| Popis: |
BackgroundPeople with dementia (PwD) as emergency acute hospital admissions may be at higher risk of inappropriate care and poorer outcomes including longer hospitalisations and higher risk of emergency re-admission or death. Since 2009, numerous national and local initiatives in England have sought to improve hospital care for PwD. We compared outcomes of emergency admissions for patients aged 65+ with and without dementia across three points in time.MethodsWe analysed emergency admissions (EAs) from the Hospital Episodes Statistics datasets for England 2010/11, 2012/13 and 2016/17. Dementia upon admission was based on a diagnosis in the patient’s hospital records within the last five years. Outcomes were length of hospital stays (LoS), long stays (>=15 days), emergency re-admissions (ERAs) and deaths within 30 days of discharge. Covariates included patient demographics, pre-existing health and reasons for admission. Hospital indices of dementia care relating to staff training, hospital governance and patient-focus were derived from National Audit of Dementia survey returns. Hierarchical multivariate regression analysis was used - separately for males and females – to evaluate patient group differences on each outcome adjusted for covariates and to examine associations with the dementia care indices.ResultsWe included 178 acute hospitals with a total of 2,569,007 EAs for male patients and 3,011,099 for female patients, of which 356,992 (13.9%) were male PwD and 561,349 (18.6%) female PwD. Covariate-adjusted differences in LoS changed little over time and in 2016/17 were 17% (95%CI 15%-18%) and 12% (10%-14%) longer for male and female PwD respectively. Adjusted excess risk of an ERA for PwD reduced over time to 17% (15%-18%) for males and 17% (16%-19%) for females. Adjusted mortality for PwD was around 30% higher throughout. No associations were found between outcomes and hospital indices of dementia care.ConclusionsOver the six-year period, covariate-adjusted hospital LoS, ERA and mortality rates for PwD showed little beneficial change relative to similar patients without dementia, despite many national and local efforts to improve hospital care for this patient group. Group differences after adjustment were mostly small and may reflect factors beyond hospital control. Greater emphasis is needed on avoiding unnecessary hospitalisations for PwD. |
