Abstract
This study examines the relationship between dementia and institutionalisation directly after hospital discharges in older people and explores potential mediators of the association. Our analyses are based on linked Scottish administrative health and social care data, including 79,983 hospital stays for 43,753 patients aged 65 or over. Our results show that dementia patients are more likely to be discharged to care institutions compared with non-dementia patients (odds ratio = 17). Further analyses reveal that this can be partially explained by the fact that dementia patients are more likely to have injury-related admissions and long hospital stays. This indirect effect accounts for around 6% of the total effect. We also investigate the effect of receiving home care, finding no evidence that it influences the likelihood of institutionalisation from hospitals in older people.
Highlights
The last three decades have witnessed a rapid increase in the older populations of most developed countries, which is likely to continue or escalate over the a few decades
Individual patients are indicated by letter i, and the number of admissions is indicated by j. di is our main variable of interest, dementia diagnosis, which is time-invariant. xij represents a vector of time-varying control variables, for example, admission source, and Charlson Comorbidity Index (CCI)
Discharged to a care institution Admitted due to injury Long hospital stay (> 7 days) Live alone prior to admission Admitted from a private residence Number of stays (n) Receive home care Female Age at first admission indicator of relative need (IoRN) score
Summary
The last three decades have witnessed a rapid increase in the older populations of most developed countries, which is likely to continue or escalate over the a few decades. In Scotland, for example, it is projected the number of older people aged 65 or over will increase by 53% from 2014 to 2039 and those aged 80 or over will be doubled over the same period of time (National Records of Scotland 2015). There are two main causes of the population ageing: the increase in life expectancy and the decrease of fertility rate (Lutz et al 2008).
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