Baseline Cognitive Performance Is a Determinant of Prospective Health Resource Utilization Among Adults with Chronic Stroke: A Secondary Analysis

Speaker(s)

Davis J1, Adjetey C2, Eng J3, Falck RS4, Dao E3, Best JR3, Tai D4, Bennett K3, McGuire K3, Hsiung GYR3, Middleton LE5, Hall P5, Liu-Ambrose T3
1University of British Columbia, Kamloops, BC, Canada, 2University of British Columbia, Kelowna, BC, Canada, 3University of British Columbia, Vancouver, BC, Canada, 4Vancouver Coastal Health Research Institute, Vancouver, BC, Canada, 5University of Waterloo, Waterloo, BC, Canada

OBJECTIVES: Cognitive impairment is a costly public health problem globally. Among older adults with chronic stroke, the literature is devoid of prospective data that identify factors responsible for driving health care resource utilization. This study aimed to ascertain key determinants of health resource utilization (HRU) at 6 and 12 months among older adults with chronic stroke.

METHODS: This study was a secondary prospective analysis of an economic evaluation conducted alongside the Vitality study, a 6-month randomized controlled trial with a 6-month followup which included 120 community-dwelling adults with chronic stroke, aged 55 years and older. Participants were randomized into 1) exercise (EX) or 2) cognitive and social enrichment activities (ENRICH), or 3) stretching and toning program (BAT) (i.e., control group). The primary outcome measure of the randomized controlled trial was the Alzheimer’s Disease Assessment Scale-Cognitive-Plus (ADAS-Cog-Plus), a global measure of cognitive performance using multidimensional item response theory. We constructed two linear regression models with HRU at 6 and 12 months as the dependent variables for each model, respectively. Predictors relating to mobility, quality of life, global cognition and executive functions were examined. Age, sex, comorbidities, and group allocation (i.e., EX, ENRICH or BAT) were included regardless of statistical significance. Costs were reported in 2022 Canadian Dollars.

RESULTS: The baseline ADAS-Cog Plus was a significant determinant of total HRU at 6 months (intervention cessation; p=0.001) and 12-months (6-month followup; p=0.004). Better baseline cognitive performance significantly predicted less health resource utilization at 6 and 12 months.

CONCLUSIONS: The ADAS-Cog Plus, a measure of cognitive performance, was a significant determinant of prospective HRU at 6 and 12 months among older adults with chronic stroke. This highlights the importance of interventions aimed at combating cognitive decline to minimize health care resource among individuals with chronic stroke.

Code

EE453

Topic

Clinical Outcomes, Economic Evaluation, Study Approaches

Topic Subcategory

Comparative Effectiveness or Efficacy, Trial-Based Economic Evaluation

Disease

Cardiovascular Disorders (including MI, Stroke, Circulatory), Geriatrics