COPD (OR=1.26), diabetes (OR=1.21), and CKD (OR=1.14) increase 180-day readmission risk in dementia patients; age 90+ (HR=3.20) and antipsychotics (HR=1.37) predict 1-year mortality post-readmission.
In older adults with dementia, comorbidities such as COPD, diabetes, and CKD increase the risk of 180-day hospital readmission, while age, multiple conditions, antipsychotic use, and care home residence predict subsequent one-year mortality.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Older adults with dementia occupy approximately one quarter of acute hospital beds in England. The risk of hospital readmission within six months of discharge increases with multiple long-term conditions, reduced mobility, and limited interdisciplinary collaboration between primary and secondary care. Subsequently, hospital readmission can increase the risk of mortality in this population. This study aimed to quantify the clinical determinants of readmission and subsequent mortality in older adults with dementia in England. Method A retrospective cohort study was conducted using anonymised data from adults in England aged 65 and over with a recorded diagnosis of dementia. Cases were identified through primary care electronic health records in the Clinical Practice Research Datalink (CPRD) GOLD, between April 1997 and November 2018. Readmissions within 180 days were identified using linked Hospital Episode Statistics. Adjusted logistic regression assessed factors associated with readmission, and Cox proportional hazards regression identified predictors of one-year mortality following readmission. Results The cohort included 24,956 patients from 253 general practices (mean age 81.93 years; 61.6% female). Chronic obstructive pulmonary disease (odds ratio OR = 1.26, 95% confidence interval CI: 1.15–1.39), diabetes mellitus (OR = 1.21, CI: 1.13–1.30), and chronic kidney disease (OR = 1.14, CI: 1.07–1.22) were strongly associated with readmission. Medication review in primary care within one year prior to admission (OR = 1.08, CI: 1.02–1.14), and primary care consultation within two weeks of discharge (OR = 1.21, CI: 1.15–1.28) were also associated with readmission. One-year mortality following readmission was associated with age (hazard ratio HR = 3.20, CI: 2.49–4.11 for ages 90+ versus 65–69), multiple long-term conditions (HR = 1.21, CI: 1.05–1.41 for 4–5 conditions versus none), prescriptions for antipsychotic medication (HR = 1.37, CI: 1.22–1.53), and care home residence (HR = 1.33, CI: 1.10–1.62). Conclusion Knowledge of clinical factors associated with readmission and mortality can inform advanced care planning between health and social care professionals, older adults with dementia and their families.
Browne et al. (Sun,) reported a other. COPD (OR=1.26), diabetes (OR=1.21), and CKD (OR=1.14) increase 180-day readmission risk in dementia patients; age 90+ (HR=3.20) and antipsychotics (HR=1.37) predict 1-year mortality post-readmission.