Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-20T11:57:12.339Z Has data issue: false hasContentIssue false
  • English
  • Français

Primary diagnoses and outcomes of emergency department visits in older people with dementia: a hospital-based retrospective study in Taiwan

Published online by Cambridge University Press:  29 April 2019

Pei-Chao Lin ,
Li-Chan Lin ,
Hsiu-Fen Hsieh ,
Yao-Mei Chen ,
Pi-Ling Chou  and
Chien-Hsun Li
Pei-Chao Lin
Affiliation:
School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Li-Chan Lin
Affiliation:
Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan
Hsiu-Fen Hsieh
Affiliation:
School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Yao-Mei Chen
Affiliation:
School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan International Medical Service Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Pi-Ling Chou
Affiliation:
School of Nursing, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Chien-Hsun Li*
Affiliation:
Department of Neurology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
*
Correspondence should be addressed to: Chien-Hsun Li, Attending physician, MD, Department of Neurology, Kaohsiung Municipal Siaogang Hospital, No. 482, Shanming Road, Siaogang Dist., Kaohsiung 812, Taiwan. Phone: +886 7 803-6783 ext. 3453. Email: [email protected].
Get access

Abstract

Objectives:

The objectives of this study were to investigate the primary diagnoses and outcomes of emergency department visits in older people with dementia and to compare these parameters with those in older adults without dementia.

Design and Setting:

This hospital-based retrospective study retrieved patient records from a hospital research database, which included the outpatient and inpatient claims of two hospitals.

Participants:

The patient records were retrieved from the two hospitals in an urban setting. The inclusion criteria were all patients aged 65 and older who had attended the two hospitals as an outpatient or inpatient between January 1, 2009, and December 31, 2016. Patients with dementia were identified to have at least three reports of diagnostic codes, either during outpatient visits, during emergency department visits, or in hospitalized database records. The other patients were categorized as patients without dementia.

Measurements:

The primary diagnosis during the emergency department visit, cost of emergency department treatment, cost of hospital admission, length of hospital stay, and diagnosis of death were collected.

Results:

A total of 149,203 outpatients and inpatients aged 65 and older who were admitted to the two hospitals were retrieved. The rate of emergency department visits in patients with dementia (23.2%) was lower than that in those without dementia (48.6%). The most frequent primary reason for emergency department visits and the main cause of patient death was pneumonia. Patients with dementia in the emergency department had higher hospital admission rates and longer hospital stays; however, the cost of treatment did not show a significant difference between the two groups.

Conclusions:

Future large and prospective studies should explore the severity of disease in older people with dementia and compare results with older adults without dementia in the emergency department.

Keywords

dementiaemergency departmenthospitalpneumonia
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Issue 1: Issue Theme: Cultural Diversity in Psychogeriatrics , January 2020 , pp. 97 - 104
Copyright
© International Psychogeriatric Association 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ahn, H. and Horgas, A. (2013). The relationship between pain and disruptive behaviors in nursing home residents with dementia. BMC Geriatrics, 13, 14. doi: 10.1186/1471-2318-13-14CrossRefGoogle ScholarPubMed
Annear, M. J., Tierney, L. T., Vickers, J. C. and Palmer, A. J. (2016). Counting the cost of dementia-related hospital admissions: a regional investigation. Australasian Journal on Ageing, 35, E32–E35. doi: 10.1111/ajag.12318.CrossRefGoogle ScholarPubMed
Bail, K. et al. (2015). The cost of hospital-acquired complications for older people with and without dementia: a retrospective cohort study. BMC Health Services Research, 15, 91. doi: 10.1186/s12913-015-0743-1.CrossRefGoogle ScholarPubMed
Briggs, R. et al. (2017). Dementia in the acute hospital: the prevalence and clinical outcomes of acutely unwell patients with dementia. QJM, 110, 33–37. doi: 10.1093/qjmed/hcw114.CrossRefGoogle ScholarPubMed
Daras, L. C., Feng, Z., Wiener, J. M. and Kaganova, Y. (2017). Medicare expenditures associated with hospital and emergency department use among beneficiaries with dementia. Inquiry, 54, 46958017696757. doi: 10.1177/004695901769757.Google ScholarPubMed
Foley, N. C., Affoo, R. H. and Martin, R. E. (2015). A systematic review and meta-analysis examining pneumonia-associated mortality in dementia. Dementia and Geriatric Cognitive Disorders, 39, 52–67. doi: 10.1159/000367783.CrossRefGoogle ScholarPubMed
Franchi, C. et al. (2017). Emergency department visits in older people: pattern of use, contributing factors, geographical differences and outcomes. Aging Clinical and Experimental Research, 29, 319–326. doi: 10.1007/s40520-016-0550-5.CrossRefGoogle ScholarPubMed
Guijarro, R. et al. (2010). Impact of dementia on hospitalization. Neuroepidemiology, 35, 101–108. doi: 10.1159/000311032.CrossRefGoogle ScholarPubMed
Hoffmann, F., van den Bussche, H., Wiese, B., Glaeske, G. and Kaduszkiewicz, H. (2014). Diagnoses indicating pain and analgesic drug prescription in patients with dementia: a comparison to age- and sex-matched controls. BMC Geriatrics, 14, 20. doi: 10/1186/1471-2318-14-20.CrossRefGoogle ScholarPubMed
Hunt, L. J. et al. (2015). Pain in community-dwelling older adults with dementia: results from the national health and aging trends study. Journal of American Geriatrics Society, 63, 1503–1511. doi: 10.1111/jgs.13536.CrossRefGoogle ScholarPubMed
Lai, S. W. et al. (2012). Association between polypharmacy and dementia in older people: a population-based case-control study in Taiwan. Geriatrics & Gerontology International, 12, 491–498. doi: 10.1111/j.1447-0594.2011.00800.x.CrossRefGoogle ScholarPubMed
LaMantia, M. A., Stump, T. E., Messina, F. C., Miller, D. K. and Callahan, C. M. (2016). Emergency department use among older adults with dementia. Alzheimer Disease and Association Disorders, 30, 35–40. doi: 10.1097/WAD.0000000000000118.CrossRefGoogle ScholarPubMed
Liu, C. K. et al. (1998). Incidence and subtypes of dementia in southern Taiwan: impact of socio-demographic factors. Neurology, 50, 1572–1579.10.1212/WNL.50.6.1572CrossRefGoogle ScholarPubMed
Mukadam, N. and Sampson, E. L. (2011). A systematic review of the prevalence, associations and outcomes of dementia in older general hospital inpatients. International Psychogeriatrics, 23, 344–355. doi: 10.1017/S1041610210001717.CrossRefGoogle ScholarPubMed
Prince, M. et al. (2013). The global prevalence of dementia: A systematic review and meta-analysis. Alzheimer’s & Dementia, 9, 63–75. doi: 10.1016/j.jalz.2012.11.007.CrossRefGoogle Scholar
Rao, A., Suliman, A., Vuik, S., Aylin, P. and Darzi, A. (2016). Outcomes of dementia: systematic review and meta-analysis of hospital administrative database studies. Archives Gerontology and Geriatrics, 66, 198–204. doi: 10.1016/j.archger.2016.06.008.CrossRefGoogle ScholarPubMed
Sadak, T., Zdonm, S. F., Ishado, E., Zaslavsky, O. and Borson, S. (2017). Potentially preventable hospitalizations in dementia: family caregiver experiences. International Psychogeriatrics, 29, 1201–1211. doi: 10.1017/S10416102117000217.CrossRefGoogle ScholarPubMed
Shen, H. N., Lu, C. L. and Li, C. Y. (2012). Dementia increases the risks of acute organ dysfunction, severe sepsis and mortality in hospitalized older patients: a national population-based study. PLoS One, 7, e42751. doi: 10.137/journal.pone.0042751.CrossRefGoogle ScholarPubMed
Silwanowicz, R. M. et al. (2017). Management of older adults with dementia who present to emergency services with neuropsychiatric symptoms. International Journal of Geriatric Psychiatry, 32, 1233–1240. doi: 10.1002/gps.4599.CrossRefGoogle ScholarPubMed
Sleeman, K. E., Perera, G., Stewart, R, and Higginson, I. J. (2018). Predictors of emergency department attendance by people with dementia in their last year of life: retrospective cohort study using linked clinical and administrative data. Alzheimer’s & Dementia, 14, 20–27. doi: 10.1016/j.jalz.2017.06.2267.CrossRefGoogle ScholarPubMed
Squires, D. and Anderson, C. (2015). U.S. health care from a global perspective: spending, use of services, prices, and health in 13 countries. Issue Brief, 15, 1–15.Google ScholarPubMed
Toot, S., Devine, M., Akporobaro, A. and Orrell, M. (2013). Causes of hospital admission for people with dementia: a systematic review and meta-analysis. Journal of the American Medical Directors Association, 14, 463–470. doi: 10.1016/j.jamda.2013.01.001.CrossRefGoogle ScholarPubMed
Tropea, J., LoGiudice, D. and Kelly, L. (2017). People with dementia in the emergency department: behavioral symptoms and use of restraint. Emergency Medicine Australasia, 29, 605–606. doi: 10.1111/1742-6723.12838.CrossRefGoogle ScholarPubMed
Wang, H. K. et al. (2014). Increased risk of hip fractures in patients with dementia: a nationwide population-based study. BMC Neurology, 14, 175. doi: 10.1186/s12883-014-0175-2.CrossRefGoogle ScholarPubMed
Zilkens, R. R., Spilsbury, K., Bruce, D. G. and Semmens, J. B. (2009). Clinical epidemiology and in-patient hospital use in the last year of life (1990–2005) of 29,884 Western Australians with dementia. Journal of Alzheimer’s Disease, 17, 399–407. doi: 10.3233/JAD-2009-1057.CrossRefGoogle ScholarPubMed