Assessing the relationship between health utilities, quality of life, and health services use in Alzheimer's disease

Int J Geriatr Psychiatry. 2009 Jan;24(1):96-105. doi: 10.1002/gps.2160.

Abstract

Objectives: To examine the relationship between use of multiple health services and health utilities, quality of life and other factors in Alzheimer's disease (AD).

Design: Data were obtained via caregiver proxy at baseline and 3- 6- and 9-months post-random assignment among 421 community-dwelling AD patients participating in the CATIE-AD trial of anti-psychotic medications. Service use includes both institutional and outpatient services. Correlates include the AD-Related Quality of Life Scale (ADRQoL), Health Utilities Index (HUI)-III, Neuropsychiatric Inventory, Mini Mental Status Examination, and AD-Cooperative Study Activities of Daily Living Scale. Chi squared tests, t-tests and logistic regression (using general estimating equations) were used to examine the correlates of service use.

Results: Three quarters (74.2%) used at least one service each month. Average monthly utilization rates for specific service types were: 4.5%, inpatient hospital; 5.6%, nursing home; 3.9%, residential care; 44.0%, AD-related outpatient; 9.4%, mental health outpatient; and 45.5%, medical-surgical outpatient. The likelihood of using any service was higher among older patients [Odds Ratio (OR) = 1.03] and non-Hispanic Whites (OR = 1.61). Each 0.10 increment on the Health Utilities Index (HUI)-III was associated with a 7.0% decrease in the odds of using one or more service (OR = 0.93). The odds of using outpatient and institutional services were 6.0% and 10.0% lower, respectively, for each 0.10 increment on the HUI-III (OR = 0.94, OR = 0.90). The AD-Related Quality of Life Scale proved significantly related to outpatient medical-surgical services only (OR = 1.01).

Conclusion: Findings suggest that the HUI-III could be combined with other known correlates of service use to inform population planning associated with AD.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Alzheimer Disease / drug therapy*
  • Alzheimer Disease / psychology
  • Antipsychotic Agents / therapeutic use
  • Chi-Square Distribution
  • Female
  • Health Services Needs and Demand / statistics & numerical data*
  • Health Services for the Aged
  • Hospitalization
  • Humans
  • Likelihood Functions
  • Male
  • Nursing Homes
  • Patient Acceptance of Health Care*
  • Psychiatric Status Rating Scales
  • Quality of Life*

Substances

  • Antipsychotic Agents