{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T04:28:40Z","timestamp":1781065720329,"version":"3.54.1"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T00:00:00Z","timestamp":1683849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["P30AG066587"],"award-info":[{"award-number":["P30AG066587"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["P30AG066587"],"award-info":[{"award-number":["P30AG066587"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham VA Health Care System","award":["CIN 13-410"],"award-info":[{"award-number":["CIN 13-410"]}]},{"name":"Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham VA Health Care System","award":["CIN 13-410"],"award-info":[{"award-number":["CIN 13-410"]}]},{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Veterans Health Administration"},{"name":"Office of Research and Development a VA HSR&D Career Development Award","award":["CDA 17-006"],"award-info":[{"award-number":["CDA 17-006"]}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01 AG057501\/AG\/NIA"],"award-info":[{"award-number":["R01 AG057501\/AG\/NIA"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Veterans Health Administration"},{"name":"Health Services Research and Development Service","award":["IIR 12-379, IIR 19-106"],"award-info":[{"award-number":["IIR 12-379, IIR 19-106"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction\/Objective<\/jats:title>\n<jats:p>Alzheimer\u2019s Disease and Other Related Dementias (AD\/ADRD) leads to frequent emergency department (ED) and inpatient use. Mental health symptoms among persons with AD\/ADRD increases cognitive and functional disabilities and could contribute to these high rates of intensive health care use. The objective of this paper is to assess the relationship of mental illness on 12-month patterns in hospitalization and ED use among Veterans aged 65 and over with a new AD\/ADRD diagnosis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We used an existing dataset of administrative electronic health record data of Veterans with AD\/ADRD from the US Veterans Health Administration linked with Medicare claims data from 2011\u20132015. We use multivariable logistic regression to examine the association between no pre-existing mental illness, pre-existing mental illness (e.g., major depressive disorder, generalized anxiety disorder, or post-traumatic stress disorder), and pre-existing severe mental illness\u2014or SMI\u2014(e.g., bipolar disorder, major depressive disorder with psychosis, or schizophrenia) and 12- month ED and hospitalization use and readmissions among Veterans who had an initial hospitalization visit. We estimated predicted probabilities, differential effect, and associated 95% confidence intervals.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>In our sample, 1.4% had SMI and 11% had non-SMI mental illness. The unadjusted percentage with inpatient and ED use was higher among Veterans with SMI (34% and 26%, respectively) and Veterans with non-SMI mental illness (20%, 16%) compared with Veterans without pre-existing mental illness (12%, 9%). Compared to individuals with no pre-existing mental illness, having a pre-existing mental illness (1.27 percentage points, 95% CI: 0.76, 1.78) and a pre-existing SMI (7.17 percentage points, 95% CI: 5.66, 8.69) were both associated with an increased likelihood of ED use. The same pattern was observed for any inpatient use (mental illness 2.18, 95% CI: 1.59, 2.77; SMI 9.91, 95% CI: 8.21, 11.61). Only pre-existing SMI was associated higher hospitalization readmission.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Discussion<\/jats:title>\n<jats:p>Pre-existing mental illness increases use of high cost, intensive health care and this association is higher of more severe mental health conditions. We also show that pre-existing mental illness exerts a unique influence, above and beyond other comorbidities, such as diabetes, on ED and inpatient visits. More needs to be done to increase recognition of the unique risks of this combination of health conditions and encourage strategies to address them. Developing, testing, and implementing comprehensive strategies that address the intersection of ADRD and mental illness is promising approach that requires more focused attention.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0282071","type":"journal-article","created":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T17:27:05Z","timestamp":1683912425000},"page":"e0282071","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Use of high cost care among Veterans with comorbid mental illness and Alzheimer\u2019s Disease and related dementias"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4020-8936","authenticated-orcid":true,"given":"Megan","family":"Shepherd-Banigan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6726-2369","authenticated-orcid":true,"given":"Katherine E. M.","family":"Miller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. Nicole","family":"Hastings","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loren J.","family":"Schleiden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua M.","family":"Thorpe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,5,12]]},"reference":[{"issue":"3","key":"pone.0282071.ref001","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1002\/alz.12328","article-title":"2021 Alzheimer\u2019s disease facts and figures.","volume":"17","author":"Alzheimer\u2019s Association","year":"2021","journal-title":"Alzheimers Dement"},{"issue":"7","key":"pone.0282071.ref002","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1212\/01.WNL.0000118301.92105.EE","article-title":"Behavioral symptoms in mild cognitive impairment","volume":"62","author":"H Feldman","year":"2004","journal-title":"Neurology"},{"issue":"12","key":"pone.0282071.ref003","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1001\/jama.288.12.1475","article-title":"Prevalence of Neuropsychiatric Symptoms in Dementia and Mild Cognitive Impairment","volume":"288","author":"CG Lyketsos","year":"2002","journal-title":"JAMA"},{"issue":"1","key":"pone.0282071.ref004","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1186\/s12916-019-1369-7","article-title":"Hospitalisation rates and predictors in people with dementia: a systematic review and meta-analysis.","volume":"17","author":"H Shepherd","year":"2019","journal-title":"BMC Med"},{"issue":"1","key":"pone.0282071.ref005","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/WAD.0000000000000118","article-title":"Emergency Department Use Among Older Adults With Dementia.","volume":"30","author":"MA LaMantia","year":"2016","journal-title":"Alzheimer Dis Assoc 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