Authors: Kaczynski, Anika | Michalowsky, Bernhard | Eichler, Tilly | Thyrian, Jochen René | Wucherer, Diana | Zwingmann, Ina | Hoffmann, Wolfgang
Article Type: Research Article
Abstract: Background: People with dementia (PwD) suffer from coexisting medical conditions, creating complex clinical challenges and increasing the risk of poor outcomes, which could be associated with high healthcare cost. Objective: To describe the prevalence of comorbidity in PwD and to analyze the association between comorbidity in dementia diseases and healthcare costs from a payer’s perspective. Methods: This cross-sectional analysis was based on n = 362 PwD of the DelpHi-MV trial (Dementia: Life-and person-centered help in Mecklenburg-Western Pomerania). Comorbidity was assessed using the Charlson comorbidity index (CCI) and was categorized into low, high, and very high comorbidity. Healthcare resource utilization and unit …costs were used to calculate costs. Multivariable regression models were applied to analyze the association between comorbidity and costs. Results: Comorbidity was highly prevalent in the sample. 47% of PwD had a very high, 37% a high, and 16% a low comorbidity in addition to dementia. The most prevalent co-existing comorbidity were diabetes mellitus (42%), peripheral vascular disease (28%) and cerebrovascular disease (25%). Total costs significantly increased by 528€ (SE = 214, CI95 = 109–947, p = 0.014) with each further comorbidity, especially due to higher cost for medication and medical aids. Compared with a low comorbidity, a very high comorbidity was significantly associated with 818€ (SE = 168, CI95 = 489–1147, p < 0.001) higher medication costs and 336€ (SE = 161, CI95 = 20–652, p = 0.037) higher cost for medical aids. There were no significant association between a higher comorbidity and cost for formal care services. Conclusions: Comorbidity in PwD represents a substantial financial burden on healthcare payers and is a challenge for patients, healthcare providers, and the health systems. Innovative approaches are needed to achieve a patient-oriented management of treatment and care in comorbid PwD to reduce long-term costs. Show more
Keywords: Alzheimer’s disease, comorbidity, dementia, economics, health care costs, health care resources
DOI: 10.3233/JAD-180896
Citation: Journal of Alzheimer's Disease, vol. 68, no. 2, pp. 635-646, 2019
Authors: Lehmann, Jana | Michalowsky, Bernhard | Kaczynski, Anika | Thyrian, Jochen René | Schenk, Nele Sophie | Esser, Alexander | Zwingmann, Ina | Hoffmann, Wolfgang
Article Type: Research Article
Abstract: Background: People with dementia (PwD) are at a high risk of hospitalization. Hospitals are often not adequately equipped for PwD and discharges often come unexpected. Therefore, PwD are at a risk of adverse outcomes. However, information about those outcomes is rare but crucial for the development of preventive strategies. Objectives: To conduct a quantitative systematic review and meta-analyses on the impact of a hospitalization on readmission, institutionalization, and mortality in PwD. To identify factors associated with these outcomes. Methods: PubMed, CENTRAL, and ScienceDirect were searched for studies including terms for dementia, hospital, readmission, institutionalization, and mortality. Relevant were assessed by …a quality criteria sheet. Results were summarized in a table. Meta-analysis was conducted with Review Manager 5.3. Results: The search yielded 1,108 studies; 20 fulfilled the inclusion criteria and 10 studies were eligible for meta-analyses. The incidence and relative risk (RR) of mortality (RR 1.74 CI95 % 1.50, 2.05) and institutionalization (RR: 2.16 CI95 % 1.31, 3.56) of PwD was significantly higher when compared to people without dementia. Results according to readmission rate were inconsistent. Factors significantly associated with the examined adverse outcomes were severity of dementia, number of medications, and deficits in daily living activities. Conclusion: Hospitalization of PwD lead to adverse outcomes. An improvement in the identification of and care for PwD in the acute setting as well as in after care in the community setting, especially in the interface between both settings, is required to prevent adverse outcomes in hospitalized PwD. Show more
Keywords: Dementia, institutionalization, mortality, prevention strategies, readmission
DOI: 10.3233/JAD-171128
Citation: Journal of Alzheimer's Disease, vol. 64, no. 3, pp. 735-749, 2018
Authors: Zwingmann, Ina | Michalowsky, Bernhard | Esser, Alexander | Kaczynski, Anika | Monsees, Jessica | Keller, Armin | Hertel, Johannes | Wucherer, Diana | Thyrian, Jochen René | Eichler, Tilly | Kilimann, Ingo | Teipel, Stefan | Dreier Wolfgramm, Adina | Hoffmann, Wolfgang
Article Type: Research Article
Abstract: Background: Caregivers providing informal care for people with dementia (PwD) often report unmet needs, burden, and health impairments. Optimal support for family dementia caregivers will likely benefit from better understanding and assessment of the prevalence and types of caregivers’ unmet needs and associated socio-demographic and clinical characteristics. Objective: The present study investigates 1) the number and types of caregivers’ unmet needs, 2) socio-demographic and clinical characteristics of both PwD and caregivers, and 3) caregivers’ burden and health-related outcomes that are related to caregivers’ unmet needs. Methods: The present analyses are based on cross-sectional data of n = 226 dyads of caregivers …and their community-dwelling PwD participating in a comprehensive standardized, computer-based caregivers’ needs assessment within a general practitioner (GP)-based, cluster-randomized intervention trial. Results: A total of n = 505 unmet needs were identified for n = 171 caregivers from the intervention group at baseline. Only 24.3% caregivers reported no unmet need (n = 55), whereas 75.7% caregivers had at least one unmet need (n = 171). Caregivers had on average 2.19 unmet needs (mean = 2.19, SD = 2.15). Specifically, 53.1% of caregivers had one up to three unmet needs (n = 120), 18.6% (n = 42) had three up to six unmet needs, and 4.0% (n = 9) had more than six unmet needs. Discussion: Our results underline the importance of a comprehensive needs assessment for family dementia caregivers to develop and implement concepts that can provide family dementia caregivers with optimal support. Show more
Keywords: Caregiver burden, caregiver interventions, caregiver supporting groups, caregiver unmet needs, randomized controlled trial
DOI: 10.3233/JAD-180244
Citation: Journal of Alzheimer's Disease, vol. 67, no. 2, pp. 527-539, 2019