Stage of Disease Among Hospitalized Persons Living With Dementia: A Multisite Study.
David H Lynch, Molly E Lynch, Kathryn L Wessell and 4 others
PMID 41962917WHAT IT FOUND
Most hospitalized dementia patients had moderate dementia, not severe.
They were more likely to be older, Black, admitted to general medicine, and diagnosed with Alzheimer's disease. Severe dementia was rare and may be missed because palliative or hospice patients were excluded.
Key findings
01Among 6303 hospitalized patients with confirmed dementia, 57.8% had moderate dementia, 39.3% had mild dementia, and 2.9% had severe dementia.
02Compared with mild dementia, moderate dementia was associated with age 75 to 84, age 85 or older, Black race, and Alzheimer's disease, and with lower odds of admission to a subspecialty or surgical service.
03Severe dementia accounted for 2.9% of patients and was associated with Black race, Asian race, and Alzheimer's disease, but not with age or ICU admission.
STILL TO COME
How it was doneWhat they foundWhat it means for OTsWhat it means for RNs
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What it does not show
The study was observational, so it cannot show that dementia stage caused hospitalization or that any care strategy would improve outcomes. All hospitals were large training and research centers, so smaller non-referral hospitals may have different patient mixes. Patients already receiving palliative care or hospice were excluded, which may make severe dementia look rarer than it is in hospitalized dementia care. Goals of care, advance directives, education, physical activity, smoking, alcohol use, behavioral symptoms, comorbidities, and reasons for hospitalization were not consistently available. Dementia staging was done from medical records and physician review, not a uniform bedside assessment, and behavioral presentations could be confused with delirium or other medical causes.
Declared interests
All authors reported no conflicts of interest related to this work. The study was supported by NIH extramural funding.
The easy way to misread this
Do not conclude that people with severe dementia rarely need hospital care. The sample came from large research hospitals and excluded patients already receiving palliative or hospice care, so severe dementia may be undercounted.