Abstract
BackgroundDementia is an irreversible chronic disease with wide-ranging effects on patients’, caregivers’ and families’ lives. Hospitalizations are significant events for people with dementia. They tend to have poorer outcomes compared to those without dementia. Most of the previous studies focused on diagnoses leading to hospitalizations using claims data. Further factors (e.g. context factors) for hospitalizations are not reproduced in this data. Therefore, we investigated the factors leading to hospitalization with an explorative, qualitative study design.MethodsWe interviewed informal caregivers (N = 12), general practitioners (GPs, N = 12) and formal caregivers (N = 5) of 12 persons with dementia using a semi-structured interview guideline. The persons with dementia were sampled using criteria regarding their living situation (home care vs. nursing home care) and gender. The transcripts were analyzed using the method of structuring content analysis.ResultsAlmost none of the hospitalizations, discussed with the (in-)formal caregivers and GPs, seemed to have been preventable or seemed unjustifiable from the interviewees’ points of view. We identified several dementia-specific factors promoting hospitalizations (e.g. the neglect of constricted mobility, the declining ability to communicate about symptoms/accidents and the shift of responsibility from person with dementia to informal or formal caregivers) and context-specific factors promoting hospitalizations (e.g. qualification of nursing home personal, the non-availability of the GP and hospitalizations for examinations/treatments also available in ambulatory settings). Hospitalizations were always the result of the interrelation of two factors: illnesses/accidents and context factors. The impact of both seems to be stronger in presence of dementia.ConclusionsPoints for action in terms of reducing hospitalization rates were: better qualified nurses, a 24-h-GP-emergency service and better compensation for ambulatory monitoring/treatments and house calls. Many hospitalizations of people with dementia cannot be prevented. Therefore, hospital staffs need to be better prepared to handle patients with dementia in order to reduce the negative effects of hospitalizations.
Highlights
Dementia is an irreversible chronic disease with wide-ranging effects on patients’, caregivers’ and families’ lives
The first section ‘circumstances and reasons for the hospitalization of persons with dementia’ shall inform the reader about the context and nature of the hospitalizations discussed during the interviews to better understand the following depiction of the main categories answering our research questions
Circumstances and reasons for the hospitalization of persons with dementia Conditions leading to hospitalization were manifold and can be categorized as: planned treatments/operations, unplanned treatment due to the aggravation of the general condition or due to exsiccosis, falls in the nursing homes, falls at home and other conditions
Summary
Dementia is an irreversible chronic disease with wide-ranging effects on patients’, caregivers’ and families’ lives. Hospitalizations are significant events for people with dementia They tend to have poorer outcomes compared to those without dementia. People with dementia are more likely to be admitted to the hospital than comparable people without dementia [5,6,7]. This is especially the case for ambulatory care-sensitive conditions (AC-SC) [6]. As hospitalizations are stressful events for people with dementia, they should be prevented if the appropriate medical treatment is available in ambulatory care [7]
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