Association of Dementia-related Psychosis with Long-term Care Use and Death.

Objective: We aimed to determine the association of dementia-related psychosis (DRP) with death and use of long-term care (LTC). We hypothesized that DRP would be associated with increased risk of death and use of LTC in patients with dementia. Methods: A retrospective cohort study was performed. Medicare claims from 2008-2016 were used to define cohorts of patients with dementia and DRP. Outcomes were LTC, defined as nursing home stays of > 100 consecutive days, and death. DRP patients were directly matched to dementia patients without psychosis by age, sex, race, number of comorbid conditions, and dementia index year. Association of DRP with outcomes was evaluated using a Cox proportional hazard regression model. Results: We identified 256,408 patients with dementia. Within 2 years after the dementia index date, 13.9% of patients developed DRP and 31.9% had died. Corresponding estimates at 5 years were 25.5% and 64.0%. Mean age differed little between those who developed DRP (83.8 ± 7.9 years) and those who did not (83.1 ±8.7 years). DRP patients were slightly more likely to be female (71.0% vs 68.3%) and white (85.7 vs 82.0%). Within 2 years of developing DRP, 16.1% entered LTC and 52.0% died; corresponding percentages for non-DRP patients were 8.4% and 30.0%, respectively. In the matched cohort, DRP was associated with greater risk of LTC (HR 2.36, 2.29-2.44) and death (HR 2.06, 2.02-2.10). Conclusions: DRP was associated with a more than doubling in the risk of death and a nearly 2.5-fold increase risk of the need for LTC.