Association of Living Alone and Hospitalization Among Community-Dwelling Elders With and Without Dementia
Ennis, Stephanie Kays
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<bold>Background:</bold> Older persons account for the majority of hospitalizations in the United States.<super>1</super> Identifying risk factors for hospitalization among elders, especially potentially preventable hospitalization, may suggest opportunities to improve primary care. Certain factors—for example, living alone—may increase the risk for hospitalization, and their effect may be greater for some subgroups, such as persons with dementia and the old-old (aged 85+). <bold>Objectives:</bold> To determine the association of living alone and risk for hospitalization, and if the observed effect is greater among persons with dementia or the old-old. <bold>Design:</bold> Retrospective longitudinal cohort study. <bold>Participants:</bold> 2,636 participants in the Adult Changes in Thought (ACT) study, a longitudinal cohort study of dementia incidence. Participants were adults aged 65+ enrolled in an integrated health care system who completed biennial follow-up visits to assess for dementia and living situation. Hospitalizations were identified using automated data. <bold>Main Measures:</bold> Hospitalization for all causes and for ambulatory care sensitive conditions (ACSCs). <bold>Key Results:</bold> At baseline, the mean age of participants was 75.5 years, 59% were female and 36% lived alone. Follow-up time averaged 8.4 years (standard deviation 3.5), yielding 10,431 approximately two-year periods for analysis. Living alone was positively associated with being aged 85+, female, and having better physical function, and negatively associated with having dementia. In a regression model adjusted for age, gender, comorbidity burden, and length of follow-up period, living alone was not associated with all-cause (odds ratio [OR] = 0.93; 95% confidence interval [CI] 0.84, 1.03) or ACSC hospitalization (OR = 0.87; 95% CI 0.72, 1.04). Among participants aged 85+, living alone was associated with a lower risk for all-cause (OR = 0.75; 95% CI 0.60, 0.92), but not ACSC hospitalization. Dementia did not modify any observed associations. <bold>Conclusion:</bold> Living alone in later life did not increase hospitalization risk, and in this population may be a marker of healthy aging in the old-old.
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