Dementia May Lead to Avoidable Hospitalizations
TUESDAY, Jan. 10 -- People with dementia are far more likely to be hospitalized than their peers who don't have any impairment in their brain function, a new study finds.
What's more, about two-thirds of the hospitalizations that occur in people with dementia are for potentially preventable illnesses, such as a urinary tract infection, the study shows.
"Hospital admissions for all causes and potentially preventable admissions were significantly higher for those with dementia," said the study's lead author, Dr. Elizabeth Phelan, an associate professor in gerontology and geriatric medicine at the University of Washington School of Medicine, and an affiliate investigator at the Group Health Research Institute in Seattle.
Hospitalizations are particularly difficult on people with dementia, Phelan noted. "There have been lots of studies looking at the risks for people with dementia in the hospital. They're at risk for delirium, falls, pressure ulcers; they may need to be restrained, and many never return to their prior level of functioning after a hospitalization. If hospitalizations could be avoided, it would be helpful for preserving cognition and avoiding new problems," she explained.
Results of the study are published in the Jan. 11 issue of the Journal of the American Medical Association.
The study included a retrospective analysis of 3,019 people recruited for a study called Adult Changes in Thought. All of the study volunteers were over 65 years old and were members of the Group Health Cooperative, a large health care delivery system. At the beginning of the study, none of the volunteers had signs of dementia.
By the end of the study, 494 people had developed dementia. Of those, 427 (86 percent) had been hospitalized at least once, while just 59 percent of those who didn't have dementia had been hospitalized at least once.
The researchers found that having dementia increased the odds of being hospitalized by 41 percent. They also found the risk of being hospitalized for potentially preventable illnesses was 78 percent higher for people with dementia.
The most common potentially preventable hospitalizations in people with dementia occurred for bacterial pneumonia, congestive heart failure, dehydration, duodenal ulcer and urinary tract infections, according to the report.
Just three of these conditions accounted for two-thirds of the admissions for potentially preventable illnesses: urinary tract infection, pneumonia and congestive heart failure.
"People caring for someone with dementia have an important role to play. They can be the eyes and ears for the care recipient. They can clue into what seems to be typical, and when there's any deviation from that, they can alert the primary care provider, who can then treat proactively," Phelan said.
She said it would also be helpful for people to develop a long-term care plan for people with dementia, so that caregivers would have a better idea of what to expect. In addition, there should be planned follow-up visits for people with dementia, though Phelan added, it isn't clear yet what these visits should include.
"The current paradigm for taking care of patients with dementia is really built in such a way that we are spending inordinate amounts of money for poor quality of life. This study shows an ounce of prevention really is worth a pound of cure," said Dr. Gayatri Devi, an attending neurologist in the department of medicine at Lenox Hill Hospital in New York City.
"The major causes of hospitalizations -- primarily urinary tract infections, pneumonia and congestive heart failure -- are all related to trouble with self-care. People with congestive heart failure have to take a number of medications, and when you combine that with memory loss, it's harder to have them take those pills," she pointed out.
Devi recommended simplifying medication regimens whenever possible. For example, giving patients a pillbox, and have a caregiver fill it with the appropriate medicine for each day of the week. She also suggested getting a portable bidet to help prevent urinary tract infections.
In addition, Devi would like to see greater reimbursement and availability of in-home help to care for people with dementia. She explained that she has a patient who is paying out-of-pocket for a home health aide to care for an elderly mother. It costs about $30,000 a year, but the cost of just one week of being hospitalized is far more than that, she noted. "Patients aren't currently supported for staying at home, but taking care of people with dementia at home is a humane thing to do," Devi said.
Posted: January 2012
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