Alzheimer's disease or other dementia and medical care utilization

Abstract

Purpose: Recent findings on medical care utilization among people with Alzheimer's disease (AD) or other dementia (OD) are conflicting. A population-based case-control study was designed to determine if patients with clinically diagnosed AD or OD have different medical care utilization patterns before and after diagnosis compared to age-matched controls.

Methods: All community dwelling incident cases of AD (n = 240) or OD (n = 208) diagnosed between July 1, 1992 and June 30, 1997, and age-matched controls (n = 363) living in an enumerated population, were included. Medical care services, defined by Physicians' Current Procedural Terminology Codes, were assessed the year prior to diagnosis and up to five years after diagnosis of AD/OD.

Results: Prior to diagnosis, AD/OD cases had a significantly greater age-adjusted average number of medical services per year, 33 and 29, respectively, compared to 20 for controls (p = 0.0001 and p = 0.0002, respectively). These differences were significant after adjusting for age, gender, follow-back time, comorbidities, and insurance status. After diagnosis, AD/OD cases still had significantly greater age-adjusted average number of medical services per year (34 services and 37 services, respectively) compared to controls with 27 services (p = 0.0064 and p = 0.0006, respectively). After adjusting for confounding variables (particularly comorbid conditions), these differences were no longer significant.

Conclusions: This research demonstrates that higher medical care utilization by patients with AD/OD after diagnosis is not due to dementia per se, but explained by their poorer physical health compared to controls. Greater utilization prior to diagnosis of AD/OD is most likely due to the search for a diagnosis for the person developing dementia.