Association of Incident Dementia With Hospitalizations

JAMA, 01/11/2012

Phelan EA et al. – Among the cohort aged 65 years or older, incident dementia was significantly associated with increased risk of hospitalization, including hospitalization for ambulatory care–sensitive conditions (ACSCs).

Methods

  • Retrospective analysis of hospitalizations among 3019 participants in Adult Changes in Thought (ACT), a longitudinal cohort study of adults aged 65 years or older enrolled in an integrated health care system.
  • All participants had no dementia at baseline and those who had a dementia diagnosis during biennial screening contributed nondementia hospitalizations until diagnosis.
  • Automated data were used to identify all hospitalizations of all participants from time of enrollment in ACT until death, disenrollment from the health plan, or end of follow-up, whichever came first.
  • Hospital admission rates for patients with and without dementia, for all causes, by type of admission, and for ACSCs.

Results

  • Four hundred ninety-four individuals eventually developed dementia and 427 (86%) of these persons were admitted at least once; 2525 remained free of dementia and 1478 (59%) of those were admitted at least once.
  • The unadjusted all-cause admission rate in the dementia group was 419 admissions per 1000 person-years vs 200 admissions per 1000 person-years in the dementia-free group.
  • After adjustment for age, sex, and other potential confounders, the ratio of admission rates for all-cause admissions was 1.41 (95% confidence interval [CI], 1.23-1.61; P < .001), while for ACSCs, the adjusted ratio of admission rates was 1.78 (95% CI, 1.38-2.31; P < .001).
  • Adjusted admission rates classified by body system were significantly higher in the dementia group for most categories.
  • Adjusted admission rates for all types of ACSCs, including bacterial pneumonia, congestive heart failure, dehydration, duodenal ulcer, and urinary tract infection, were significantly higher among those with dementia.

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