End-of-Life Healthcare Utilization in Lewy Body Dementia

Article type: Research Article

Authors: Alipour-Haris, Golnoosh^a | Armstrong, Melissa J.^{b; c; *} | Goodin, Amie J.^a | Guo, Jingchuan Serena^a | Brown, Joshua D.^a

Affiliations: [a] Center of Drug Evaluation & Safety and Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, FL, USA | [b] Departments of Neurology and Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA | [c] Fixel Institute for Neurological Diseases, Gainesville, FL, USA

Correspondence: [*] Correspondence to: Melissa J. Armstrong, MD, MSc, Department of Neurology, University of Florida College of Medicine, P.O. Box 100268, Gainesville, FL 32611, USA. Tel.: +1 352 273 5550; Fax: +1 352 273 5575; E-mail: melissa.armstrong@neurology.ufl.edu.

Abstract: Background:Lewy body dementia (LBD) is the second most common neurodegenerative dementia in the US, presenting unique end-of-life challenges. Objective:This study examined healthcare utilization and care continuity in the last year of life in LBD. Methods:Medicare claims for enrollees with LBD, continuously enrolled in the year preceding death, were examined from 2011–2018. We assessed hospital stays, emergency department (ED) visits, intensive care unit (ICU) admissions, life-extending procedures, medications, and care continuity. Results:We identified 45,762 LBD decedents, predominantly female (51.8%), White (85.9%), with average age of 84.1 years (SD 7.5). There was a median of 2 ED visits (IQR 1–5) and 1 inpatient stay (IQR 0–2). Higher age was inversely associated with ICU stays (Odds Ratio [OR] 0.96; 95% Confidence Interval [CI] 0.96–0.97) and life-extending procedures (OR 0.96; 95% CI 0.95–0.96). Black and Hispanic patients experienced higher rates of ED visits, inpatient hospitalizations, ICU admissions, life-extending procedures, and in-hospital deaths relative to White patients. On average, 15 (7.5) medications were prescribed in the last year. Enhanced care continuity correlated with reduced hospital (OR 0.72; 95% CI 0.70–0.74) and ED visits (OR 0.71; 95% CI 0.69–0.87) and fewer life-extending procedures (OR 0.71; 95% CI 0.64–0.79). Conclusions:This study underscored the complex healthcare needs of people with LBD during their final year, which was influenced by age and race. Care continuity may reduce hospital and ED visits and life-extending procedures.

Keywords: Alzheimer’s disease, care continuity, dementia, demographics, end-of-life care, healthcare outcomes, ICU admissions, inpatient visits, Lewy body disease, life-extending procedures, medication utilization

DOI: 10.3233/JAD-240194

Journal: Journal of Alzheimer's Disease, vol. 101, no. 1, pp. 133-145, 2024