Dementia is associated with increased rates and often poorer outcomes of hospitalization, including worsening cognitive status. New evidence is needed to determine whether excess admissions in dementia might be potentially preventable.
To determine whether dementia onset is associated with higher rates or different reasons for hospitalization, particularly for ambulatory care sensitive conditions (ACSCs) for which proactive outpatient care might prevent the need for a hospital stay.
Design, Setting, and Participants
We conducted a retrospective analysis of hospitalizations among 3019 participants in Adult Changes in Thought (ACT), a longitudinal cohort study of initially non-demented adults aged 65 and older enrolled in an integrated healthcare system. Automated data were used to identify all hospitalizations from time of enrollment in ACT until death, disenrollment from the health plan, or end of follow-up, whichever came first. The study period spanned from February 1, 1994 to December 31, 2007.
Main Outcome Measures
Hospital admission rates for dementia and dementia-free groups, for all causes, by type of admission, and for ACSCs.
Four hundred ninety-four cognitively normal individuals eventually developed dementia and 427 (86%) of these persons were admitted at least once; 2525 remained dementia free and 1478 (59%) were admitted at least once. The unadjusted all-cause admission rate in the dementia group was 419 admits per 1000 person-years vs. 200 admits/1000 in the dementia-free group. After adjustment for age, gender, and other potential confounders, the ratio of admission rates for all-cause admissions was 1.41 (95% confidence interval [CI], 1.23 to 1.61; P<.0001), while for ACSCs, the adjusted ratio of admission rates was 1.78 (95% CI, 1.38 to 2.31; P<.0001). Adjusted admission rates classified by body system were significantly higher in the demented group for most categories. Adjusted admission rates for all types of ACSCs, including bacterial pneumonia, congestive heart failure, dehydration, duodenal ulcer, and urinary tract infection, were significantly higher among those with dementia.
Among patients aged 65 years and older, incident dementia was significantly associated with increased risk of hospitalization, including hospitalization for ACSCs.