Abstract
BackgroundHospitalisation is often harmful for people with dementia and results in high societal costs, so avoidance of unnecessary admissions is a global priority. However, no intervention has yet reduced admissions of community-dwelling people with dementia. We therefore aimed to examine hospitalisation rates of people with dementia and whether these differ from people without dementia and to identify socio-demographic and clinical predictors of hospitalisation.MethodsWe searched MEDLINE, Embase, and PsycINFO from inception to 9 May 2019. We included observational studies which (1) examined community-dwelling people with dementia of any age or dementia subtype, (2) diagnosed dementia using validated diagnostic criteria, and (3) examined all-cause general (i.e. non-psychiatric) hospital admissions. Two authors screened abstracts for inclusion and independently extracted data and assessed included studies for risk of bias. Three authors graded evidence strength using Cochrane’s GRADE approach, including assessing for evidence of publication bias using Begg’s test. We used random effects meta-analysis to pool estimates for hospitalisation risk in people with and without dementia.ResultsWe included 34 studies of 277,432 people with dementia: 17 from the USA, 15 from Europe, and 2 from Asia. The pooled relative risk of hospitalisation for people with dementia compared to those without was 1.42 (95% confidence interval 1.21, 1.66) in studies adjusted for age, sex, and physical comorbidity. Hospitalisation rates in people with dementia were between 0.37 and 1.26/person-year in high-quality studies. There was strong evidence that admission is associated with older age, and moderately strong evidence that multimorbidity, polypharmacy, and lower functional ability are associated with admission. There was strong evidence that dementia severity alone is not associated.ConclusionsPeople with dementia are more frequently admitted to hospital than those without dementia, independent of physical comorbidities. Future interventions to reduce unnecessary hospitalisations should target potentially modifiable factors, such as polypharmacy and functional ability, in high-risk populations.
Highlights
Hospitalisation is often harmful for people with dementia and results in high societal costs, so avoidance of unnecessary admissions is a global priority
Four other studies [23, 34, 41, 46] did not adjust for comorbidity and two of these found notably higher relative risk estimates (3.68 and 4.19), but we did not include these in our meta-analysis as we wished to examine the hospitalisation risk accounting for the potential confounding effect of physical illness; we were unable to include one other study which did not provide a specific p value or confidence interval [44]
The pooled relative risk of hospitalisation for people with dementia compared to those without was 1.42 in studies adjusted for age, sex, and physical comorbidity
Summary
Hospitalisation is often harmful for people with dementia and results in high societal costs, so avoidance of unnecessary admissions is a global priority. No intervention has yet reduced admissions of community-dwelling people with dementia. We aimed to examine hospitalisation rates of people with dementia and whether these differ from people without dementia and to identify socio-demographic and clinical predictors of hospitalisation. We aimed to examine the rates of all general hospitalisations of people with dementia, whether these differ from those without dementia, and to identify socio-demographic and clinical predictors of admission. Understanding these would help to plan services for future increasing numbers of people with dementia. Identifying admission predictors may elucidate modifiable risk factors which future interventions could target in populations most likely to benefit
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