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. 2023 Dec 5;23(1):807.
doi: 10.1186/s12877-023-04506-9.

Diagnosis of behavioral symptoms as a predictor of institutionalization among Medicaid patients with dementia

Rezaul Karim Khandker  1 , Farid Chekani  2 , Kirti Mirchandani  3 , Niranjan Kathe  3
Affiliations

Diagnosis of behavioral symptoms as a predictor of institutionalization among Medicaid patients with dementia

Rezaul Karim Khandker et al. BMC Geriatr. .

Abstract

Objectives: Behavioral symptoms are commonly observed in the course of dementia. This study aimed to assess the association of the diagnosis of a cluster of behavioral symptoms (e.g., agitation, aggression, psychotic symptoms, and delirium/wandering) with the likelihood of subsequent institutionalization.

Methods: A retrospective cohort study of adults aged 65 and above diagnosed with dementia identified in the IBM® MarketScan® Multistate Medicaid database between October 01, 2015, and September 30, 2019, was conducted. The index date was defined as the first diagnosis date of dementia. The presence or absence of behavioral symptoms was identified in the 6 months prior to the index date (baseline). Institutionalization was evaluated 12 months (follow-up) post the index date. The association between diagnosed behavioral symptoms during the baseline period and institutionalization in the follow-up period was assessed using a multivariable logistic regression, adjusting for baseline sociodemographic and clinical characteristics.

Results: The study cohort included 40,714 patients with dementia. A diagnosis of behavioral symptoms was found among 2,067 (5.1%) patients during the baseline period. An increased likelihood of institutionalization was found during the follow-up among patients with agitation and aggression in baseline (OR = 1.51 (95% CI: 1.18-1.92)) compared to patients without these symptoms at baseline. Patients with psychotic symptoms in baseline had significantly higher odds of getting institutionalized during the follow-up compared to patients without psychotic symptoms in baseline (OR = 1.36 (95% CI: 1.20-1.54)). Similarly, patients with symptoms of delirium and wandering in baseline had a higher likelihood of institutionalization than patients without these symptoms at baseline (OR = 1.61 (95% CI: 1.30-1.99)).

Conclusion: Several diagnosed behavioral symptoms were associated with a higher risk of institutionalization among older adults with dementia and should be considered when planning treatment strategies for the effective management of the condition.

Keywords: Behavioral symptoms; Cohort study; Dementia; Institutionalization.

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Conflict of interest statement

FC and RKK employees of Merck Sharp & Dohme Corp., a Merck & Co., Inc. subsidiary, Rahway, NJ, USA, who may own and/or hold stock options in Merck & Co., Inc., Rahway, NJ, USA. KM is an employee of Complete HEOR Solutions, Chalfont, PA, USA, which received financial compensation to conduct the study analysis. NK was an employee of Complete HEOR Solutions when the study was conducted. The authors report no other relevant conflicts of interest to report.

Figures

Fig. 1
Fig. 1
Study design
Fig. 2
Fig. 2
Cohort selection flowchart
See this image and copyright information in PMC

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