Length of hospital stay and dementia: A systematic review of observational studies

Möllers, Tobias; Stocker, Hannah; Wei, Wenjia; Perna, Laura; Brenner, Hermann

doi:10.1002/gps.4993

Cited by 63 publications

(54 citation statements)

References 88 publications

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“…The estimated worldwide cost of dementia in 2015 was US$818 billion [2]. Dementia impacts length of hospital stay, morbidity, and mortality [3, 4]. Alzheimer’s disease (AD) accounts for 60–80% of dementia cases [3].…”

Section: Introductionmentioning

confidence: 99%

Anesthesiology and cognitive impairment: a narrative review of current clinical literature

2019

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Background: The impact of general anesthesia on cognitive impairment is controversial and complex. A large body of evidence supports the association between exposure to surgery under general anesthesia and development of delayed neurocognitive recovery in a subset of patients. Existing literature continues to debate whether these short-term effects on cognition can be attributed to anesthetic agents themselves, or whether other variables are causative of the observed changes in cognition. Furthermore, there is conflicting data on the relationship between anesthesia exposure and the development of long-term neurocognitive disorders, or development of incident dementia in the patient population with normal preoperative cognitive function. Patients with pre-existing cognitive impairment present a unique set of anesthetic considerations, including potential medication interactions, challenges with cooperation during assessment and non-general anesthesia techniques, and the possibility that pre-existing cognitive impairment may impart a susceptibility to further cognitive dysfunction. Main body: This review highlights landmark and recent studies in the field, and explores potential mechanisms involved in perioperative cognitive disorders (also known as postoperative cognitive dysfunction, POCD). Specifically, we will review clinical and preclinical evidence which implicates alterations to tau protein, inflammation, calcium dysregulation, and mitochondrial dysfunction. As our population ages and the prevalence of Alzheimer's disease and other forms of dementia continues to increase, we require a greater understanding of potential modifiable factors that impact perioperative cognitive impairment. Conclusions: Future research should aim to further characterize the associated risk factors and determine whether certain anesthetic approaches or other interventions may lower the potential risk which may be conferred by anesthesia and/or surgery in susceptible individuals.

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Section: Introductionmentioning

confidence: 99%

Anesthesiology and cognitive impairment: a narrative review of current clinical literature

2019

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“…Typically, patient is discharged to home after 2–4 weeks of hip fracture occurrence ( 3 ). Hospital stays both in general and due to hip fractures are longer among patients with dementia than without cognitive disorder ( 11 ).…”

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confidence: 99%

Length of Hospital Stay for Hip Fracture and 30-Day Mortality in People With Alzheimer’s Disease: A Cohort Study in Finland

Lavikainen

Koponen

Taipale

et al. 2020

The Journals of Gerontology: Series A

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Background Persons with Alzheimer’s disease (AD) are in higher risk of hip fractures (HF) than general older population and have worse prognosis after HF. Hospital stays after HF have shortened along time. We investigated the association between length of hospital stay after HF and mortality after discharge among persons with AD. Methods The MEDALZ cohort includes all Finnish community dwellers who received clinically verified AD diagnosis in 2005–2011 (n=70,718). Patients who experienced first HF after AD diagnosis in 2005‒2015 (n=6999) were selected. Length of hospital stay for HF was measured as a sum of the consecutive days spent in hospital after HF until discharge. Outcome was defined as death within 30-days after hospital discharge. Results Mean of overall length of hospital stay after a HF decreased from 52.6 (SD 62.9) days in 2005 to 19.6 (SD 23.1) days in 2015. Shortest treatment decile (1‒4 days) had the highest risk of death within 30 days after discharge (adjusted hazard ratio, aHR, 2.76; 95% confidence interval, CI, 1.66–4.60) in addition to second (5‒6 days; aHR 2.52; 95% CI 1.50–4.23), and third (7‒10 days; aHR 2.22; 95% CI 1.34–3.69) deciles when compared to the sixth decile of length of stays (21‒26 days). Conclusions Among persons with AD, shorter length of hospital stay after HF was associated with an increased risk of death after discharge. After acute hip fracture treatment, inpatient rehabilitation or proper care and services in home need to be organized to older persons with AD.

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“…heart disease, diabetes) [4]. Those admitted to hospital with dementia experience complications and adverse outcomes including longer length of stay, greater mortality and increased risk of institutionalization post-discharge compared to those without dementia [5,6]. While 20% of hospital admissions of Plwd are potentially preventable [7] some unplanned admissions are unavoidable, and it is important that hospital care supports the needs of those affected by dementia.…”

Section: Introductionmentioning

confidence: 99%

Activity interventions to improve the experience of care in hospital for people living with dementia: a systematic review

et al. 2020

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Background: An increasingly high number of patients admitted to hospital have dementia. Hospital environments can be particularly confusing and challenging for people living with dementia (Plwd) impacting their wellbeing and the ability to optimize their care. Improving the experience of care in hospital has been recognized as a priority, and non-pharmacological interventions including activity interventions have been associated with improved wellbeing and behavioral outcomes for Plwd in other settings. This systematic review aimed at evaluating the effectiveness of activity interventions to improve experience of care for Plwd in hospital. Methods: Systematic searches were conducted in 16 electronic databases up to October 2019. Reference lists of included studies and forward citation searching were also conducted. Quantitative studies reporting comparative data for activity interventions delivered to Plwd aiming to improve their experience of care in hospital were included. Screening for inclusion, data extraction and quality appraisal were performed independently by two reviewers with discrepancies resolved by discussion with a third where necessary. Standardized mean differences (SMDs) were calculated where possible to support narrative statements and aid interpretation. Results: Six studies met the inclusion criteria (one randomized and five non-randomized uncontrolled studies) including 216 Plwd. Activity interventions evaluated music, art, social, psychotherapeutic, and combinations of tailored activities in relation to wellbeing outcomes. Although studies were generally underpowered, findings indicated beneficial effects of activity interventions with improved mood and engagement of Plwd while in hospital, and reduced levels of responsive behaviors. Calculated SMDs ranged from very small to large but were mostly statistically non-significant. Conclusions: The small number of identified studies indicate that activity-based interventions implemented in hospitals may be effective in improving aspects of the care experience for Plwd. Larger well-conducted studies are needed to fully evaluate the potential of this type of non-pharmacological intervention to improve experience of care in hospital settings, and whether any benefits extend to staff wellbeing and the wider ward environment.

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Length of hospital stay and dementia: A systematic review of observational studies

Cited by 63 publications

References 88 publications

Anesthesiology and cognitive impairment: a narrative review of current clinical literature

Anesthesiology and cognitive impairment: a narrative review of current clinical literature

Length of Hospital Stay for Hip Fracture and 30-Day Mortality in People With Alzheimer’s Disease: A Cohort Study in Finland

Activity interventions to improve the experience of care in hospital for people living with dementia: a systematic review

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