Abstract
BackgroundHalf of nursing home residents (NHR) suffer from dementia. End-of-life hospitalizations are often burdensome in residents with dementia. A systematic review was conducted to study the occurrence of hospitalizations at the end of life in NHR with dementia and to compare these figures to NHR without dementia.MethodsA systematic literature search in MEDLINE, CINAHL and Scopus was conducted in May 2018. Studies were included if they reported proportions of in-hospital deaths or hospitalizations of NHR with dementia in the last month of life. Two authors independently selected studies, extracted data, and assessed quality of studies.ResultsNine hundred forty-five citations were retrieved; 13 studies were included. Overall, 7 studies reported data on in-hospital death with proportions ranging between 0% in Canada and 53.3% in the UK. Studies reporting on the last 30 days of life (n = 8) varied between 8.0% in the Netherlands and 51.3% in Germany. Two studies each assessed the influence of age and sex. There seem to be fewer end-of-life hospitalizations in older age groups. The influence of sex is inconclusive. All but one study found that at the end of life residents with dementia were hospitalized less often than those without (n = 6).ConclusionsWe found large variations in end-of-life hospitalizations of NHR with dementia, probably being explained by differences between countries. The influence of sex and age might differ when compared to residents without dementia. More studies should compare NHR with dementia to those without and assess the influence of sex and age.Trial registrationPROSPERO registration number CRD42018104263.
Highlights
Dementia is one of the most important reasons for transitions to nursing homes in elderly people and the prevalence of dementia in nursing home residents (NHR) is much higher compared to community-dwelling older adults [1,2,3]
If the original publication stratified its results by different groups, such as race or location of the nursing home, we reported the total proportion of hospitalizations for all NHR with dementia
Comparison with other studies and interpretation In this systematic review, we found large variations in endof-life hospitalizations of NHR with dementia, probably being explained by differences between countries
Summary
Dementia is one of the most important reasons for transitions to nursing homes in elderly people and the prevalence of dementia in nursing home residents (NHR) is much higher compared to community-dwelling older adults [1,2,3]. There are variations in the literature, most studies found that about 50% or even more of NHR suffer from dementia [4,5,6,7,8,9]. Residents with dementia differ in many important aspects from those without They are typically older [7, 10], need more support to manage activities of daily living and behavioral problems [10, 11] and spend, on average, a longer time in the Hospitalizations at the end of life do lead to a substantial economic burden, but they are often not beneficial for NHR [17]. There seems to be a large variation in the literature on hospitalizations of NHR with dementia at the end of life, even in bordering countries. A systematic review was conducted to study the occurrence of hospitalizations at the end of life in NHR with dementia and to compare these figures to NHR without dementia
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