Association of Incident Dementia With Hospitalizations

Abstract

Claims-based, retrospective studies have long reported that dementia is associated with increased hospitalizations,^1-9 but empirical data to elucidate this finding are few. Suboptimal management in the outpatient setting may be a contributing factor, as suggested by lower prescription drug costs and fewer office visits after diagnosis.⁴ Accomplishing adequate chronic disease management is more difficult in persons with dementia, which may lead to hospitalization for acute exacerbation of comorbid conditions.^4,5 Nonelective hospitalization of older people, particularly those with dementia, is not a trivial event. Among older persons without dementia, hospitalization for serious illness is associated with subsequent cognitive decline,¹⁰ and frail elders, including those with dementia, are at increased risk of delirium, functional decline, and iatrogenic complications during an inpatient stay.^11-13 Identifying conditions that precipitate hospitalization of elderly individuals with dementia could focus clinical priorities on secondary and tertiary prevention in the outpatient setting and improve health care for this vulnerable and increasing population. We used a unique longitudinal data set to determine whether dementia onset is associated with higher rates of or different reasons for hospitalization, particularly for ambulatory care–sensitive conditions (ACSCs), for which proactive outpatient care might prevent the need for a hospital stay.