Do Caregiving Factors Affect Hospitalization Risk Among Disabled Older Adults?
Open accessAbstract
BACKGROUND/OBJECTIVES: Hospitalization is common among older adults with disability, many of whom receive help from a caregiver and have dementia. Our objective was to evaluate the association between caregiver factors and risk of hospitalization and whether associations differ by dementia status. DESIGN: Longitudinal observational study. SETTING: The 1999 and 2004 National Long‐Term Care Survey and the 2011 and 2015 National Health and Aging Trends Study, linked caregiver surveys, and Medicare claims. PARTICIPANTS: A total of 2,589 community‐living Medicare fee‐for‐service beneficiaries, aged 65 years or older (mean age = 79 years; 63% women; 31% with dementia), with self‐care or mobility disability and their primary family or unpaid caregiver. MEASUREMENTS: Self‐reported characteristics of older adults and their caregivers were assessed from older adult and caregiver survey interviews. Older adult hospitalization over the subsequent 12 months was identified in Medicare claims. Multivariable Cox proportional hazards models adjusted for older adult characteristics and were stratified by dementia status. RESULTS: In this nationally representative cohort, 38% of older adults with disabilities were hospitalized over 12 months following interview. Increased hospitalization risk was associated with having a primary caregiver who helped with healthcare tasks (adjusted hazard ratio (aHR) = 1.22; 95% confidence interval (CI) = 1.05–1.40), reported physical strain (aHR = 1.21; 95% CI = 1.04–1.42), and provided more than 40 hours of care weekly (aHR = 1.26; 95% CI = 1.04–1.54 vs ≤20 hours). Having a caregiver who had helped for 4 years or longer (vs <1 year) was associated with 38% lower risk of hospitalization (aHR = 0.62; 95% CI = 0.49–0.79). Older adults with and without dementia had similar rates of hospitalization (39.5% vs 37.3%; P = .4), and caregiving factors were similarly associated with hospitalization regardless of older adults' dementia status. CONCLUSION: Select caregiving characteristics are associated with hospitalization risk among older adults with disability. Hospitalization risk reduction strategies may benefit from understanding and addressing caregiving circumstances.
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Individuals with dementia are more likely to be hospitalized if their caregiver has less than one year of caregiving experience compared with caregivers who have provided assistance for more than one year.
“Individuals with dementia are more likely to be hospitalized if their caregiver has less than one year of caregiving experience when compared with caregivers who have provided assistance for more than one year.538”
From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [538]
The Results (Dementia stratified cohort; page not supplied) report lower hospitalization risk among older adults with dementia whose caregivers had provided help for ≥4 years compared with <1 year. The claim broadens that comparison to all caregivers with more than one year of experience, which the reported result does not establish. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIndividuals with dementia are more likely to be hospitalized if their caregiver has less than one year of caregiving experience when compared with caregivers who have provided assistance for more than one year.
“Individuals with dementia are more likely to be hospitalized if their caregiver has less than one year of caregiving experience when compared with caregivers who have provided assistance for more than one year. 586”
From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [586]
The Results (Dementia stratified cohort; page not supplied) report lower hospitalization risk among older adults with dementia whose caregivers had provided help for ≥4 years, compared with <1 year. The claim broadens that comparator to all caregivers with more than one year of experience, which the reported comparison does not establish. (LLM, conf=0.86)
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- Authors
- Amjad, H., Mulcahy, J., Kasper, J. D., Burgdorf, J., Roth, D. L., Covinsky, K., & Wolff, J. L.
- Affiliations
- Johns Hopkins University (US)
- University of California, San Francisco (US)
- Corresponding author
- Amjad, Halima
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2020-09-22
- Volume
- 69
- Issue
- 1
- Pages
- 129-139
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC7856284
- OpenAlex
- W3088010460
- Cited by
- 38
- References
- 45
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 8 · 2023: 5 · 2022: 10 · 2021: 3
- FWCI
- 6.93
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R01 AG047859)
- Topics
- Health Sciences › Health Professions › Pharmacy › Nursing care and research
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- caregiver burden, hospitalization risk, older adults with disabilities, dementia, unpaid family caregivers, physical strain, caregiver hours, caregiver experiences, self-care disability, mobility impairment, Medicare beneficiaries, community-dwelling older adults
- MeSH terms
- Aged, Dementia, Female, Persons with Disabilities, Medicare, Hospitalization, Humans, Insurance Claim Review, Interviews as Topic, Longitudinal Studies, Male, Self Care, United States, Caregivers, Fee-for-Service Plans, Independent Living
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