April 12, 2022
Ellen McCarthy, PhD, MPH executive director of the IMPACT Administration Core, co-authored this retrospective cohort study of Medicare beneficiaries hospitalized in 2016 to determine whether patients with dementia have an increased risk of adverse outcomes following hospital discharge. The article was published in the Journal of General Internal Medicine.
Background
Patients with dementia are frequently hospitalized and may face barriers in post-discharge care.
Objective
To determine whether patients with dementia have an increased risk of adverse outcomes following discharge.
Design
Retrospective cohort study.
Subjects
Medicare beneficiaries hospitalized in 2016.
Main Measures
Co-primary outcomes were mortality and readmission within 30 days of discharge. Multivariable logistic regression models were estimated to assess the risk of each outcome for patients with and without dementia accounting for demographics, comorbidities, frailty, hospitalization factors, and disposition.
Key Results
The cohort included 1,089,109 hospitalizations of which 211,698 (19.3%) were of patients with diagnosed dementia (median (IQR) age 83 (76–89); 61.5% female) and 886,411 were of patients without dementia (median (IQR) age 76 (79–83); 55.0% female). At 30 days following discharge, 5.7% of patients with dementia had died compared to 3.1% of patients without dementia (adjusted odds ratio (aOR) 1.21; 95% CI 1.17 to 1.24). At 30 days following discharge, 17.7% of patients with dementia had been readmitted compared to 13.1% of patients without dementia (aOR 1.02; CI 1.002 to 1.04). Dementia was associated with an increased odds of readmission among patients discharged to the community (aOR 1.07, CI 1.05 to 1.09) but a decreased odds of readmission among patients discharge to nursing facilities (aOR 0.93, CI 0.90 to 0.95). Patients with dementia who were discharged to the community were more likely to be readmitted than those discharged to nursing facilities (18.9% vs 16.0%), and, when readmitted, were more likely to die during the readmission (20.7% vs 4.4%).
Conclusions
Diagnosed dementia was associated with a substantially increased risk of mortality and a modestly increased risk of readmission within 30 days of discharge. Patients with dementia discharged to the community had particularly elevated risk of adverse outcomes indicating possible gaps in post-discharge services and caregiver support.