Abstract
BackgroundDelirium and dementia are prominent psychiatric diseases in old age and connected with poor outcomes for people affected. Nevertheless, there is a lack of knowledge concerning the long-term prognosis of patients with dementia and delirium. This study analyzes mortality, readmission rates and discharge destinations of patients with dementia or delirium superimposed on dementia (DSD) within 3 years after discharge from hospital.MethodsA cross-sectional, monocentric cohort study was conducted at the department of geriatric psychiatry of the LVR hospital cologne, using structured telephone interviews and analyses from the clinical information system. All patients with dementia and DSD, admitted between December 2014 and November 2015, were screened for eligibility.ResultsIn total, 113 patients were included, 49 patients with dementia (M 80 years, female 49%) and 64 with DSD (M 82 years, female 47%). Three years after discharge, 66 patients (58%) had died (95% CI 91.9–112.5; p = 0.53). Within the first 3 months, 9 patients (14%) with DSD deceased, but no patient from the dementia group (95% CI 11.3–12.7; p = 0.01). Out of all patients, 17 patients were readmitted and nursing homes were the predominant discharge destination (55%).ConclusionsThis analysis revealed a high post-discharge mortality rate of patients with dementia and DSD. For patients with DSD, a close clinical monitoring, mainly within the first 3 months after discharge, should challenge the significantly increased acute-mortality. These findings should set the pattern for a comprehensive analysis of long-term effects of dementia and DSD. More studies are required for better understanding and comparability in this field of research and healthcare.
Highlights
The hospital treatment of patients with dementia is often caused by or complicated due to the occurrence of delirium and neuropsychiatric symptoms [1]
The 3 year mortality for patients with dementia only was 59% (n = 29) and 58% (n = 37) for patients with delirium superimposed on dementia (DSD), revealing no significant difference (Figure 2)
The DSD group showed a significantly higher mortality rate during the first 3 months after discharge, with 14% (n = 9) vs. 0% from the dementia only group
Summary
The hospital treatment of patients with dementia is often caused by or complicated due to the occurrence of delirium and neuropsychiatric symptoms [1]. Delirium alone and delirium superimposed on dementia (DSD) are associated with an increased risk of mortality in geriatric acute care and in long-term analysis after discharge [6]. The highest mortality risk for delirium alone was reported after 6 months and after 1 year; in the medium- to long-term analysis patients with dementia showed higher mortality rates [7]. A Brazilian investigation including geriatric patients reported significant differences after hospital discharge, whereas 50% of patients with delirium and 34% of patients without delirium died within the first year after discharge [8]. The aim of this study is to investigate mortality in a follow-up analysis after discharge from acute care of patients with delirium and dementia as well as readmissions and aftercare. This study analyzes mortality, readmission rates and discharge destinations of patients with dementia or delirium superimposed on dementia (DSD) within 3 years after discharge from hospital
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