Frequent hospitalizations and readmissions are recognized as markers of poor quality care for older adults. Risk prediction models to date have neglected factors such as cognitive impairment. Specifically, mild cognitive impairment (MCI) has not been explored as a potential contributor to increased utilization.Objective: To determine whether older adults classified with MCI experience increased rates of index hospitalization and 30-day readmission compared to those with normal cognition.Design

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... nd Setting: Post-hoc analysis of prospectively gathered data on incident hospitalization and readmission from the Ginkgo Evaluation of Memory Study (GEMS), a randomized double-blind placebo-controlled clinical trial designed to assess the impact of Ginkgo biloba on incidence of dementia.Participants: 2742 community-dwelling adults age 75 or older with normal cognition (n=2314) or MCI (n=428) at baseline cognitive testing. Measurements: Index hospitalization and 30-day hospital readmission, adjusted for age, sex, race, education, clinic site, trial assignment status, comorbidities, number of prescription medications, and whether participants lived with an identified proxy. Results: MCI was associated with a 17% increase in the hazard of index hospitalization as compared with participants with normal cognition (adjusted HR 1.17, 1.02 -1.34). In participants who lived with their proxy, MCI was associated with a 39% increased hazard of index hospitalization (adjusted HR 1.392, 1.169 -1.657). Baseline MCI was not associated with increased odds of 30-day hospital readmission(adjusted OR 0.90, 0.60 -1.36). Conclusion: MCI may represent a target condition for healthcare providers to coordinate care and ambulatory support services in an effort to reduce acute utilization and subsequent disability. A patient-identified caregiver relates to probability of acute utilization in MCI.