Emergency department and hospital admissions among people with dementia living at home or in nursing homes: results of the European RightTimePlaceCare project on their frequency, associated factors and costs

BMC Geriatrics

Mercè Comas¹  F. Javier Afonso-Argilés²  Maria Soto-Martin³  Connie Lethin⁴  Hilde Verbeek⁵  Kai Saks⁶  Helena Leino-Kilpi⁷  Astrid Stephan⁸  Gabriele Meyer⁸  Adelaida Zabalegui⁹  Ansgar Wübker^1,10  Caroline Sutcliffe^1,11  Anna Renom-Guiteras^1,12 

[1] Department of Epidemiology and Evaluation. Hospital del Mar, Parc de Salut Mar, Barcelona, Spain;Member of the Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain;Department of Geriatric Medicine and Palliative Care. Badalona Serveis Assistencials, Barcelona, Spain;Universitat Autònoma de Barcelona, Barcelona, Spain;Department of Geriatric Medicine, Gerontopole, Alzheimer Disease Research Center, Inserm UMR 1027, University Hospital of Toulouse, Toulouse, France;Department of Health Sciences. Faculty of Medicine, Lund University, SE-221 00, Lund, Sweden;Clinical Memory Research Unit. Department of Clinical Sciences, Lund University, SE-221 00, Lund, Sweden;Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands;Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands;Department of Internal Medicine, University of Tartu, Tartu, Estonia;Department of Nursing Science and Nurse Director, Turku University Hospital, University of Turku, Turku, Finland;Department of Nursing Science, Witten/Herdecke University, Witten, Germany;Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany;Hospital Clinic de Barcelona, Barcelona, Spain;School of Medicine, Universitat de Barcelona, Barcelona, Spain;RWI – Leibniz-Institute for Economic Research, Leibniz Science Campus Ruhr and RUB, Essen, Germany;School of Health Sciences, University of Manchester, Manchester, UK;Universitat Autònoma de Barcelona, Barcelona, Spain;Member of the Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain;Department of Geriatric Medicine, Parc de Salut Mar, Barcelona, Spain;

关键词: Aged;    Dementia;    Geriatric syndrome;    Home care;    Hospitalisation;    Nursing home;   

DOI  :  10.1186/s12877-020-01835-x

来源: Springer

【 摘 要 】

BackgroundEvidence is lacking on the differences between hospitalisation of people with dementia living in nursing homes and those living in the community. The objectives of this study were: 1) to describe the frequency of hospital admission among people with dementia in eight European countries living in nursing homes or in the community, 2) to examine the factors associated with hospitalisation in each setting, and 3) to evaluate the costs associated with it.MethodsThe present study is a secondary data analysis of the RightTimePlaceCare European project. A cross-sectional survey was conducted with data collected from people with dementia living at home or who had been admitted to a nursing home in the last 3 months, as well as from their caregivers. Data on hospital admissions at 3 months, cognitive and functional status, neuropsychiatric symptoms, comorbidity, polypharmacy, caregiver burden, nutritional status, and falls were assessed using validated instruments. Multivariate regression models were used to investigate the factors associated with hospital admission for each setting. Costs were estimated by multiplying quantities of resources used with the unit cost of each resource and inflated to the year 2019.ResultsThe study sample comprised 1700 people with dementia living in the community and nursing homes. Within 3 months, 13.8 and 18.5% of people living in nursing homes and home care, respectively, experienced ≥1 hospital admission. In the nursing home setting, only polypharmacy was associated with a higher chance of hospital admission, while in the home care setting, unintentional weight loss, polypharmacy, falls, and more severe caregiver burden were associated with hospital admission. Overall, the estimated average costs per person with dementia/year among participants living in a nursing home were lower than those receiving home care.ConclusionAdmission to hospital is frequent among people with dementia, especially among those living in the community, and seems to impose a remarkable economic burden. The identification and establishment of an individualised care plan for those people with dementia with polypharmacy in nursing homes, and those with involuntary weight loss, accidental falls, polypharmacy and higher caregiver burden in the home care setting, might help preventing unnecessary hospital admissions.

【 授权许可】

CC BY