Pneumonia Readmissions in Older Adults With Dementia

BACKGROUND/OBJECTIVES: Pneumonia readmissions have significant quality of care and policy implications for patients and health care providers. Research indicates that initiatives to decrease readmissions should target high-risk subgroups. Older adults with dementia have an increased risk of pneumonia and subsequent hospitalizations, suggesting that they may be at high-risk of pneumonia readmissions. The purpose of this study was to determine if associations between patient factors and readmission rates differ for older adults with and without dementia who were hospitalized for pneumonia. DESIGN: This was a retrospective study of secondary data. PARTICIPANTS: A nationally representative sample of 389,198 discharge records was extracted from the 2013 Nationwide Readmission Database. MEASURES: Differences between groups were analyzed using χ and t tests. A generalized linear model was utilized to examine associations between patient factors and pneumonia readmissions. RESULTS: Significant differences were found (P<0.001) when comparing patient characteristics of older adults with and without dementia who were readmitted. Older adults with dementia had a readmission rate of 23.5% and were 2.9 times more likely to be readmitted (odds ratio; 95% confidence interval, 1.93, 4.40) than older adults without dementia. Associations were calculated using a generalized linear model with dementia included as an interactive effect. Dementia significantly modified (P<0.05) the relationship between pneumonia readmissions and 4 factors; (a) discharge disposition, (b) chronic conditions, (c) risk of mortality, and (d) median household income. CONCLUSIONS: Classifying older adults with dementia as a high-risk subgroup for pneumonia readmissions is supported by the findings of this study. Development of strategies to reduce pneumonia readmissions that are tailored to individuals with dementia should be considered.