Blog | Monday, November 21, 2011

QD: News Every Day--Dementia inpatients must be shifted away from hospitals, back to nursing homes

Sending dementia patients to the hospital could overwhelm the health care system and not offer them any better care at the end of life, researchers noted.

The researchers obtained data on all hospitalizations involving a dementia diagnosis for the 85 years and older group between years 2000 and 2008 from the nationally representative Nationwide Inpatient Sample database, a part of the Agency for Healthcare Research and Quality Healthcare Costs and Utilization Project.

Annual hospitalization data came from the U.S. Census Bureau. They projected the future volume of hospitalizations involving a dementia diagnosis in the 85 years and older group two ways, with and without allowing for population growth, to compute the absolute minimum potential growth and then to account for population growth and 7 the observed historic increase in the age-adjusted incidence of dementia hospitalizations between years 2000 and 2008.

The research letter appeared in the Nov. 14 issue of Archives of Internal Medicine.

Researchers noted that between 2000 and 2008, patients 85 years and older comprised less than 2% of the total U.S. population, they represented more than 40% of all annual hospitalizations associated with dementia. The actual absolute volume growth from 700,000 to 1.2 million hospitalizations among patients with a dementia diagnosis between 2000 and 2008 equated to population incidence increase from 16,398 to 21,088 cases per 100,000 population.

The estimated 2050 volume of dementia hospitalizations in the 85 years and older group may be between 3 and 7 million, depending upon accounting for population growth, or a potential a 10-fold growth in the volume of these hospitalizations.

Even at its minimum, the absolute growth in hospitalizations involving a dementia diagnosis could overwhelm the health care system, the authors noted.

"In addition, humanistic considerations dictate that this degree of aggressive care may be inappropriate for many patients with dementia," the authors wrote. "For example, it has been reported that patients with advanced-stage disease have a prognosis comparable to metastatic breast cancer or stage IV heart failure. Although our data are unable to convey the severity of the observed dementia diagnoses, a recent study noted that 18.7% of nursing home residents with advanced dementia were hospitalized near the end of life, even though the most frequently stated goal of care was comfort. For such patients, hospitalizations represent more of an intrusive burden than a desirable intervention."

Commenters told Reuters that the burden will have to shift back to nursing homes to care for non-life threatening illnesses such as pneumonia, in order to lower acute-care hospitalization costs and provide more comfortable care.