Injury-related emergency department use among assisted living residents with Alzheimer's disease and related dementias

Abstract

Background: Injuries are a leading cause of emergency department (ED) visits among older adults, and individuals with Alzheimer's disease and related dementias (ADRD) may be at particular risk. We compared injury-related ED use among assisted living (AL) residents with and without ADRD and assessed differences in the risk of injury-related ED visits among individuals with ADRD residing in ALs with memory care designation versus general AL.

Methods: Using Medicare claims, we identified a cohort of fee-for-service beneficiaries who lived in AL in 2018 and resided in one of 20 states with site-specific information on memory care designation (n = 116,754). Outcomes included all injury-related ED visits and injury-related ED visits resulting in hospitalization in the calendar year 2018. We fit multilevel models of the association between ADRD and outcomes, adjusting for resident demographic characteristics and chronic conditions, license type characteristics, and AL characteristics, with random intercepts at the AL and license type levels. Among residents with ADRD, we examined whether memory care licensure was associated with injury-related ED visits.

Results: The adjusted risk of injury-related ED use during the year was 20.1% (95% CI: 19.6%, 20.6%) for residents with ADRD compared to 16.1% for residents without ADRD (95% CI: 15.7%, 16.5%; p < 0.001). The adjusted risk of injury-related ED use ending in hospitalization was 4.9% (95% CI: 4.6%, 5.1%) for AL residents with ADRD and 3.9% for residents without ADRD (95% CI: 3.8%, 4.1%; p < 0.001). There were no significant differences in injury-related ED visits between residents with ADRD in ALs with memory care designation and residents in general AL.

Conclusions: Injury-related ED visits are common among AL residents with ADRD and residents in memory care, but residents in memory care AL experienced similar risks of injury as those in general AL. Further research should identify modifiable factors that can prevent injury among AL residents with ADRD.

Keywords: dementia; emergency department; injury.

Figure 1.

Adjusted risks of at least one injury-related emergency department visit in the year 2018, Alzheimer’s disease and related dementias vs. no Alzheimer’s disease and related dementias Abbreviations: ADRD, Alzheimer’s disease and related dementias. ED, emergency department Data came from the 2017 and 2018 Medicare Master Beneficiary Summary File and Chronic Conditions, Medicare Provider Analysis and Review file, and Medicare outpatient claims. Residents were enrolled in fee-for-service Medicare and resided in assisted living on December 31, 2017 and lived in one of 20 states where memory care license information was available. Risks were derived from predictive margins and were adjusted for resident, assisted living, and license type characteristics (see Supplementary Table S1).

Figure 2.

Adjusted risks of at least one injury-related emergency department visit in the year 2018 among assisted living residents with Alzheimer’s disease and related dementias, memory care vs. no memory care Abbreviations: ED, emergency department Data came from the 2017 and 2018 Medicare Master Beneficiary Summary File and Chronic Conditions, Medicare Provider Analysis and Review file, and Medicare outpatient claims. Residents were enrolled in fee-for-service Medicare and resided in assisted living on December 31, 2017 and lived in one of 20 states where memory care license information was available. Risks were derived from predictive margins and were adjusted for resident, assisted living, and license type characteristics (see Supplementary Table S2).