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Mild Cognitive Impairment (MCI) and conversion to dementia due to Alzheimer's disease (AD) is a growing and costly epidemic. Of the 5.3 million Americans currently diagnosed with AD, about a quarter of cases are in the mild or early stage (Alzheimer's Association, 2015). By the year 2050, prevalence is expected to triple and the associated costs are projected to rise to >$1 trillion a year (Alzheimer's Association, 2015). One cost-containment strategy is for afflicted individuals to remain in their family home with formal homecare services (e.g. home health aides, adult day care) retained as needed. Over time, however, up to three quarters of those with dementia will transition into institutional settings (Hermann et al., 2006). Among community-dwelling cases, annual dementia-related costs generally double as people transition from mild to severe stages of illness: $1,300-$5,300 (mild), $6,000-$7,200 (moderate), and $2,300-$18,100 (severe). In institutionalized patients, total annual care costs show similar variability across stages of dementia severity: $6,600-$15,500 (mild), $14,200-$34,900 (moderate), and $18,300-$56,100 (severe) (Quentin et al., 2010).
Identifying patient-level predictors of risk for needing homecare assistance and institutionalization may help defray costs by guiding when to institute treatment strategies that could delay onset to higher levels of care. For example, increasing the dose of cholinesterase inhibitors has been shown to delay starting home health services by an average of two months and reduced overall home health service use by 37 hours per year; this corresponds to an annual cost saving of $2,600 per person (Wattmo et al., 2013). Additionally, a randomized controlled trial of an intervention to reduce caregiver burden lessened AD patients' nursing home (NH) admissions by 28% overall and delayed time to NH admission by ~1.5 years (Mittelman et al., 2006).
Although dementia tends to be the strongest predictor of institutionalization (Luppa et al., 2010), MCI determined via consensus diagnosis also predicts institutionalization several years following diagnosis (Gnjidic et al., 2012). Other notable predictors include prior use of formal community-based services (Gaugler et al., 2003), female sex (Luppa et al., 2009), and males living without a spouse (Luppa et al., 2012).
Strain et al. (2003) examined relative risks for institutionalization in community-dwelling cognitively.
