June 10, 2012
People with Alzheimer’s and other forms of dementia are much more likely to be hospitalized for a range of illnesses than those without dementia, a new study finds. And in many cases, the hospitalizations could have been prevented.
The findings are concerning since a visit to the hospital is especially disorienting for anyone with dementia and can lead to disorientation, falls and other problems that complicate medical care. Even a short hospital visit may lead to a prolonged stay and hasten physical and cognitive decline in someone with Alzheimer’s disease.
“Nonelective hospitalization of older people, particularly those with dementia, is not a trivial event,” wrote the authors of a study from the University of Washington in Seattle. The findings appeared in The Journal of the American Medical Association.
For the study, the researchers focused on conditions that can sometimes be prevented with proper outpatient medical care and careful patient monitoring. They analyzed hospitalizations among more than 3,000 seniors who were part of the Adults Changes in Thought (ACT) study, none of whom had dementia at the start of the study period in 1994.
By the end of the study, in 2007, 494 participants had developed dementia, and 86 percent of them had been admitted to the hospital at least once. Among the 2,525 participants who didn’t have dementia, only 59 percent required hospital stays during the study period.
Among those with dementia, the average annual hospital admission rate was more than twice that of those without dementia. Hospitalizations for circulatory problems, genitourinary issues, infections, nerve disorders and respiratory problems were significantly higher among dementia sufferers compared with those without dementia.
Three conditions that can often be treated at home or the doctor’s office, without an overnight hospital stay, accounted for two-thirds of the hospitalizations that might have been prevented: bacterial pneumonia, congestive heart failure and urinary tract infections. Hospital admission rates for these conditions were much higher for those with dementia than those who didn’t have it.
Hospital admission rates for two other preventable complaints – dehydration and duodenal ulcers – were also higher for those with dementia than those without it.
Knowledge of preventable conditions that are likely to lead to hospitalization is important for family members, caregivers and doctors, who can work together to help prevent them from getting worse. Proactive, early management for these conditions and regular monitoring is especially important for those with Alzheimer’s and other forms of dementia, since hospital stays can be so difficult for these patients. The extent and quality of care at home is an important factor that can determine the success or failure of treating illnesses at home.
In an editorial that accompanied the study, Dr. Constantine G. Lyketsos of Johns Hopkins University writes that, “Physicians should participate in this effort by making detection of dementia in its early stages and implementation of dementia care a priority.” Major goals of dementia care, he notes, are to manage accompanying medical illnesses and taking steps to prevent them whenever possible from happening in the first place.
Source: Elizabeth A. Phelan; Soo Borson; Louis Grothaus; Steven Balch; Eric B. Larson: “Association of Incident Dementia With Hospitalizations.” Journal of the American Medical Association, Vol. 307 (2), Jan. 11, 2012, pages 165-172.