The Impact of Hospitalization on Readmission, Institutionalization, and Mortality of People with Dementia: A Systematic Review and Meta-Analysis

Lehmann, Jana; Michalowsky, Bernhard; Kaczynski, Anika; Thyrian, Jochen René; Schenk, Nele Sophie; Esser, Andrea; Zwingmann, Ina; Hoffmann, Wolfgang

doi:10.3233/jad-171128

Cited by 42 publications

(43 citation statements)

References 53 publications

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“…It is well established that admission to a hospital can worsen pre-existing cognitive problems, and can increase the risk for readmission, institutionalization or mortality [12][13][14]. These risks are aggravated by factors such as high age, comorbidities, malnutrition, low level of everyday functioning, depression and other mental disorders.…”

Section: Introductionmentioning

confidence: 99%

Describing people with cognitive impairment and their complex treatment needs during routine care in the hospital – cross-sectional results of the intersec-CM study

Kracht

Boekholt

Schumacher-Schönert

et al. 2021

Preprint

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Background: Cognitive impairment is an important determinant in health care. In the acute hospital setting cognition has a strong impact on treatment and care. Cognitive impairment can negatively affect diagnostics and treatment success. However, little is known about the individual situation and specific risks of patients with cognitive impairments (PCI) during hospital stays. The aim of the present research is to describe and analyze the treatment needs of PCI in acute hospital care. Methods: The analyses use baseline data of the ongoing multisite, longitudinal, randomized controlled intervention trial intersec-CM (Supporting elderly people with cognitive impairment during and after hospital stays with Intersectoral Care Management), which recruited 402 participants at baseline. We assessed sociodemographic aspects, cognitive status, functional status, frailty, comorbidities, level of impairment, formal diagnosis of dementia, geriatric diagnoses, delirium, depression, pharmacological treatment, utilization of health care services and health care related needs.Results: The sample under examination had been on average mildly cognitively impaired (MMSE M=22.3) and had a mild to moderate functional impairment (Barthel Index M=50.4; HABAM M=19.1). The Edmonton Frail Scale showed a mean of 7.4 and half of the patients (52.3%) had been assigned a care level. About 46.9% had a geriatric diagnosis, 3.0% had a diagnosis of dementia. According to DSM-V 19.2% of the patients had at least one main symptom of depression. The mean number of regularly taken drugs per patient was 8.2. Utilization of health care services prior to the hospital stay was rather low. On average, the sample showed 4.38 care related needs in general, of which 0.60 needs were unaddressed at the time of assessment.Conclusions: Descriptive analyses highlight an in-depth insight into impairments and different care needs of PCI. The results emphasize the need for gender-specific analyses as well as an increased attention to the heterogeneity of needs of PCI related to specific wards, settings and regions where they are admitted. Our results indicate also that PCI represent a high proportion of older patients in acute hospital care.Trial registration: The intersec-CM trial is registered at ClinicalTrials.gov (NCT03359408).

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Section: Introductionmentioning

confidence: 99%

Describing people with cognitive impairment and their complex treatment needs during routine care in the hospital – cross-sectional results of the intersec-CM study

Kracht

Boekholt

Schumacher-Schönert

et al. 2021

Preprint

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“…People with dementia have a higher risk for comorbid health conditions (such as high blood pressure, diabetes and stroke) compared with those of similar age without dementia (Bunn et al., 2014). Consequently, they are hospitalized more often (Shepherd et al., 2019), and they suffer from more complications during hospitalization, including higher levels of anxiety, agitation, depression, infections and falls (Lehmann et al., 2018). Moreover, compared to those without dementia, people with cognitive deterioration have significantly longer hospital stays, higher rehospitalization and even mortality rates (Annear et al., 2016).…”

Section: Introductionmentioning

confidence: 99%

Validating the Hebrew version of the Person‐Centered Care of Older People with Cognitive Impairment in Acute Care scale

et al. 2020

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Aim To validate the Hebrew version of the Person‐Centered Care of Older People with Cognitive Impairment in the Acute Care scale. Background The Person‐Centered Care of Older People with Cognitive Impairment in Acute Care scale is a reliable and valid measure to assess the extent to which person‐centred care among people with dementia is adopted in the acute care setting. Methods A cross‐sectional study using a self‐reporting structured questionnaire was conducted with 678 professionals (69% nurses, 26% physicians, 5% other health care professionals) in five hospitals across Israel. Results Similar to other languages, best results were obtained using 14 of the 15 items included in the original scale. Confirmatory factor analysis indicated the appropriateness of a three‐factor structure for the Hebrew version of the scale. Cronbach's alpha scores for these factors were moderate to good. Conclusions The Hebrew version of the scale is a reliable and valid tool for assessing hospital professionals' perceptions of person‐centred care. Implications for Nursing Management A new language validated version of the scale will allow nurse managers to learn from multiple countries' experience while conducting international comparisons. Such developments will improve and expand the implementation of the person‐centred care among people with dementia in hospital settings.

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“…The behavioral and psychological symptoms of dementia are common in older PCI in hospitals and are associated with considerable distress in the nursing staff [19]. Admission to hospital is associated with cognitive problems or worsening of pre-existing cognitive problems, which increase the risk for readmission, institutionalization, and mortality [20–22]. These risks are aggravated by factors such as comorbidities, malnutrition, activities of daily living (ADL), depression, and other mental disorders.…”

Section: Introductionmentioning

confidence: 99%

Supporting elderly people with cognitive impairment during and after hospital stays with intersectoral care management: study protocol for a randomized controlled trial

Nikelski

Keller

Schumacher-Schönert

et al. 2019

Trials

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Background: The sectorization of health-care systems leads to inefficient treatment, especially for elderly people with cognitive impairment. The transition from hospital care to primary care is insufficiently coordinated, and communication between health-care providers is often lacking. Consequences include a further deterioration of health, higher rates of hospital readmissions, and institutionalization. Models of collaborative care have shown their efficacy in primary care by improving patient-related outcomes. The main goal of this trial is to compare the effectiveness of a collaborative care model with usual care for people with cognitive impairment who have been admitted to a hospital for treatment due to a somatic illness. The aim of the intervention is to improve the continuity of treatment and care across the transition between the in-hospital and adjoining primary care sectors. Methods/design: The trial is a longitudinal multisite randomized controlled trial with two arms (care as usual and intersectoral care management). Inclusion criteria at the time of hospital admission due to a somatic illness are age 70+ years, cognitive impairment (Mini Mental State Examination, MMSE ≤26), living at home, and written informed consent. Each participant will have a baseline assessment at the hospital and two follow-up assessments at home (3 and 12 months after discharge). The estimated sample size is n = 398 people with cognitive inmpairement plus their respective informal caregivers (where available). In the intersectoral care management group, specialized care managers will develop, implement, and monitor individualized treatment and care based on comprehensive assessments of the unmet needs of the patients and their informal caregivers. These assessments will occur at the hospital and in participants' homes. Primary outcomes are (1) activities of daily living, (2) readmission to the hospital, and (3) institutionalization. Secondary outcomes include (a) frailty, (b) delirium, (c) quality of life, (d) cognitive status, (e) behavioral and psychological symptoms of dementia, (f) utilization of services, and (g) informal caregiver burden.

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The Impact of Hospitalization on Readmission, Institutionalization, and Mortality of People with Dementia: A Systematic Review and Meta-Analysis

Abstract: Hospitalization of PwD lead to adverse outcomes. An improvement in the identification of and care for PwD in the acute setting as well as in after care in the community setting, especially in the interface between both settings, is required to prevent adverse outcomes in hospitalized PwD.

Cited by 42 publications

References 53 publications

Describing people with cognitive impairment and their complex treatment needs during routine care in the hospital – cross-sectional results of the intersec-CM study

Describing people with cognitive impairment and their complex treatment needs during routine care in the hospital – cross-sectional results of the intersec-CM study

Validating the Hebrew version of the Person‐Centered Care of Older People with Cognitive Impairment in Acute Care scale

Supporting elderly people with cognitive impairment during and after hospital stays with intersectoral care management: study protocol for a randomized controlled trial

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