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

on behalf of the RightTimePlaceCare Consortium¹  Mercè Comas²  F. Javier Afonso-Argilés³  Maria Soto-Martin⁴  Connie Lethin⁵  Hilde Verbeek⁶  Kai Saks⁷  Helena Leino-Kilpi⁸  Astrid Stephan⁹  Gabriele Meyer⁹  Adelaida Zabalegui^1,10  Ansgar Wübker^1,11  Caroline Sutcliffe^1,12  Anna Renom-Guiteras^1,13 

[1] ;Department of Epidemiology and Evaluation. Hospital del Mar;Department of Geriatric Medicine and Palliative Care. Badalona Serveis Assistencials;Department of Geriatric Medicine, Gerontopole, Alzheimer Disease Research Center, Inserm UMR 1027, University Hospital of Toulouse;Department of Health Sciences. Faculty of Medicine, Lund University;Department of Health Services Research, Care and Public Health Research Institute, Maastricht University;Department of Internal Medicine, University of Tartu;Department of Nursing Science and Nurse Director, Turku University Hospital, University of Turku;Department of Nursing Science, Witten/Herdecke University;Hospital Clinic de Barcelona;RWI – Leibniz-Institute for Economic Research, Leibniz Science Campus Ruhr and RUB;School of Health Sciences, University of Manchester;Universitat Autònoma de Barcelona;

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

DOI  :  10.1186/s12877-020-01835-x

来源: DOAJ

【 摘 要 】

Abstract Background Evidence 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. Methods The 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. Results The 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. Conclusion Admission 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】

Unknown