Patterns of Unplanned Hospital Admissions Among People With Dementia

From Diagnosis to the End of Life

Emel Yorganci; Robert Stewart; Elizabeth L Sampson; Katherine E Sleeman

Disclosures

Age Ageing. 2022;51(5):afac098 

In This Article

Abstract and Introduction

Abstract

Background: hospitalisations are sentinel events for people with dementia. How patterns of unplanned hospital admissions change among people with dementia after diagnosis is relatively unknown.

Objective: to describe patterns of unplanned hospital admissions of people with dementia from diagnosis until death/study end.

Methods: retrospective cohort study using mental healthcare provider data of people diagnosed with dementia in London, UK (1995–2017), linked to mortality and hospital data. The primary outcome was the rate of unplanned hospital admissions after diagnosis until death/study end. We calculated the cumulative incidence of unplanned hospital admissions. The rates of unplanned hospital admissions and the percentage of time spent as an inpatient were stratified by time from first dementia diagnosis.

Results: for 19,221 people with dementia (61.4% female, mean age at diagnosis 81.0 years (standard deviation, SD 8.5)), the cumulative incidence of unplanned hospital admissions (n = 14,759) was 76.8% (95% CI 76.3%–77.3%). Individuals remained in the study for mean 3.0 (SD 2.6) years, and 12,667 (65.9%) died. Rates and lengths of unplanned hospital admissions remained relatively low and short in the months after the dementia diagnosis, increasing only as people approached the end of life. Percentage of time spent as an inpatient was <3% for people who were alive at the study end but was on average 19.6 and 13.3% for the decedents in the last 6 and 12 months of life, respectively.

Conclusions: the steep rise in hospitalisations before death highlights the need for improved community care and services for people with dementia who are approaching the end of life.

Introduction

The number of people living with dementia is increasing.[1–3] As dementia and comorbidities progress, provision of care can become challenging.[4,5] Unplanned hospital admissions (those that occur unexpectedly and urgently)[6] for people with dementia can be associated with functional and cognitive decline, though the causal relationship remains unclear.[7] Understanding when unplanned hospital admissions are most likely to occur can guide investment in the resources needed for providing high-quality dementia care.

Most studies examining unplanned hospital admissions of people with dementia have focused on specific subgroups of people with dementia (e.g. people diagnosed with Alzheimer's disease or people who live in the community)[8,9] or timeframes (e.g. year after diagnosis or last year of life;).[10–12] Prospective studies have been small[4,13] or have obtained hospitalisation information from carers, and are therefore subject to recall bias. Although some people live many years following a dementia diagnosis, for others the time between diagnosis and death is shorter. Patterns of unplanned hospital admissions, and how these change before death, are relatively unknown. In this study, we aimed to describe the patterns of unplanned hospital admissions of people with dementia from the point of diagnosis.

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