Adverse Events,Functional Decline,and Access to Allied Health Therapies for Patients With Dementia During Acute Hospitalization

Abstract

The number of patients attending acute care hospitals with a diagnosis of dementia is increasing. The impact of hospitalization on function and adverse events is perceived to be greater for patients with dementia than those without. This study compared adverse events (falls, wounds, delirium, medication errors, infections, and incontinence), functional decline, and allied health therapy for patients with and without dementia (n = 240). Patients with dementia experienced significantly more adverse events and constant observation by staff, were more dependent with mobility, hygiene and feeding, more often nil by mouth, confused, and incontinent. Patients with dementia were significantly more likely to receive speech and physiotherapy, although they did not significantly improve in function during their hospital stay. Conversely, patients without dementia significantly improved in mobility and continence. The unique health care needs of patients with dementia need to inform models of care, policy, and practice to support safe health care delivery in this vulnerable population.

Keywords

dementia hospitalization acute care adverse events allied health therapy functional decline

Background

Globally, the number of people living with a diagnosis of dementia is expected to increase to over 150 million by the year 2050 (World Health Organization, 2017). One in 10 people over the age of 65 years have dementia and, every year, approximately 25% of these will require an admission to hospital (Dementia Australia, 2019). The leading causes of hospitalization for patients with dementia are urinary tract infection, chest infection, syncope, falls, hip fracture, and delirium (Rao et al., 2016).

Research reporting the hospital experience and health outcomes indicate that older people are at higher risk of functional decline during hospitalization (Basic et al., 2017; Lizarondo, 2016) with up to 50% of older people in acute care facilities experiencing a decline during their hospital stay (Palese et al., 2016). Functional decline has been measured using various tools; however, the focus remains on mobility and capacity to independently attend to needs such as eating and hygiene cares (Basic et al., 2017; Palese et al., 2016; Zekry et al., 2008). Functional decline is associated with poor health outcomes, such as reduced ability to complete activities of daily living and increased rates of discharge to a care facility (Palese et al., 2016). Rationing of nursing care occurs when there are limited resources, often resulting in aspects of care being withheld or not delivered (Papastavrou et al., 2014). This rationing of care has been identified as contributing to cognitive and functional decline in older patients during acute hospitalization (Bail & Grealish, 2016).

Research on the impact of hospitalization on older people suggest that 14% will experience an adverse event while in hospital (Ackroyd-Stolarz et al., 2009). Patients with dementia in acute medical and surgical wards have 2.5 times the risk of having a preventable complication compared with patients without dementia when matched by age group (Bail et al., 2013). Patients with dementia experience significantly higher hospital readmission rates, urinary tract infections, pressure ulcers, pneumonia, dehydration, and electrolyte imbalances compared with patients without dementia (Rao et al., 2016). Furthermore, dementia has been identified as a significant factor for extending the length of hospital stay for older people (Challis et al., 2014). Factors influencing delayed discharge from acute care facilities include cognitive impairment, comorbidities, dependency, and discharge to a residential aged care facility (RACF) (Challis et al., 2014; Salonga-Reyes & Scott, 2017). Research by Fogg and colleagues (2017) reported that patients with cognitive impairment or a diagnosis of dementia were at higher risk of malnutrition and dying in hospital than other patients.

Rehabilitation programs in acute care facilities can improve function and reduce nursing home admissions for older patients (Lizarondo, 2016). Rehabilitation therapies are provided by multidisciplinary health professionals, such as occupational, speech, or physiotherapists, with the aim of improving function before discharge thereby maintaining or improving health outcomes of patients with dementia (Basic et al., 2017). Mitchell et al. (2016) found that patients with dementia in subacute and nonacute settings were 4.3 times less likely to receive rehabilitation despite demonstrating similar functional gain to patients without dementia. Similarly, Rosler et al. (2009) reported that in a group of patients undergoing osteosynthesis of the proximal femur, patients with dementia received less individual and group therapy sessions. People with dementia may be perceived to have limited rehabilitation potential due to their cognitive impairment (Draper et al., 2014), yet are at high risk for functional decline during acute hospitalization.

There is evidence surrounding the impact of hospitalization for older people, and some for nonacute care of people with dementia. However, the influence of an increased length of stay in an acute hospital on health outcomes for patients with dementia is unclear. This study aimed to further understand the factors that affect patient health outcomes with a view to implementing models of care that promote optimal health outcomes for this group in the future. This exploratory, system-level research examined the acute hospital experience of older people with and without dementia specifically focusing on length of stay, functional decline, adverse hospital events, and access to allied health therapies.

Method

A retrospective chart audit of people over the age of 65 years admitted to a 270 bed outer metropolitan public teaching hospital during the 2017 calendar was conducted.

Study Sample

Using International Statistical Classification of Disease (ICD) coding to identify patients with a diagnosis of dementia (as recorded in their medical chart by a medical officer), two randomized lists of patients with and without dementia, aged 65 years or older, admitted to an acute care ward for 24 hours or more during 2017, were generated. De-identified data were collected from 120 eligible participants from each list (N = 240). Three researchers completed the chart audit and 10% (24) of all cases were checked for interrater reliability. An average consensus of 98% on the variables collected was achieved.

Measures

Patients were first coded as Yes or No to having a dementia diagnosis based on ICD codes and verified by a cross check of medical notes in the patient’s chart by the research team. Patient demographic data—age, gender, primary diagnosis, admission and discharge date, time and location—were collected. Length of stay was calculated using date and time of admission and discharge and reported in days. Two registered nurses (members of the research team) categorized the patient’s primary diagnosis as either surgical or nonsurgical and orthopedic or nonorthopedic. The nurses agreed 100% of the time on the diagnosis of dementia and 92% of the time on the patient’s primary diagnosis. A third member of the research team adjudicated the discrepancy and an agreement was reached. The Nursing Care Plan, Progress Notes, Incident Reports, and other standard hospital documents were used to identify adverse events (falls, wounds, hospital acquired infection or incontinence, delirium and medication errors) and if the patient required constant observation (CO) by a staff member during hospitalization. Any adverse event documented in the medical chart was recorded.

The patient’s level of physical function on admission and discharge were recorded based on the ability to complete activities of daily living (mobility, feeding and hygiene cares) as either independent or not independent. Continence was recorded as either continent or not continent. If the patient received allied health therapy, the type (dietician, speech, occupational and/or physiotherapist) and number of sessions the patient attended were recorded. The initial visit was considered an assessment rather than a therapeutic session. This research received ethical approval from the relevant Hospital and Health Service, Human Research Ethics Committee.

Analysis

Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) Version 25(Armonk, NY) with p values < .05 considered statistically significant. Patient characteristics were summarized using the mean and standard deviation for continuous variables and frequency and percentages for categorical variables. Descriptive analyses were used to examine the differences between patients with and without dementia. T-tests and chi-square tests (or Fischer’s exact test) were used to determine bivariate differences for continuous or categorical variables, respectively. Binomial logistic regressions were used to estimate the odds ratio (OR) and 95% confidence interval (CI) of predictor variables associated with patients experiencing adverse events, undergoing surgery, dying while in hospital and being discharged to a RACF when admitted from home. Linear regression analysis was used to examine the effect of predictor variables on length of stay. The related samples McNemar’s test was used to measure differences in patient’s physical function (measured as a dichotomous variable) between admission and discharge.

Results

Participant Demographics at Admission

There were 125 female and 115 male participants with no statistical difference in gender between patients with and without dementia (Table 1). For all other patient characteristics, there were significant differences between patients with and without dementia (Table 1).

Table 1.

Comparison of Patient Characteristics at Admission.

Characteristic	Patients with dementia	Patients without dementia	t or χ²	p
Characteristic	N = 120	N = 120	t or χ²	p
Gender, n (%)
Female	59 (49.2)	66 (55.0)	χ² = .819	.366
Male	61 (50.8)	54 (45.0)
Age in years, M (SD) [range]	83.5 (7.38) [65–98]	76.4 (8.27) [65–101]	t = 7.092	<.001
Female	85.7 (6.22) [69–98]	76.4 (8.63) [65–101]	t = 6.840	<.001
Male	81.5 (7.86) [65–94]	76.4 (7.90) [65- 95]	t = 3.481	.001
Admission source, n (%)
Home	49 (40.8)	107 (89.2)	—	<.001 ^a
RACF	70 (58.3)	5 (4.2)
Other health care facility	1 (0.8)	8 (6.7)
Primary diagnosis, n (%)			χ² = 6.998	.008
Surgical	18 (15.0)	35 (29.2)
Nonsurgical	102 (85.0)	85 (70.8)
Mobility, n (%)	n = 113	n = 119	χ² = 56.814	<.001
Independent	7 (6.2)	61 (51.3)
Not independent	106 (93.8)	58 (48.7)
Cognition, n (%)	n = 117	n = 120	χ² = 168.46	<.001
Not confused	15 (12.8)	116 (96.7)
Confused	102 (87.2)	4 (3.3)	3
Hygiene cares, n (%)	n = 116	n = 120	χ² = 59.719	<.001
Independent	4 (3.4)	57 (47.5)
Not independent	112 (96.6)	63 (52.5)
Feeding ability,^a n (%)	n = 99	n = 113	χ² = 76.707	<.001
Independent	24 (24.2)	95 (84.1)
Not independent	75 (75.8)	18 (15.9)
Nil by mouth, n (%)	n = 113	n = 118	χ² = 5.082	.024
Yes	14 (12.4)	5 (4.2)
No	99 (87.6)	113 (95.8)
Continence, n (%)	n-116	n = 120	χ² = 47.746	<.001
Continent	30 (25.9)	85 (70.8)
Not continent	86 (74.1)	35 (29.1)

Note. RACF = residential aged care facility.

Excludes nil by mouth patients.

Note. Bold values are statistically significant at p = < 0.05.

The mean age of patients with dementia was 85.5 years, which was significantly older than patients without dementia (76.4 years). Over half of patients with dementia (58.3%) were admitted from an RACF while most patients without dementia (89.2%) were admitted from home. There were statistically significant differences in primary diagnosis with patients with dementia less likely to undergo surgery compared with patients without dementia. However, when exploring the likelihood of surgery in multivariable analysis, age but not dementia was a significant predictor (OR = 0.9).

There were significant differences between patients with and without dementia on all measures of patient function on admission. Patients with dementia were more likely to be dependent with mobility, hygiene and feeding, and to be nil by mouth, confused, and incontinent when compared with patients without dementia (Table 1). When controlling for age, these differences remained significant for all variables apart from nil by mouth with p values ranging from <.001 to .018 (data not shown). Nil by mouth was explained better by age than dementia diagnosis, with patients aged 80 years and older more likely to be nil by mouth than younger patients.

Patient Experience of Hospitalization

There were statistically significant differences between patients with and without dementia on all measures of health care, with patients with dementia experiencing worse outcomes than patients without dementia (Table 2).

Table 2.

Comparison of Patient Experience of Hospitalization.

Characteristic	Patients with dementia	Patients without dementia	t or χ²	p
Characteristic	N = 120	N = 120	t or χ²	p
Length of stay in daysMedian, M (SD) IQR	5.0, 10.3 (14.37) 9.18	2.2, 3.8 (5.31) 2.39	t = 4.632	<.001
Adverse event, n (%)			χ² = 19.509	<.001
Yes	34 (28.3)	8 (6.7)
No	86 (71.7)	112 (93.3)
Adverse event type, n (%)^a
Wound	13	2
Fall	10	1
Delirium	8	3
Medication error	5	2
Hospital acquired infection	2	0
Hospital acquired incontinence	2	0
Total	40	8
Constant observation, n (%)			χ² = 36.144	<.001
Yes	36 (30.0)	2 (1.7)
No	84 (70.0)	118 (98.3)
Constant observation, daysMedian, M (SD) IQR	3, 4.0 (4.33) 4.00	4, 4.0 (1.41) -	t = 1.000	1.000
Cognitive test, n (%)			χ² = 20.948	<.001
Yes	60 (50.0)	26 (21.7)
No	60 (50.0)	94 (78.3)
Physiotherapy, n (%)			χ² = 5.780	.016
Yes	44 (36.7)	27 (22.5)
No	76 (63.3)	93 (77.5)
Occupational therapy, n (%)			χ² = 1.553	.213
Yes	16 (13.3)	10 (8.3)
No	104 (86.7)	110 (91.7)
Speech therapy, n (%)			χ² = 15.238	<.001
Yes	25 (20.8)	5 (4.2)
No	95 (79.2)	115 (95.8)
Dietitian, n (%)			χ² = 1.553	.213
Yes	16 (13.3)	10 (8.3)
No	104 (86.7)	110 (91.7)
Mobility at discharge, n (%)	n = 109	n = 119	χ² = 69.619	<.001
Independent	9 (8.3)	73 (61.3)
Not independent	100 (91.7)	46 (38.7)
Cognition at discharge, n (%)	n = 114	n = 119	χ² = 150.257	<.001
Not confused	14 (12.3)	110 (92.4)
Confused	100 (87.7)	9 (7.6)
Hygiene cares at discharge, n (%)	n = 117	n = 117	χ² = 59.837	<.001
Independent	6 (5.1)	59 (50.4)
Not independent	111 (94.9)	58 (49.6)
Feeding ability^b at discharge, n (%)	n = 101	n = 117	χ² = 84.123	<.001
Independent	23 (22.8)	99 (84.6)
Not independent	78 (77.2)	18 (15.4)
Nil by mouth at discharge, n (%)	n = 110	n = 117		.001 ^c
Yes	9 (8.2)	0 (0.0)
No	101 (91.8)	110 (100.0)
Continence at discharge, n (%)	n = 113	n = 118	χ² = 74.241	<.001
Continent	27 (23.9)	95 (80.5)
Not continent	86 (76.1)	23 (19.5)
Discharge destination, n (%)	n = 105	n = 188
Home	25 (23.8)	91 (77.1)	χ² = 93.798	<.001
RACF	71 (67.6)	7 (5.9)
Other health care facility	9 (8.6)	20 (16.9)
Admitted home^d & discharged RACF, n (%)	n = 43	n = 105
Yes	13 (30.2)	1 (1.0)	—	<.001 ^c
No	30 (69.8)	104 (99.0)
Mortality, n (%)
Died in hospital	15 (12.5)	2 (1.7)	χ² = 10.699	.001

Note. IQR = interquartile range; RACF = residential aged care facility.

Six patients with dementia experienced two adverse events. ^bExcludes nil by mouth patients. ^cFisher’s exact test. ^dIncludes only patients admitted from home and excludes patients who died in hospital, n = 148.

Note. Bold values are statistically significant at p = < 0.05.

Patients with dementia were more likely to have longer length of stay (LOS) than patients without (median 5.0 days vs. 2.2 days). Adverse events identified in patient medical notes were wounds, in-hospital falls, delirium, hospital acquired infection and/or incontinence, and medication errors. Patients with dementia had a greater relative risk (RR) of experiencing an adverse event (RR = 4.3, 95% CI [2.05, 8.80]); requiring constant patient observation (RR = 18.0, 95% CI [4.43, 73.08]); and undergoing a cognitive examination using the 4AT test (RR 2.3, 95% CI [1.57, 3.39]), compared with patients without dementia. Conducting a 4AT test on patients at this site was not routine practice but a response to an observed change in orientation, behavior, or cognition suggesting delirium.

Overall, 166 (69.2%) patients had an assessment by at least one allied health therapist. Patients with dementia were significantly more likely to have at least one allied health assessment compared with patients without dementia (n = 96, 80.0% vs. n = 70, 58.3%; χ² = 13.207, p < .001). Of these, 94 patients went on to have more than one visit from an allied health professional during hospitalization; 61(50.8%) patients with dementia and 33 (27.5%) patients without dementia. Patients with dementia were more likely to receive physiotherapy and speech therapy compared with patients without dementia. There were no differences in the number of occupational therapy and dietitian sessions between the two groups.

There were significant differences between patients with and without dementia on all measures of patient function at discharge. Patients with dementia were more likely to be dependent with mobility, hygiene, and feeding, and to be nil by mouth, confused, and incontinent.

Patients with dementia were more likely to be admitted from and discharged to a RACF and less likely to be discharged to another health care facility. This included another hospital or to a nonacute area such as rehabilitation in the same hospital. For those patients admitted from home, patients with dementia were significantly more likely to be discharged to a RACF (30.2%) compared with patients without dementia (1.0%). The relative risk of people with dementia compared with people without dementia admitted from home being discharged to an RACF was 31.7 (95% CI [4.28, 235.21]). Patients with dementia were significantly more likely to die in hospital (12.5%) compared with patients without dementia (1.7%). The relative risk of people with dementia compared with people without dementia dying during their hospital admission was 7.5 (95% CI [1.75, 32.09]).

Predictors of Length of Stay and Adverse Events

Variables identified in the literature and those that had a significant bivariate relationship (p < .10) with length of stay or experiencing an adverse event were explored further through multivariable analysis. In addition to a diagnosis of dementia, gender, patient age, mobility, self-feeding ability, continence, and primary diagnosis were all examined as potential predictors of both length of stay and experiencing an adverse event (Table 3).

Table 3.

Summary of Regression Analysis for Variables Predicting Length of Stay and Experiencing an Adverse Event.

Variable	Length of stay^a (n = 207)				Adverse event^b (n = 224)
	Model 1		Model 2		Model 1		Model 2
	B	β	B	β	B	OR	B	OR
Constant	3.673**		.106		−2.612**	0.07	−2.882	0.06
Dementia diagnosis	5.662**	.315	4.137*	.230	1.669**	5.31	1.612*	5.01
Gender: male vs. females			1.148	.064			0.556	1.74
Age on admission (years)			0.037	.036			−0.003	0.99
Mobility on admission: dependent vs. independent			0.782	.041			−0.264	0.77
Admission continence: not continent vs. continent			−0.069	−.004			0.322	1.38
Feed ability admission^c dependent vs. independent			1.224	.068			—	—
Nil by mouth admission			—	—			1.829*	6.23
Primary diagnosis: surgical vs. not surgical			−1.246	−.058			0.369	1.45
	R² = .099		R² =.113		Nagelkerke R² = .134		Nagelkerke R² = .220
	F = 22.579		F = 3.627
			ΔR² = .014
			ΔF = .521

Note. OR = odds ratio.

Hierarchical linear regression. ^bLogistic regression. ^cPatients nil by mouth on admission (N = 19) excluded.

p < .05. **p < .001.

Length of stay

Hierarchical linear regression was run to determine whether these variables contributed to the prediction of length of stay over and above the dementia diagnosis. Although the overall model was statistically significant, R² = .113, F(7,199) = 3.627, p = .001; adjusted R² = .82, the addition of the other predictor variables did not contribute significantly to the model—increase of R² of .014, F(6,199) = .521, p = .79. The strongest and only significant predictor remained a diagnosis of dementia.

Adverse events

Logistic regression was used to determine whether the predictor variables had a relationship with patients experiencing an adverse event while in hospital. A diagnosis of dementia remained a significant predictor. A patient with dementia had 5.0 times the odds of experiencing an adverse event compared with a patient without dementia (p = .003). Overall, the model was significant, χ² (31.637), p<.001, and explained 22.0% (Nagelkerke R²) of the variance in whether an adverse event was experienced or not. The model correctly classified 83.9% of cases. Sensitivity was 18.4%, specificity was 97.3%, positive predictive value was 58.3%, and negative predictive value was 85.4%. Also contributing to the explanatory power of the model was being nil by mouth on admission (OR = 6.2).

Changes in Level of Physical Function From Admission to Discharge

For patients with dementia, there was no significant difference on any of the physical function measures from admission to discharge (Table 4). For patients without dementia, there was a significant improvement in both mobility and continence between admission and discharge and no difference on the other measures.

Table 4.

Comparison of Patient Functional Ability From Admission and Discharge by Dementia Diagnosis.

Function	Patients with dementia				Patients without dementia
	n (%)		McNemar^a		n (%)		McNemar^a
	Admission	Discharge	n	p	Admission	Discharge	n	p
Mobility			104	.727			118	.027
Independent	7 (6.7)	9 (8.7)			61 (51.7)	72 (61.0)
Not independent	97 (93.3)	95 (91.3)			57 (48.3)	46 (39.0)
Cognition			113	1.000			119	.125
Not confused	14 (12.4)	14 (12.3)			115 (96.6)	110 (92.4)
Confused	99 (87.6)	99 (87.6)			4 (3.4)	9 (7.6)
Hygiene cares			113	.754			117	.850
Independent	4 (3.5)	6 (5.3)			57 (48.7)	59 (50.4)
Not independent	109 (96.5)	107 (94.7)			60 (51.3)	58 (49.6)
Feeding ability^b			91	.481			112	.581
Independent	22 (24.2)	18 (19.8)			94 (83.9)	97 (86.6)
Not independent	69 (75.8)	73 (80.2)			18 (16.1)	15 (13.4)
Nil by mouth			106	.180			116	.125
Yes	13 (12.3)	8 (7.5)			4 (3.4)	0 (0.0)
No	93 (87.7)	98 (92.5)			112 (96.6)	116 (100.0)
Continence			111	1.000			118	.017
Continent	28 (25.2)	27 (24.3)			83 (70.3)	95 (80.5)
Not continent	83 (74.8)	84 (75.7)			35 (29.7)	23 (19.5)

Related samples McNemar test. ^bExcludes nil by mouth patients.

Note. Bold values are statistically significant at p = < 0.05.

Discussion

Patient demographic findings in this study concur with previous research. There was no statistical difference in gender between patients with and without dementia; however, patients with dementia were significantly older, had higher in-hospital mortality rates and longer hospital lengths of stay than patients without dementia. This is consistent with a systematic review by Mukadam and Sampson (2011) who also reported patients with dementia required more nursing care hours than patients without dementia. Challis and colleagues (2014) reported comorbidities, dependency, and discharge to a residential facility influenced length of stay. However, after adjusting for age, mobility, hygiene, self-feeding ability, continence, and primary diagnosis, our study found the strongest and only significant predictor of length of stay remained a diagnosis of dementia.

This research highlights statistically significant variations across all health care outcomes measured in this study. People with dementia were significantly more likely to be admitted from and discharged to a RACF. If the patient was admitted from home, those with dementia were more likely to be discharged to a RACF. Zekry et al. (2009) examined patients in acute and rehabilitation settings and reported that the best predictor of institutionalization was a diagnosis of dementia, although length of stay was best predicted by higher comorbidity scores. In our study, patients identified as not independent with mobility and self-feeding were more likely to receive physio and speech therapy. Nearly 70% of patients with dementia were admitted from and discharged to a RACF with less than 10% experiencing a change in destination following hospitalization. Independence with mobility or feeding and patient discharge destination were two factors that may have influenced the length of stay for patients with dementia.

Patients with dementia were significantly more likely to experience an adverse event, require constant observation (CO), and undergo a cognitive assessment. Research by Bail and colleagues (2013) examined preventable complication rates and found patients with dementia to be more likely to experience urinary tract infection, pressure ulcer, pneumonia, and delirium. In our study, 28% versus 7% of patients with and without dementia experienced an adverse event. The outcomes measured in this study have not been replicated in other studies; however, this indicates that adverse events may be far more preventable for patients with dementia than previously understood, suggesting more extensive research should be undertaken. Given the relationship of adverse events to length of stay and subsequent cost of hospitalization (Ackroyd-Stolarz et al., 2009), this is an area of concern not only for people with dementia and health care providers, but also from an economic perspective for health system managers.

All measures of physical function on admission and discharge showed significant variance between patients with and those without a diagnosis of dementia. After adjusting for age, patients with dementia were still more likely to be confused, incontinent, and dependent with daily cares. These findings add to the current body of knowledge by Zekry et al. (2008) who reported that instrumental activities of daily living, functional independence measures, and mini nutritional assessments of patients with dementia were lower on admission for patients with dementia than those without. In our study, physical function of patients with dementia did not vary significantly from admission to discharge, while patients without dementia showed significant improvement in both mobility and continence. This finding varies significantly from that of Palese et al. (2016) who found that up to 50% of older acute care patients experience functional decline during hospitalization.

Patients with dementia in this study were not only significantly more likely to be assessed by an allied health therapist but also more likely to receive ongoing speech and physiotherapy sessions. Conversely, Mitchell et al. (2016) found that patients with dementia in sub- and nonacute care have been reported to be less likely to receive rehabilitation. Patient and caregiver desire to return home, along with health care facility policy and procedures promoting home discharge may be driving access to therapy in acute care settings. In addition, the introduction of new standards in which a patient must be reviewed by a physiotherapist to assess mobility on admission may be contributing to these findings.

Strengths and Limitations

This study used robust methods to ensure a random sample was achieved and that accurate data was collected. However, as this was a single-center sample, the results may not be generalizable to other settings. The small sample size in this study has prevented the matching of pairs according to gender, diagnosis, or comorbidities, all of which may have impacted upon results. In addition, the use of retrospective data is dependent upon accurate coding and documentation by multiple staff on multiple occasions, and as such this may have led to reporting bias in some cases.

Conclusion

It has been well established that older people who are admitted to acute care are at greater risk of experiencing functional decline and adverse events, yet little was known about the predictive factors of health outcomes for patients with dementia. This research has reinforced findings in relation to hospital length of stay and mortality. It adds important understanding in relation to the physical function of patients with dementia compared with those without and some findings in relation to the access to allied health therapies in acute settings. In this study, patients with dementia were more dependent across all physical functions, were more likely to require constant observation and more likely to experience an adverse event during hospitalization. These findings highlight the increased care needs of patients with dementia in acute care settings.

Footnotes

Acknowledgements

The authors would like to acknowledge the support of Dr. Elaine Fielding from the Dementia Collaborative Research Centre, QUT in the data analysis for this study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research was funded by two grants (An Institute of Health and Biomedical Innovation Seed Grant $10,000 and a Private Practice Trust Fund $10,000).

Ethical Approval

This research has ethics approval from the Queensland Health Metro North Hospital and Health Service, Human Research Ethics Committee (Approval Number: HREC/18/QPCH/150).

ORCID iD

Amanda Fox

References

Ackroyd-Stolarz

Guernsey

J. R.

MacKinnon

N. J.

Kovacs

(2009). Adverse events in older patients admitted to acute care: A preliminary cost description. The Healthcare Management Forum. Fall, 32–36.

Bail

Berry

Grealish

Draper

Karmel

Gibson

Peut

(2013). Potentially preventable complications of urinary tract infections, pressure areas, pneumonia, and delirium in hospitalised dementia patients: Retrospective cohort study. BMJ Open, 3(6), Article e002770.

Bail

Grealish

(2016). “Failure to Maintain”: A theoretical proposition for a new quality indicator of nurse care rationing for complex older people in hospital. International Journal of Nursing Studies, 63, 146–161. https://doi.org/10.1016/j.ijnurstu.2016.08.001

Basic

Ni Chroinin

Conforti

Shanley

(2017). Predictors on admission of functional decline among older patients hospitalised for acute care: A prospective observational study. Australasian Journal on Ageing, 36, E57–E63. https://doi.org/10.1111/ajag.12458

Challis

Hughes

Xie

Jolley

(2014). An examination of factors influencing delayed discharge of older people from hospital. International Journal of Geriatric Psychiatry, 29(2), 160–168.

Dementia Australia. (2019). Dementia statistics: Key facts and statistics. https://www.dementia.org.au/statistics

Draper

Hudson

Peut

Karmel

Chan

Gibson

(2014). Hospital Dementia Services Project: Aged care and dementia services in New South Wales hospitals. Australasian Journal on Ageing, 33(4), 237–243. https://doi.org/10.1111/ajag.12042

Fogg

Meredith

Bridges

Gould

Griffiths

(2017). The relationship between cognitive impairment, mortality and discharge characteristics in a large cohort of older adults with unscheduled admissions to an acute hospital: A retrospective observational study. Age and Ageing, 46, 794–801. https://doi.org/10.1093/ageing/afx022

IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.

10.

Lizarondo

(2016). Older adults: Preventing functional decline during hospitalization [EBP Database]. Johanna Briggs Institute.

11.

Mitchell

Harvey

Brodaty

Draper

(2016). Hip fracture and the influence of dementia on health outcomes and access to hospital-based rehabilitation for older individuals. Disability and Rehabilitation, 38(23), 2286–2295. https://doi.org/10.3109/09638288.2015.1123306

12.

Mukadam

Sampson

(2010). A systematic review of the prevalence, associations and outcomes of dementia in older general hospital inpatients. International Psychogeriatric Association. 23(3), 344-355. Doi:101017/S1041610210001717

13.

Palese

Gonella

Moreale

Guarnier

Barelli

Zambiasi

. . . Marin

(2016). Hospital-acquired functional decline in older patients cared for in acute medical wards and predictors: Findings from a multicentre longitudinal study. Geriatric Nursing, 37(3), 192–199.

14.

Papastavrou

Andreou

Efstathiou

(2014). Rationing of nursing care and nurse-patient outcomes: a systematic review of quantitative studies. International Journal of Health Planning and Management 29(1), 3-25.

15.

Rao

Suliman

Vuik

Aylin

Darzi

(2016). Outcomes of dementia: Systematic review and meta-analysis of hospital administrative database studies. Archives of Gerontology and Geriatrics, 66, 198–204. https://doi.org/10.1016/j.archger.2016.06.008

16.

Rosler

Krause

Niehuus

von Renteln-Kruse

(2009). Dementia as a cofactor for geriatric rehabilitation-outcome in patients with osteosynthesis of the proximal femur: A retrospective, matched-pair analysis of 250 patients. Archives of Gerontology and Geriatrics, 49(1), e36–e39. https://doi.org/10.1016/j.archger.2008.08.003

17.

Salonga-Reyes

Scott

I. A.

(2017). Stranded: Causes and effects of discharge delays involving non-acute in-patients requiring maintenance care in a tertiary hospital general medicine service. Australian Health Review, 41(1), 54–62.

18.

World Health Organization. (2017). Dementia fact sheet. https://www.who.int/news-room/fact-sheets/detail/dementia

19.

Zekry

Herrmann

Grandjean

Meynet

Michel

Gold

Krause

K.-H.

(2008). Demented versus non-demented very old inpatients: The same comorbidities but poorer functional and nutritional status. Age and Ageing, 37, 83–89.

20.

Zekry

Herrmann

Grandjean

Vitale

De Pinho

Michel

Krause

K.-H.

(2009). Does dementia predict adverse hospitalization outcomes? A prospective study in aged inpatients. International Journal of Geriatric Psychiatry, 24(3), 283–291. https://doi.org/10.1002/gps.2104