Abstract
BackgroundElderly bedridden patients with dementia (EBRPD) are a growing segment of the population. We aimed to describe acute care hospitalization of EBRPD in internal medicine wards: the prevalence of EBRPD, their impact on hospital resources and hospital ecology, one-year survival, and one-year readmission-free survival.MethodsThe study setting was the internal medicine division of one tertiary care hospital in Israel. We conducted a point-prevalence survey to measure the prevalence of EBRPD and the prevalence of multidrug-resistant organism (MDRO) carriage. We also conducted a retrospective chart review of EBRPD who were hospitalized in the internal medicine division in order to assess resource use, survival, and readmission.ResultsIn the point prevalence surveys (N = 1667 patients), EBRPD comprised 24.3% of patients and 59.0% of mechanically ventilated patients. EBRPD were twice as likely to be colonized or infected by MDROs as other patients (39.3% vs. 18%, p < 0.001); thus, 41% of MDRO carriers during the survey days were EBRPD. In the retrospective study (N = 517 EBRPD), 80% of EBRPD received antibiotics; on average, they received an antibiotic on 87.7% of their hospital days. One-year survival was 35.6% and one-year readmission-free survival was 16.4%.ConclusionsAcute care hospitalization of EBRPD accounted for a high proportion of bed occupancy and ventilator use in internal medicine wards. EBRPD significantly increase the potential for MDRO transmission. Policymakers should seek alternatives to acute care hospitalization for EBRPD.
Highlights
The prevalence of dementia increases with age
We reviewed reports from the microbiology laboratory to identify colonization or infection with the following multidrug-resistant organism (MDRO): methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococci (VRE), carbapenem-resistant Enterobacteriaceae (CRE), extendedspectrum beta-lactamase- (ESBL) producing Enterobacteriaceae, Clostridium difficile, and multidrug-resistant (MDR) A. baumannii
Point prevalence study On the 5 days surveyed, 1667 patients were hospitalized in the internal medicine division; 405 (24.3%) of them were classified as Elderly bedridden patients with dementia (EBRPD)
Summary
The prevalence of dementia increases with age. In OECD countries, dementia affects 2% of people aged 65–69, 7% of those aged 75–79, 20% of those aged 85–89, and 41% of people aged 90 and older [1]. The hospitalization of elderly bedridden patients with dementia (EBRPD) in acute care hospitals carries a price, namely, a drain on scarce resources such as hospital beds. An additional societal toll is the ecological impact, i.e., the potential for collateral damage to other patients in the form of transmission of multidrug-resistant organisms (MDROs) and the use of antibiotics, which affect the hospital microbial ecology. These risks are not well described and have important ramifications for policy and clinical decision-making. We aimed to describe acute care hospitalization of EBRPD in internal medicine wards: the prevalence of EBRPD, their impact on hospital resources and hospital ecology, one-year survival, and one-year readmission-free survival
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