Use of physician and acute care services by persons with and without Alzheimer's disease: A population-based comparison

OBJECTIVE: To estimate differences in use of acute care services between pe rsons with and without Alzheimer's disease (AD). STUDY DESIGN: Population-based historical cohort study. SETTING/SUBJECTS: All Rochester, Minnesota, residents with AD onset between January 1, 1980, and December 31, 1984 (n = 301), plus one age- and sex-ma tched nondemented control per case, were identified with a retrospective re view of community-based medical records. MEASUREMENTS: Cases and controls were followed in their medical records for number of acute care encounters in the year before January 1 of the index year (year of onset for AD case and their matched control) and in the 4 yea rs following December 31 of the index year. Encounters included clinician v isits (office or nursing home), emergency room (ER)visits, hospitalizations (inpatient and outpatient), and inpatient days. Multivariate regression an alyses were adjusted for age, sex, pre-index level of illness, and follow-u p time. RESULTS: In the pre-index period, cases and controls were similar with resp ect to level of illness, number of office visits, ER visits, and hospitaliz ations. In the year before AD onset, 17 cases (7%) had a clinician visit in the nursing home compared with no controls. In the 4 years after the index year, mean length of follow-up was 3.4 years for both eases and controls. The numbers of ER visits, hospitalizations, and inpatient days were similar for cases and controls. Sixty-four percent of AD cases had a clinician vis it in a nursing home versus 1% of controls. Controls experienced more offic e visits than cases(median = 16 vs 10, P < .001). CONCLUSIONS: The onset of AD is not associated with greater use of acute ca re services. However, neither is the high use of nursing home care offset b y fewer ER or hospital encounters.