Boston – Older people with dementia tend to be hospitalized more often than those without cognitive impairment. Now a team of investigators at the Beth Israel Deaconess Medical Center (BIDMC) has discovered that in recent years, an increasing number of these hospitalizations were aimed at conditions under which hospitalization can often be avoided with improvements in outpatient care. The results, published today in the Journal of the American Geriatric Society, indicate the need for improved strategies to safeguard the health of people suffering from dementia, to avoid the need for hospital treatment.
For the study, the researchers looked at nationally representative hospital discharge data from 2012 to 2016 for 1.8 million hospitalizations of older U.S. adults (65 years of age or older) with dementia.
Analysis revealed that 40 percent of hospitalizations in the elderly with dementia related to potentially preventable conditions, including those such as pneumonia and heart failure which can be avoided with access to high-quality outpatient care. Although the national incidence of all hospitalizations for people with dementia decreased between 2012 and 2016, the incidence of hospitalizations for potentially preventable conditions has increased. In particular, between 2012 and 2016, the incidence of hospitalizations for any cause decreased from 1.87 million to 1.85 million per year, while the incidence of potentially avoidable hospitalizations increased from 0.75 million to 0.87 million per year, driven by an increase in the number of hospitalizations for sepsis, injuries and dehydration of the elderly with dementia living in the community.
“Care for the elderly with dementia is often incorrectly defined as a problem exclusively in nursing homes, but our study shows that over 80 percent of hospitalizations occur in the elderly living in the community,” said Timothy Anderson, MD , lead author of the study and a general internist and health services researcher in the general medicine division at BIDMC and a medical instructor at Harvard Medical School. “Therefore, initiatives to reduce preventable hospitalizations must include outpatient care.”
Anderson noted that tackling sepsis, a serious condition caused by the body’s response to an infection, should have top priority. “Our results suggest that infections are a particularly important factor for potentially preventable hospitalizations, indicating that we need better strategies to detect infections in the elderly with dementia early enough to treat them before they become life-threatening.”
The study also found that among patients with dementia hospitalized for potentially preventable conditions, hospitalized deaths decreased from 6.4 percent in 2012 to 6.1 percent in 2016, median costs adjusted for inflation increased from $ 7.319 to $ 7.543 and total annual costs increased from $ 7.4 billion to $ 9.3 billion. Although 86% of hospitalized patients have been hospitalized by the community, only 33% have been discharged from the community.
“These preventable hospitalizations have important effects that extend beyond hospital stay, both in terms of patient outcomes – since most are discharged to qualified nursing facilities rather than returning home – and in terms of costs for the healthcare system. “said Anderson.
He stressed that extensive studies are needed to implement and evaluate the impact of patient-centered programs to improve outpatient care for the elderly with dementia towards the goal of preventing hospitalizations.
Co-authors of the study included BIDMC investigators Edward R. Marcantonio, MD, SM, Ellen P. McCarthy, PhD, MPH (also from Hebrew SeniorLife) and Shoshana J. Herzig, MD, MPH.