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Preventable hospitalizations among older patients with cognitive impairments and dementia

Published online by Cambridge University Press:  17 September 2018

Dominik Wolf ,
Carolin Rhein ,
Katharina Geschke  and
Andreas Fellgiebel
Dominik Wolf
Affiliation:
Department for Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
Carolin Rhein
Affiliation:
Department for Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
Katharina Geschke
Affiliation:
Department for Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
Andreas Fellgiebel*
Affiliation:
Department for Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
*
Correspondence should be addressed to: Prof. Dr. Andreas Fellgiebel, Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany. Phone: +49-6131-172525. Email: andreas.fellgiebel@unimedizin-mainz.de.
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Abstract

Objectives:

Dementia and cognitive impairment are associated with higher rates of complications and mortality during hospitalization in older patients. Moreover, length of hospital stay and costs are increased. In this prospective cohort study, we investigated the frequency of hospitalizations caused by ambulatory care-sensitive conditions (ACSCs), for which proactive ambulatory care might prevent the need for a hospital stay, in older patients with and without cognitive impairments.

Design:

Prospective cohort study.

Setting:

Eight hospitals in Germany.

Participants:

A total of 1,320 patients aged 70 years and older.

Measurements:

The Mini-Cog test has been used to assess cognition and to categorize patients in the groups no/moderate cognitive impairments (probably no dementia) and severe cognitive impairments (probable dementia). Moreover, lengths of hospital stay and complication rates have been assessed, using a binary questionnaire (if occurred during hospital stay or not; behavioral symptoms were adapted from the Cohen-Mansfield Agitation Inventory). Data have been acquired by the nursing staff who received a special multi-day training.

Results:

Patients with severe cognitive impairments showed higher complication rates (including incontinence, disorientation, irritability/aggression, restlessness/anxiety, necessity of Tranquilizers and psychiatric consults, application of measures limiting freedom, and falls) and longer hospital stays (+1.4 days) than patients with no/moderate cognitive impairments. Both groups showed comparably high ACSC-caused admission rates of around 23%.

Conclusions:

The study indicates that about one-fourth of hospital admissions of cognitively normal and impaired older adults are caused by ACSCs, which are mostly treatable on an ambulatory basis. This implies that an improved ambulatory care might reduce the frequency of hospitalizations, which is of particular importance in cognitively impaired elderly due to increased complication rates.

Keywords

dementiacognitive impairmentshospitalization ratesprevention of hospitalizationambulatory care sensitive conditions
Type
Original Research Article
Information
International Psychogeriatrics , Volume 31 , Issue 3: Issue Theme: Caregiving for People with Dementia , March 2019 , pp. 383 - 391
Copyright
Copyright © International Psychogeriatric Association 2018 

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