40% of hospitalizations of older adults with dementia could have been prevented: study

July 31, 2020
by Valerie Dimond, Contributing Reporter
New research published in the Journal of the American Geriatric Society reveals that while older people with dementia are at higher risk of being hospitalized compared to those without cognitive impairment, many hospital stays could have been avoided with better outpatient care. Investigators at Beth Israel Deaconess Medical Center (BIDMC) say fewer people with dementia would be hospitalized if improvements are made.

"Care for older adults with dementia is often mischaracterized as exclusively a nursing home issue, but our study shows that over 80% of hospitalizations occur in older adults who reside in the community," said Dr. Timothy Anderson, the study's lead author and a general internist and health services researcher in the Division of General Medicine at BIDMC, in a news release. "Thus, initiatives to reduce preventable hospitalizations must encompass outpatient care."

The researchers studied nationally representative hospital discharge data from 2012 to 2016 pertaining to 1.8 million hospitalizations of older U.S. adults aged 65 years and older with dementia. They found that even though overall hospitalization had decreased among patients with dementia during that time, the hospitalizations for potentially preventable conditions increased from 0.75 million to 0.87 million per year. The most common cause of hospitalizations among this population was pneumonia and heart failure along with sepsis, injuries, and dehydration.

Anderson, also an instructor in medicine at Harvard Medical School, says earlier detection and treatment strategies for addressing physical health among older adults with dementia should take priority.

"These preventable hospitalizations have important effects that stretch beyond the hospital stay, both in terms of outcomes for the patients — as the majority are discharged to skilled nursing facilities rather than returning home — and in terms of costs to the health system," said Anderson.

For example, 86 percent of hospitalized patients were admitted from the community but only 33 percent were discharged to the community. Also, among patients with dementia who were hospitalized for potentially preventable conditions, inpatient deaths declined from 6.4 percent to 6.1 percent. However, inflation-adjusted median costs increased from $7,319 to $7,543, and total annual costs increased from $7.4 billion to $9.3 billion.

These findings come at the same time other reports, including one by Blue Cross Blue Shield Association that shows early-onset dementia is also on the rise. According to that report, the number of commercially insured Americans diagnosed between 30 and 64 with early-onset dementia or Alzheimer’s disease increased by 200% between 2013 and 2017.

Another study reported by Clinical Psychiatry News reported that older adult patients who already had cognitive decline when they were admitted to a hospital often left with a significantly accelerated rate of decline.

“Some data suggest this could actually be seen as a public health crisis since 40% of all hospitalized patients in the U.S. are older than 65, and the risk of past-hospitalization cognitive impairment rises with age,” said Dr. James of the Rush Alzheimer’s Disease Center, Chicago.

With COVID-19 cases on a steady rise, the threat could be even more serious, says the Sepsis Alliance, which is partnering with Elara Caring, a large home-based care provider, to improve care and outcomes for COVID-19 patients with sepsis in the home care setting. The new public-private collaboration aims to provide home healthcare workers with training and education on sepsis.