Risk of death or hospital admission among community-dwelling older adults living with dementia in Australia

Abstract

BackgroundOlder people living with dementia prefer to stay at home to receive support. But they are at high risk of death and/or hospital admissions. This study primarily aimed to determine risk factors for time to death or hospital admission (combined) in a sample of community-dwelling older people living with dementia in Australia. As a secondary study purpose, risk factors for time to death were also examined.MethodsThis study used the data of a previous project which had been implemented during September 2007 and February 2009. The original project had recruited 354 eligible clients (aged 70 and over, and living with dementia) for Extended Aged Care At home Dementia program services during September 2007 and 2008. Client information and carer stress had been collected from their case managers through a baseline survey and three-monthly follow-up surveys (up to four in total). The principal data collection tools included Global Deterioration Scale, Modified Barthel Index, Instrumental-Dependency OARS, Adapted Cohen-Mansfield Agitation Inventory, as well as measures of clients’ socio-demographic characteristics, service use and diseases diagnoses. The sample of our study included 284 clients with at least one follow-up survey. The outcome variable was death or hospital admission, and death during six, nine and 16-month study periods. Stepwise backwards multivariate Cox proportional hazards analysis was employed, and Kaplan-Meier survival analysis using censored data was displayed.ResultsHaving previous hospital admissions was a consistent risk factor for time to death or hospital admission (six-month: HR = 3.12; nine-month: HR = 2.80; 16-month: HR = 2.93) and for time to death (six-month: HR = 2.27; 16-month: HR = 2.12) over time. Previously worse cognitive status was a consistent risk factor over time (six- and nine-month: HR = 0.58; 16-month: HR = 0.65), but no previous use of community care was only a short-term risk factor (six-month: HR = 0.42) for time to death or hospital admission.ConclusionsPrevious hospital admissions and previously worse cognitive status are target intervention areas for reducing dementia clients’ risk of time to death or hospital admission, and/or death. Having previous use of community care as a short-term protective factor for dementia clients’ time to death or hospital admission is noteworthy.

Effectiveness of home care for fever treatment in older people: A case–control study compared with hospitalized care

“…These studies have reported that the venue of treatment does not affect the mortality rate, but that deterioration of motor and cognitive functions is less likely to occur when patients receive home care. [6][7][8][9] However, caution must be exercised when applying overseas-sourced findings directly to the Japanese context, as Japan has many unique aspects, including medical care and longterm care systems, culture and customs. We previously conducted a preliminary study of older people in Japan who regularly received home care; our findings suggested that when such individuals develop a fever, home care leads to a more favorable outcome than hospitalized care.…”

Home care service utilisation by people with dementia—A retrospective cohort study of community nursing data in Australia

“…A study of community‐dwelling older adults with dementia found that a previous hospital admission or previously worse cognition increased the risk of hospital admission or death. Use of community services was considered a short‐term protective factor (You et al, ). The progressive nature of dementia and the long duration of dependency may limit the possibility of remaining at home until the end of life.…”

“…Use of community services was considered a short-term protective factor (You et al, 2014). The progressive nature of dementia and the long duration of dependency may limit the possibility of remaining at home until the end of life.…”

“…Due to the cross-sectional nature of these studies, there is a distinct lack of information pertaining to service use over time. In Australia, there have been several population studies examining data from the Home and Community Care (HACC) and Aged Care Assessment Program (ACAP) Minimum Data Sets (MDS) (Karmel, Gibson, Anderson, Wells, & Duckett, 2012;Vecchio, Fitzgerald, Radford, & Fisher, 2016;You, Dunt, White, Vander Hoorn, & Doyle, 2014). The HACC and ACAP MDS do not include formal diagnostic information and instead report "memory problems" as a surrogate measure of dementia (Vecchio et al, 2016).…”

Defining Randomly Measured Glycemic Values As a Risk Factor for Dementia: Accurate and Adequate?

“…Cerebrovascular and cardiovascular events, aspiration pneumonia, pressure ulcers, and delirium are the most frequent causes of death in individuals with dementia. [6][7][8] Additional information regarding the existence of specific cause of death at the end of the study could have been useful to understand the underlying mechanism. Finally, there are many types and three stages of dementia for which there are different mortality rates.…”