Association between dementia and discharge status in patients hospitalized with pneumonia

Jo, Taisuke; Yasunaga, Hideo; Sasabuchi, Yusuke; Michihata, Nobuaki; Morita, Kojiro; Yamauchi, Yasuhiro; Hasegawa, Wakae; Takeshima, Hideyuki; Sakamoto, Yuta; Matsui, Hiroki; Fushimi, Kiyohide; Nagase, Takahide

doi:10.1186/s12890-017-0473-8

Cited by 6 publications

(8 citation statements)

References 42 publications

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“…However, the study also had some limitations. First, we found a dementia prevalence of 8.7%, which is in concordance with another register-based study on dementia in hospitalized pneumonia patients [ 50 ], but lower than the prevalence of 18–42% reported in studies performing cognitive testing upon acute admissions [ 51 , 52 ]. Yet, dementia should be assessed in a person who is not acutely unwell to avoid falsely misclassifying, for instance, delirium as dementia, and therefore, these studies may have overestimated the dementia prevalence.…”

Section: Discussionsupporting

confidence: 91%

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Dementia and the risk of short-term readmission and mortality after a pneumonia admission

Graversen

Pedersen²,

Sandbæk

et al. 2021

PLoS ONE

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Background At time of discharge after a pneumonia admission, care planning for older persons with dementia is essential. However, care planning is limited by lack of knowledge on the short-term prognosis. Aim To investigate 30-day mortality and readmission after hospital discharge for pneumonia in persons with versus without dementia, and to investigate how these associations vary with age, time since discharge, and medication use. Methods Using the Danish registries, we investigated 30-day mortality and readmission in persons (+65 years) discharged after pneumonia in 2000–2016 (N = 298,872). Adjusted mortality rate ratios (aMRRs) and incidence rate ratios (aIRRs) were calculated for persons with versus without dementia, and we investigated if these associations varied with use of benzodiazepines, opioids, and antipsychotics, and with age and time since discharge. Results Among 25,948 persons with dementia, 4,524 died and 5,694 were readmitted within 30 days. The risk of 30-day mortality was 129% higher (95% CI 2.21–2.37) in persons with versus without dementia after adjustment for sociodemographic characteristics, admission-related factors, and comorbidities. Further, the highest mortality risk was found in persons with both dementia and use of antipsychotics (aMRR: 3.39, 95% CI 3.19–3.59); 16% of deaths in this group could not be explained by the independent effect of each exposure. In those with dementia, the highest aMRRs were found for the youngest and for the first days after discharge. The risk of 30-day readmission was 7% higher (95% CI 1.04–1.10) in persons with versus without dementia. In those with dementia, the highest aIRRs were found for the first days after discharge. Conclusions Dementia was associated with higher short-term mortality after pneumonia, especially in users of antipsychotics, and with slightly higher readmission, especially in the first days after discharge. This is essential knowledge in the care planning for persons with dementia who are discharged after a pneumonia admission.

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Section: Discussionsupporting

confidence: 91%

“…dysphagia and impaired functional status) and more frequent use of sedative medications, which are all established risk factors for developing pneumonia [1][2][3]. Around one in eight persons with dementia dies during their pneumonia admission [4,5], but the prognosis for those discharged from hospital remains underexplored.…”

Section: Introductionmentioning

confidence: 99%

Dementia and the risk of short-term readmission and mortality after a pneumonia admission

Graversen

Pedersen²,

Sandbæk

et al. 2021

PLoS ONE

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“…Even small changes in the ADL functional level are associated with clinically relevant outcomes. ADL functional status decline can lead to adverse clinical outcomes in infections [8][9][10][11], acute medical patients [6,[12][13][14], dementia [15], heart failure [16], hip fractures [17,18] and geriatric trauma [19]. The ADL functional status may be one of the predictor factor for in-hospital mortality in older patients with CAP.…”

Section: Introductionmentioning

confidence: 99%

Activity of daily living upon admission is an independent predictor of in-hospital mortality in older patients with community-acquired pneumonia

et al. 2021

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Background Older patients hospitalized with community-acquired pneumonia (CAP) are at high risk for short-term mortality. Activity of daily living (ADL) is associated with clinical outcomes in older patients. We aimed to investigate the prognostic value of ADL upon admission on the in-hospital mortality in older patients with CAP. Methods We conducted a retrospective cohort study involving patients aged ≥65 years admitted to Beijing Chao-Yang hospital due to CAP between June 2012 and June 2020. ADL evaluation upon admission was performed by Barthel Index (BI). Data from all patients were extracted from the electronic medical records. Results Four thousand eight hundred eighty patients were included, 131 patients (2.7%) died during their hospitalization. Median BI in the Deceased group was 45 (20–65), Deceased group had lower BI scores than Survivors group (p < 0.001). Low BI (< 60) was more frequent in patients who died in the hospital than in patients discharged alive (69.5% vs. 13%, p < 0.001). In-hospital mortality was higher among patients with worse ADL upon admission (BI< 60) compared to those BI≥60 (12.6% vs. 0.9%). The worse ADL upon admission (BI< 60) was associated with an increase in the risk of death during CAP hospitalization, worse ADL upon admission (BI< 60) showed an odds ratio (OR) for in-hospital mortality of 7.53 (95%CI: 2.77–20.48; P < 0.01). This association remained significant after adjustment for age, comorbid conditions, respiratory failure, pathogens and laboratory findings (OR, 3.74; 95%CI, 2.37–5.91; P < 0.01). Receiver operating characteristic (ROC) curve revealed that BI upon admission is a predictor related to in-hospital mortality in elderly patients, the area under the ROC curve of BI in predicting in-hospital mortality was 0.81 (with 95% confidence interval: 0.78–0.85). The predictive value of ADL upon admission was better than age in our study population. Conclusion Activity of daily living upon admission is an independent predictor of in-hospital mortality in older patients with community-acquired pneumonia.

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“…Even little changes in the ADL function could lead to poor clinical outcomes [30][31] . ADL functional status has been shown to be an independent predictor of mortality in heterogeneous populations [7][8][9][10][11] . In CAP, a worse ADL is directly related to increased immediate and long-term mortality [32] .…”

Section: Discussionmentioning

confidence: 99%

“…ADL functional status decline can lead to adverse clinical outcomes in pulmonary infections, dementia [7] , heart failure [8] , hip fractures [9][10] , and acute medical patients [11] . The baseline ADL functional status may be one of the determinants for the evolution of pneumonia.…”

Section: Introductionmentioning

confidence: 99%

Activities of Daily Living (ADL) Predicts in-hospital Mortality in Geriatric Patients with Community-acquired Pneumonia (CAP)

Kang

Fang

wang

et al. 2020

Preprint

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Background: Community-acquired pneumonia (CAP) is an important problem with significant mortality. Activity of daily living (ADL) function decline is associated with increased mortality in elderly patients. We aimed to investigate the prognostic value of ADL at admission on the in-hospital mortality in geriatric patients with pneumonia. Methods: Patients over 65 years old admitted to Beijing Chao-yang hospital due to CAP from June 2012 through June 2020 were retrospectively reviewed by electronic medical records. Risk factors for mortality in pneumonia patients described in literature were included in our study. ADL evaluation at admission was performed by Barthel index (BI). Results: 4880 patients were included, 131 patients (2.7%) died during their admission. 69.5% patients in Dead group had a BI scores < 60. Mean BI score in the Dead group and Alive group were 49.89±30.20 and 81.57±22.14, respectively. Dead group had lower BI scores than Alive group (p＜0.001). A low BI was associated with increased in-hospital mortality. Logistic regression analyses demonstrated that ADL function at admission was significantly and independently associated with the in-hospital mortality, either in younger (age 65-74years) or very elderly (age≥75years) patients. Receiver operating characteristic ( ROC ) curve analysis revealed that BI at admission is an predictor related to in-hospital mortality in elderly patients, The area under the receiver operating characteristic (ROC) curves of BI in predicting in-hospital mortality was 0.81 (with 95% confidence interval: 0.78–0.85).Conclusion: ADL decline is associated with increased risk of in-hospital mortality among elderly patients hospitalized with CAP. ADL function at admission can predict in-hospital mortality in geriatric patients with CAP. Barthel Index (BI) can be used as a simple and convenient method for the assessment of the ADL functional status at admission in geriatric patients with CAP to identify patients at high risk and conducive to clinical decision making.

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Association between dementia and discharge status in patients hospitalized with pneumonia

Cited by 6 publications

References 42 publications

Dementia and the risk of short-term readmission and mortality after a pneumonia admission

Dementia and the risk of short-term readmission and mortality after a pneumonia admission

Activity of daily living upon admission is an independent predictor of in-hospital mortality in older patients with community-acquired pneumonia

Activities of Daily Living (ADL) Predicts in-hospital Mortality in Geriatric Patients with Community-acquired Pneumonia (CAP)

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