The association between dementia severity and hospitalisation profile in a newly assessed clinical cohort: The South London and Maudsley case register

TY - JOUR

T1 - The association between dementia severity and hospitalisation profile in a newly assessed clinical cohort

T2 - The South London and Maudsley case register

AU - Gungabissoon, Usha

AU - Perera, Gayan

AU - Galwey, Nicholas W.

AU - Stewart, Robert

PY - 2020/4

Y1 - 2020/4

N2 - Objectives To evaluate the risk and common causes of hospitalisation in patients with newly diagnosed dementia and variation by severity of cognitive impairment. Setting We used data from a large London mental healthcare case register linked to a national hospitalisation database. Participants Individuals aged ≥65 years with newly diagnosed dementia with recorded cognitive function and the catchment population within the same geography. Outcome measures We evaluated the risk and duration of hospitalisation in the year following a dementia diagnosis. In addition we identified the most common causes of hospitalisation and calculated age-standardised and gender-standardised admission ratios by dementia severity (mild/moderate/severe) relative to the catchment population. Results Of the 5218 patients with dementia, 2596 (49.8%) were hospitalised in the year following diagnosis. The proportion of individuals with mild, moderate and severe dementia who had a hospital admission was 47.9%, 50.8% and 51.7%, respectively (p= 0.097). Duration of hospital stay increased with dementia severity (median 2 days in mild to 4 days in severe dementia, p 0.0001). After excluding readmissions for the same cause, the most common primary hospitalisation discharge diagnoses among patients with dementia were urinary system disorders, pneumonia and fracture of femur, accounting for 15%, 10% and 6% of admissions, respectively. Overall, patients with dementia were hospitalised 30% more than the catchment population, and this trend was observed for most of the discharge diagnoses evaluated. Standardised admission ratios for urinary and respiratory disorders were higher in those with more severe dementia at diagnosis. Conclusions Individuals with a dementia diagnosis were more likely to be hospitalised than individuals in the catchment population. The length of hospital stay increased with dementia severity. Most of the common causes of hospitalisation were more common than expected relative to the catchment population, but standardised admission ratios only varied by dementia stage for certain groups of conditions.

AB - Objectives To evaluate the risk and common causes of hospitalisation in patients with newly diagnosed dementia and variation by severity of cognitive impairment. Setting We used data from a large London mental healthcare case register linked to a national hospitalisation database. Participants Individuals aged ≥65 years with newly diagnosed dementia with recorded cognitive function and the catchment population within the same geography. Outcome measures We evaluated the risk and duration of hospitalisation in the year following a dementia diagnosis. In addition we identified the most common causes of hospitalisation and calculated age-standardised and gender-standardised admission ratios by dementia severity (mild/moderate/severe) relative to the catchment population. Results Of the 5218 patients with dementia, 2596 (49.8%) were hospitalised in the year following diagnosis. The proportion of individuals with mild, moderate and severe dementia who had a hospital admission was 47.9%, 50.8% and 51.7%, respectively (p= 0.097). Duration of hospital stay increased with dementia severity (median 2 days in mild to 4 days in severe dementia, p 0.0001). After excluding readmissions for the same cause, the most common primary hospitalisation discharge diagnoses among patients with dementia were urinary system disorders, pneumonia and fracture of femur, accounting for 15%, 10% and 6% of admissions, respectively. Overall, patients with dementia were hospitalised 30% more than the catchment population, and this trend was observed for most of the discharge diagnoses evaluated. Standardised admission ratios for urinary and respiratory disorders were higher in those with more severe dementia at diagnosis. Conclusions Individuals with a dementia diagnosis were more likely to be hospitalised than individuals in the catchment population. The length of hospital stay increased with dementia severity. Most of the common causes of hospitalisation were more common than expected relative to the catchment population, but standardised admission ratios only varied by dementia stage for certain groups of conditions.

KW - dementia

KW - epidemiology

KW - health economics

UR - https://www.scopus.com/pages/publications/85083386451

U2 - 10.1136/bmjopen-2019-035779

DO - 10.1136/bmjopen-2019-035779

M3 - Article

C2 - 32284392

AN - SCOPUS:85083386451

SN - 2044-6055

VL - 10

JO - BMJ Open

JF - BMJ Open

IS - 4

M1 - e035779

ER -