Impact of the COVID-19 pandemic on care-quality outcomes in older adults admitted to hospital with altered mental status.

Autor: Fluck A; Faculty of Medical Sciences, The Medical School, Newcastle University, Newcastle upon Tyne, UK., Fry CH; School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK., Robin J; Department of Medicine, Ashford and St Peter's Hospitals NHS Foundation Trust, Surrey, UK., Fluck D; Department of Cardiology, Ashford and St Peter's Hospitals NHS Foundation Trust, Surrey, UK., Han TS; Department of Endocrinology, Ashford and St Peter's Hospitals NHS Foundation Trust, Surrey, UK.; Institute of Cardiovascular Research, Royal Holloway, University of London, Surrey, UK.
Jazyk: angličtina
Zdroj: International journal of geriatric psychiatry [Int J Geriatr Psychiatry] 2024 Jul; Vol. 39 (7), pp. e6125.
DOI: 10.1002/gps.6125
Abstrakt: Objectives: During the coronavirus disease (COVID-19) pandemic, patients with altered mental status (AMS: dementia, delirium and delirium superimposed on dementia) were profoundly affected by an abrupt transformation in healthcare systems. Here, we evaluated quality-care outcomes, including length of stay (LOS), in-hospital mortality, early readmission and mortality after hospital discharge, in older adults admitted for AMS during the pandemic and compared them to patients admitted prior to the pandemic.
Methods: Chi-squared and Fisher's exact tests were used to examine changes to admissions for AMS before and during the pandemic, and their outcomes. Logistic regression analyses, with reference to pre-pandemic data, were conducted to examine the impact of the pandemic on outcomes.
Design: Prospective data of 21,192 non-COVID admissions to an acute general medical department in a Surrey (UK) hospital were collected from patients admitted before (1st April 2019 to 29th February 2020) and during the pandemic (1st March 2020 to 31st March 2021).
Results: There were 10,173 (47.7% men) from the pre-pandemic and 11,019 (47.5% men) from the pandemic periods; overall mean age  =  68.3yr. During the pandemic AMS patients had significantly higher admission rates (1.1% vs 0.6%, P < 0.001). However, median LOS in hospital was shorter (9.0 days [IQR = 5.3-16.2] vs 15.5 days [IQR  =  6.2-25.7], P < 0.001) and thus were less likely to stay in hospital >3 weeks: adjusted OR  =  0.26 (95%CI  =  0.12-0.57). In-hospital mortality and readmission within 28 days of discharge did not change during the pandemic, but were less likely to die within 30 days of discharge: adjusted OR = 0.32 (95%CI = 0.11-0.96).
Conclusions: This combination of higher admission rate, shorter LOS, and an unchanging early readmission suggests a higher admission-discharge turnover of different patients with AMS and provides important insights into the potential impact of the COVID-19 pandemic on healthcare delivery to individuals with AMS.
(© 2024 The Author(s). International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
Externí odkaz: