The Effect of Functional Status on Nursing Home Admission among Patients with Advanced Parkinson’s Disease (P1.024)

Abstract

Objective: Estimate the relationship between functional status (FS) and nursing home admission (NHA) in Parkinson’s disease (PD) patients, and simulate the effect of advanced PD (APD) treatments on NHA risk. Background: Functional limitations are a risk factor for NHA, and their prevalence increases with advancing PD. To date, no study has investigated the effect of FS on NHA risk in the APD population. Methods: PD patients (n=1,826) were identified from the Medicare Current Beneficiary Survey data (1992-2010). PD patients were classified as APD using a working definition based on literature and input from a clinical expert. FS was measured using limitations in activities of daily living (ADLs) and instrumental ADLs (IADLs), which include physical and cognitive activities. Logit models were used to estimate the risk of (I)ADL limitations and the effect of FS on NHA. The effect of an APD treatment, Duopa (carbidopa-levodopa enteral suspension), on NHA risk was estimated using a simulation model incorporating its efficacy as demonstrated in a RCT (control: oral levodopa-carbidopa IR). Results: Relative to the non-PD population, APD patients had 42[percnt] and 32[percnt] increased risk of any ADL and IADL limitations, respectively. Among ADLs, walking and toileting had the largest effects on NHA. APD patients had increased NHA risk: 2.6 and 7.1 times higher than non-advanced PD (absolute risk (AR)=3.1[percnt]) and non-PD population (AR=1.2[percnt]), respectively. When simulating only its effect on walking, we found Duopa may reduce NHA risk by 13[percnt] (relative to control) for APD patients. This NHA risk reduction is quantitatively similar to that of doubling Medicaid home care expenditures. Conclusions: APD patients have a higher risk of NHA, with FS limitations contributing to this risk. Treatments which improve FS may reduce the NHA risk in PD. Future research should consider the comprehensive effect of APD treatments on (I)ADLs in reducing NHA risk.

Disclosure: Dr. Shih has received personal compensation for activities with PHE. Dr. Sullivan has received personal compensation for activities with PHE as an employee. Dr. Sail has received personal compensation from AbbVie as an employee of the organization. Dr. Jalundhwala has received personal compensation for activities with AbbVie as an employee. Dr. Van Eijnhoven has received personal compensation for activities with PHE as an employee. Dr. Marshall has received personal compensation for activities with AbbVie, Inc. as an employee. Dr. Zadikoff has received personal compensation for activities with AbbVie, Merz, UCB, GlaxoSmithKline, and Teva as a consultant, scientific advisory board member, or speaker. Dr. Lakdawalla has received personal compensation for activities with Precision Health Economics. Dr. Lakdawalla has received research support from AbbVie.