Baseline Cognitive Performance Is a Determinant of Prospective Health Resource Utilization Among Adults with Chronic Stroke: A Secondary Analysis
Jennifer C Davis, Cassandra Adjetey, Janice J Eng, Ryan S Falck, Elizabeth Dao, John R. Best, Daria Tai, Kimberly J Bennett, Katherine McGuire, Ging‐Yuek Robin Hsiung, Laura E Middleton, Peter A Hall, Teresa Liu‐Ambrose- Psychiatry and Mental health
- Cellular and Molecular Neuroscience
- Geriatrics and Gerontology
- Neurology (clinical)
- Developmental Neuroscience
- Health Policy
- Epidemiology
Abstract
Background
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.
Method
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 follow‐up 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/ comparator). 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.
Result
The 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).
Conclusion
The ADAS‐Cog Plus, a measure of cognitive performance, was a significant determinant of 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.