The Effect of Dementia on Acute Care in a Geriatric Medical Unit

Abstract

Treatment of dementia costs billions of dollars in long-term care and community services every year. Dementia also burdens the acute care system and may contribute to financial problems for hospitals serving large numbers of demented elderly. In a specialized geriatric medical unit devoted to acute care of the frail elderly, Alzheimer's disease and vascular and mixed dementias afflicted 63% of inpatients and were associated with excess consumption of nursing resources, complications of treatment, nosocomial infections, lengthy hospitalizations, and financial losses to the hospital. Due in part to the effects of dementia on mobility, continence, and nutrition, demented patients suffered more frequently from life-threatening infections, sepsis, iatrogenic disease, and prolonged hospital stays. Hospital losses were 75% higher for demented patients than for nondemented patients.Dementia affected the majority of acute care patients in this study. However, it was rarely coded as an admitting diagnosis, even though it may have been the proximate cause of the medical morbidity which led to the acute hospitalization. In addition, despite the significant impact of dementia on the hospital course and costs, it was a factor in hospital reimbursement in less than one third of cases. The results indicate that dementia was not considered to be an acute diagnosis, nor was it recognized as a complex medical illness. The impact of dementia on acute hospitalization, including the mechanisms by which dementia prolongs the hospital stay, requires further investigation.

Prospective observational study of dementia and delirium in the acute hospital setting

“…43.3%, 63%), 29,30 delirium was not screened for in those studies, with the result that some patients with delirium may have been misclassified as having dementia and hence overinflating the rate. Like others, 1,3 we also found the dementia prevalence increased with increasing age, with almost half of the oldest patients (Ն90 years) found to have dementia in our study -a figure considerably higher than the 25% reported by Draper's group, which they acknowledge as an underestimate.…”

The economic consequences of Alzheimer's disease in the context of new drug developments

“…This is true for a number of countries, and applies to residential care homes (Darton and Knapp, 1984;Darton and Wright, 1992), nursing homes (Fries et al, 1993;Hu et al, 1986;Maas, 1988;Trabucchi et al, 1995) and hospitals (Hu et al, 1986;Torian et al, 1992). Welch et al (1992) found that the median length of nursing home stay for Alzheimer's disease residents in their USA sample (2.75 years) was over 10 times the national median for all diagnoses.…”

The Use of Screening Instruments for the Detection of Dementia

“…Other 'secondary' causes of dementia are less prevalent. Progressive dementias are associated not only with intel lectual and physical deterioration but also with complications such as falls, fractures, delirium, infections, and incontinence [7], Dementia is associated with, and complicates the clinical management of, other comorbid conditions [8] and contributes to increased use of health and human services, particularly to use of long-term institutionalization in so cieties where this is an option. Social and emotional costs to dementia victims' families are considerable.…”