Predictive factors of hospitalizations in Alzheimer's disease: a two-year prospective study in 686 patients of the REAL.FR study.

BACKGROUND: During the course of the Alzheimer's disease (AD), many patients need to be hospitalized either due to the direct consequences of the disease itself, or due to associated diseases or life event. The objective of the present study was to determine predictive factors for hospitalisation in AD patients.
METHODS: Six hundred eighty-six AD patients from the French Network on AD (REAL-FR) were follow up and assessed every 6 months for 2 years. During follow-up, all events occurring between two visits, in particular hospital admissions were carefully recorded.
RESULTS: Annual incidences for hospitalizations were 26.13% (95% CI, 22.52 to 29.74). After two years, 202 subjects were hospitalized for 296 hospitalizations. Three variables were found to be significant predictors of hospitalisations in the multivariate regression model: dependency for ADL (RR=0.81; 95% CI: 0.70-0.95, p=0.0091), the drug use (use of four or more drugs) (RR=1.83; 95% CI: 1.31-2.58, p=0.0005) and the NPI score (RR=1.011; 95% CI: 1.001-1.022, p=0.0427). For hospitalizations due to the direct consequences of the disease itself, three variables were found to be significant predictors of hospitalisations: dependency for ADL (RR=0.69; 95% CI: 0.53-0.88, p=0.0033), the caregiver burden Zarit score (RR=1.03; 95% CI: 1.01-1.05, p=0.0079) and the NPI score (RR=1.07; 95% CI: 1.03-1.12, p=0.0007).
CONCLUSIONS: Intervention to support patients and caregivers to manage loss of ADL may be a practical approach to reduce hospitalisation. Prevention of drug use or optimal treatment of associated diseases in AD seem to be also a challenge to decrease the rates of hospitalization or readmission, and the costs of providing care.