Clinical Report: Hospital Admission May Raise Health Care Spending in Dementia

Overview

Revise to explicitly state the lack of mortality improvement despite increased spending.

Background

Understanding the implications of hospital admissions for patients with dementia is crucial, as these patients often face unique risks during inpatient care, including functional decline and increased mortality. The rising healthcare costs associated with unnecessary admissions highlight the need for more effective management strategies in this vulnerable population. This study provides insights into the financial impact of hospital admissions and raises questions about their clinical value.

Data Highlights

Key Findings

• 55% of emergency department visits resulted in hospital admission among dementia patients.
• No evidence that hospital admission reduced mortality or subsequent inpatient days.
• Hospital admissions were associated with significant increases in healthcare spending, primarily due to postacute care services.
• Admission propensity varied significantly among emergency physicians, ranging from 38% to 70%.
• No meaningful differences in physical or cognitive function scores were observed 90 days post-admission for long-term nursing home residents.

Clinical Implications

Healthcare professionals should carefully evaluate the necessity of hospital admissions for dementia patients, considering the potential for increased costs without improved outcomes. Strategies to minimize unnecessary admissions, such as enhanced outpatient care and home health services, may be beneficial in managing this population effectively.

Conclusion

The findings suggest that hospital admissions for older patients with dementia may not provide the expected clinical benefits and instead contribute to higher healthcare costs. Future research should focus on identifying strategies to reduce low-value admissions.

Related Resources & Content

1. Ikesu R, et al., Annals of Internal Medicine, 2023 -- Hospital Admission May Raise Health Care Spending in Dementia
2. Drugs - Real World Outcomes — Examining Inappropriate Use of Bladder Antimuscarinics in Dementia Patients: Findings from a Retrospective Cohort Analysis
3. JAMA Network Open — Home Health Value-Based Purchasing and Postacute Home Health Visits Among Older Adults With Dementia
4. JAMA Network Open — Outcomes Associated With Hospital at Home vs Traditional Inpatient Stay
5. conexiant — Hospital-Treated Infections Linked to Dementia Risk
6. NICE National Institute for Health and Care Excellence Guidance
7. American Psychiatric Association Practice Guideline for the Prevention and Treatment of Delirium
8. GRADE-Based Clinical Practice Guidelines for Emergency Department Delirium Risk Stratification
9. Delirium prevalence in emergency department patients: A systematic review and meta‐analysis - Wang - 2024 - Nursing in Critical Care - Wiley Online Library
10. Geriatric Emergency Department Guidelines | ACEP
11. Outcomes of emergency department observation units for geriatric assessment: a systematic review and meta-analysis - PubMed
12. Efficacy and Safety of Hospital-at-Home versus Traditional Hospital Care in Older Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials | Gerontology | Karger Publishers
13. Acute Hospital Care at Home Data Release Fact Sheet | CMS
14. Guiding an Improved Dementia Experience Model
15. GUIDE (Guiding an Improved Dementia Experience) Model | CMS
16. Predicting Mortality and Costs After Emergency Department Visits by People With Dementia: Timing and Location Matter - PMC