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2 results

  • Preventable hospitalizations among older patients with cognitive impairments and dementia

  • Dominik Wolf, Carolin Rhein, Katharina Geschke, Andreas Fellgiebel
  • Journal:
    International Psychogeriatrics / Volume 31 / Issue 3 / March 2019
    Published online by Cambridge University Press:
    17 September 2018, pp. 383-391
  • 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.

  • Hospitalization Rates of Nursing Home Residents and Community-Dwelling Seniors in British Columbia*

  • Lisa A. Ronald, Margaret J. McGregor, Kimberlyn M. McGrail, Robert B. Tate, Anne-Marie Broemling
  • Journal:
    Canadian Journal on Aging / La Revue canadienne du vieillissement / Volume 27 / Issue 1 / Spring/Printemps 2008
    Published online by Cambridge University Press:
    31 March 2010, pp. 109-115

  • The overall use of acute care services by nursing home (NH) residents in Canada has not been well documented. Our objectives were to identify the major causes of hospitalization among NH facility residents and to compare rates to those of community-dwelling seniors. A retrospective cohort was defined using population-level health administrative data, including all individuals aged 65 years and older living in a British Columbia NH facility between April 1996 and March 1999. Hospitalization rates of NH residents were compared to estimated rates for community-dwelling seniors, using age- and sex-adjusted standardized incidence ratios (SIRs): SIR = 2.81 (95%CI: 2.71, 2.91) for femoral fractures, 1.96 (1.88, 2.04) for pneumonia, 0.73 (0.70, 0.76) for other heart disease, and 1.01 (0.99, 1.02) for all causes. NH residents have disproportionately higher rates of hospitalization for femoral fractures and pneumonia, with NH residents accounting for approximately one quarter of all femoral fracture hospitalizations of BC seniors.