Hospitalizations and long-term care for older adults with Alzheimer's disease and related dementia: Differences across geographic regions of the United States

BackgroundAlzheimer's disease and related dementia (ADRD) leads to adverse health outcomes, such as higher risk of hospitalizations and long-term institutionalization. However, little is known about differences in ADRD health outcomes for older adults in the Deep South compared to those in the rest of the United States (non-Deep South).ObjectiveThis study aims to examine the prevalence of hospitalization and long-term use of skilled nursing facilities (SNF) among older adults with ADRD, and factors influencing these healthcare utilization outcomes in the Deep South versus non-Deep South regions.MethodsWe conducted secondary analyses of claims data for 115,879 Medicare beneficiaries with ADRD in 2013-2015. Modified Poisson regression was used to examine the association of outcomes with individual and context-level factors for Deep South and non-Deep South separately.ResultsHospitalization rates were slightly higher in the Deep South. Utilization of long-term SNF was similar across regions. In adjusted analyses, within each region, differences between non-Hispanic Black and White beneficiaries were not significant. Comorbidities, specialist visits, ADRD drug use, and Medicare/Medicaid dual eligibility were associated with more hospitalizations and SNF use for all beneficiaries in the Deep South. For beneficiaries in the non-Deep South region, context-level factors (limited availability of medical resources and poor population health) were significantly associated with healthcare utilization.ConclusionsWe identified differences across regions in the factors associated with hospitalizations and long-term SNF stays, with patient-level factors being relevant in the Deep South region and context-level factors in the non-Deep South region.