Background: The number of individuals with Alzheimer’s disease and related dementias (ADRD) in the U.S is projected to reach 16 million by 2050. Currently, they account for 3.2 million hospital admissions per year and over 75% of hospitalized persons with ADRD display Behavioral and Psychological Symptoms of Dementia (BPSD). The study aimed to evaluate management practices BPSD as well as patient outcomes in hospitalized older patients with ADRD.
Methods: A retrospective chart review across 7 hospitals within a large health system compared patients 65 and older with a previous ADRD diagnosis vs a random sampling of age matched patients with no previous ADRD diagnosis. Primary outcomes included: restraints, psychoactive medications, 1:1 observation. Secondary measures included: length of stay (LOS), in-hospital mortality, and 30-day readmission. Competing risks analysis (i.e., subdistribution hazards model) was used to account for risk of death when estimating incidence of being discharged alive. Chi-square test was used for association between ADRD status and 30-day readmission.
Results: The ADRD group (n=6195) had a median age of 84.6 (female 63%, white 65%), while the non-ADRD group (n=7660) had a median age of 77.0 (female 54%, white 62%). Patients with ADRD were more likely to receive psychoactive medications (13% vs. 1.7%), restraints (6.6% vs. 2.5%), and 1:1 observations (14% vs. 3%). With regard to secondary outcomes, patients with ADRD as compared to those without ADRD were found to have: a longer LOS (5 days vs 4 days; sub-distribution hazard ratio was 1.23, p<0.0001), higher incidence of in-hospital mortality (estimated cumulative incidence of being discharged alive at 5 days after admission was 51.5% [95% CI: 50.6, 52.3] vs. 58.9% [95% CI: 58.0, 59.8]), and 3% increased risk of 30-day readmissions (95% CI: 2, 4.5, p<0.0001).
Conclusions: Hospitalization in older persons with ADRD is associated with increased LOS, in-hospital mortality, and 30-day readmission. In addition, hospitalized older adults with ADRD who display behavioral symptoms are commonly treated with psychoactive medications, restraints, and 1:1 observation. Initiatives to raise awareness and improve the management of hospitalized older adults with ADRD are urgently needed.