require additional support to do so.227”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [227]
The Methods describe informants familiar with participants’ daily activities, and the Conclusions discuss supporting caregivers in managing behavioral symptoms. Neither section addresses whether people with dementia engage more in preferred activities or need additional support to do so compared with people without dementia. Searches for preferred activities and activity participation found no passage addressing that claim. (LLM, conf=0.76)
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- Authors
- Maust, D. T., Kales, H. C., McCammon, R. J., Blow, F. C., Leggett, A., & Langa, K. M.
- Affiliations
- University of Michigan (US)
- Corresponding author
- Maust, Donovan T.
- ORCID
- Venue
- The American Journal of Geriatric Psychiatry
- Publisher
- Elsevier BV
- Published
- 2017-10
- Volume
- 25
- Issue
- 10
- Pages
- 1074-1082
- ISSN
- 1064-7481 (ISSN-L)
- PMC
- PMC5600647
- OpenAlex
- W2619034706
- Cited by
- 74
- References
- 45
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 2 · 2023: 3 · 2022: 12 · 2021: 10 · 2020: 11 · 2019: 10 · 2018: 7 · 2017: 3
- FWCI
- 6.95
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Beeson Career Development Award Program (K08AG048321)
- National Institute on Aging (P30 AG024824, U01 AG009740)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Keywords
- dementia, behavioral and psychological symptoms of dementia, caregiver distress, delusions, hallucinations, dementia-related psychosis, agitation, health care utilization, health care costs, emergency department visits, hospitalization, Medicare claims data, older adults, caregiver support
- MeSH terms
- Aged, Aged, 80 and over, Aggression, Cross-Sectional Studies, Delusions, Dementia, Emergency Service, Hospital, Female, Hallucinations, Medicare, Hospitalization, Humans, Male, Psychomotor Agitation, Retrospective Studies, Stress, Psychological, United States, Caregivers, Health Care Costs
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