Hospital Consolidation and Access to Inpatient Care for Older Adults with Alzheimer’s Disease and Related Dementias

Older adults with Alzheimer’s disease and related dementias (ADRD) experience high rates of hospitalization, readmission, and transitions to institutional care. Because cognitive impairment increases reliance on caregivers and coordinated services, changes in hospital availability and geographic access may have particularly serious consequences for this population. At the same time, hospital mergers and health system consolidation have substantially reshaped inpatient capacity, referral networks, and service availability, especially in rural and socioeconomically disadvantaged communities. However, little is known about how these structural changes affect access to hospital care and post-acute transitions for older adults with ADRD. Using hospital discharge and health system data, this study will examine whether hospital consolidation affects inpatient utilization and travel distance, 30-day readmissions and avoidable emergency department visits, and discharge to home versus skilled nursing facilities among older adults with ADRD.