Abstract
People with dementia who are admitted to hospital have worse outcomes than those without dementia. Identifying interventions that could reduce the risk of hospitalisation in people with dementia has the potential to positively impact on lives of people with dementia. This review aimed to investigate whether there are non-pharmacological interventions that successfully reduce hospitalisation risk, length of stay and mortality in people with dementia. 7 electronic databases and trial registries were searched from inception to October 2018. We included randomised controlled trials that evaluated non-pharmacological interventions in out of hospital settings and targeted people with any type of dementia. All stages of the review process were performed by two reviewers. Risk of bias was assessed using the Cochrane Risk of Bias tool. We grouped studies based on intervention: care management, counselling/self-help, enhanced GP services or memory clinics, and physiotherapy or occupational therapy. Data were pooled within intervention categories using random effects meta-analysis. There was no evidence that any of the intervention categories were associated with reduced hospital admission or mortality. There was very weak evidence to suggest that care management interventions (mean difference, MD, -0.16, 95% CI -0.32, 0.01), physiotherapy/occupational therapy (MD -0.16, 95% CI -0.36, 0.03) and enhanced GP/memory clinics (MD -0.14, 95% CI -0.31, 0.03) were associated with small reductions in hospital stay. There was no evidence for an effect of counselling/self-help interventions on length of hospital stay. Current evidence from randomised trials suggests no clear benefit or harm associated with any of interventions on risks of hospitalisation, duration of hospitalisation or death. Further research with the primary aim to reduce hospitalisation in people with dementia is required.
Highlights
Global dementia cases are estimated at 46.8 million people worldwide, forecast to increase to 130 million by 2050
There was no evidence that any of the intervention categories were associated with reduced hospital admission or mortality
There was very weak evidence to suggest that care management interventions, physiotherapy/ occupational therapy (MD -0.16, 95% confidence intervals (CI) -0.36, 0.03) and enhanced General practitioner (GP)/memory clinics (MD -0.14, 95% CI -0.31, 0.03) were associated with small reductions in hospital stay
Summary
Global dementia cases are estimated at 46.8 million people worldwide, forecast to increase to 130 million by 2050. Whilst rarely being a direct cause of hospital admission, dementia is a significant co-morbidity, increasing the likelihood of attending hospital This in itself increases morbidity, accelerated cognitive decline, and mortality[3,4,5]. Hospitalisation may precede institutionalisation (movement from a personal home to a care/nursing home) [4, 5, 7], which is further associated with worsening cognitive and physical performance and increased mortality [8]. This culminates in both higher in-hospital and higher post-discharge costs for people with dementia compared to others with the same condition. This review aimed to investigate whether there are non-pharmacological interventions that successfully reduce hospitalisation risk, length of stay and mortality in people with dementia
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