Study Reveals Increasing Rates of Preventable Hospitalizations Among Older Adults with Dementia

Boston — Older adults with dementia tend to be hospitalized more often than those without cognitive impairment. Now a team of investigators at Beth Israel Deaconess Medical Center (BIDMC) has found that in recent years, increasing numbers of these hospitalizations were for conditions for which hospitalization can often be avoided with improvements in outpatient care. The findings, published today in the Journal of the American Geriatric Society, point to the need for improved strategies to safeguard the health of individuals in the community who have dementia, to avoid the need for hospitalized care.

For the study, researchers examined nationally representative hospital discharge data from 2012 to 2016 pertaining to 1.8 million hospitalizations of older U.S. adults (aged 65 years and older) with dementia.

The analysis revealed that 40 percent of hospitalizations of older adults with dementia were for potentially preventable conditions, including those like pneumonia and heart failure that can possibly be avoided with access to high quality outpatient care. Although the national incidence of all hospitalizations for individuals with dementia declined between 2012 and 2016, the incidence of hospitalizations for potentially preventable conditions increased. Specifically, between 2012 and 2016, the incidence of hospitalizations for any cause declined from 1.87 million to 1.85 million per year, while the incidence of potentially preventable hospitalizations increased from 0.75 million to 0.87 million per year, driven by an increased number of hospitalizations for sepsis, injuries, and dehydration of older adults with dementia living in the community.

"Care for older adults with dementia is often mischaracterized as exclusively a nursing home issue, but our study shows that over 80 percent of hospitalizations occur in older adults who reside in the community," said Timothy Anderson, MD, the study's lead author and a general internist and health services researcher in the Division of General Medicine at BIDMC and Instructor in Medicine at Harvard Medical School. "Thus, initiatives to reduce preventable hospitalizations must encompass outpatient care."

Anderson noted that addressing sepsis, a serious condition caused by the body's response to an infection, should take high priority. "Our findings suggest that infections are a particularly important driver of potentially preventable hospitalizations, indicating that we need better strategies to detect infections in older adults with dementia early enough to treat them before they become life-threatening."

The study also found that among patients with dementia who were hospitalized for potentially preventable conditions, inpatient deaths declined from 6.4 percent in 2012 to 6.1 percent in 2016, inflation-adjusted median costs increased from $7,319 to $7,543, and total annual costs increased from $7.4 billion to $9.3 billion. Although 86 percent of hospitalized patients were admitted from the community, only 33 percent were discharged to the community.

"These preventable hospitalizations have important effects that stretch beyond the hospital stay, both in terms of outcomes for the patients — as the majority are discharged to skilled nursing facilities rather than returning home — and in terms of costs to the health system," said Anderson.

He stressed that in-depth studies are needed to implement and evaluate the impact of patient-centered programs to improve outpatient care for older adults with dementia towards the goal of preventing hospitalizations.

Study co-authors included BIDMC investigators Edward R. Marcantonio, MD, SM, Ellen P. McCarthy, PhD, MPH (also of Hebrew SeniorLife), and Shoshana J. Herzig, MD, MPH.

This work was supported by grants from the National Institute on Aging (L30AG060493 and R03AG06437,K23AG042459, K24 AG035075 and under Award Number U54AG063546, which funds NIA Imbedded Pragmatic Alzheimer's Disease and AD-Related Dementias Clinical Trials Collaboratory (NIA IMPACT Collaboratory).