The likelihood of hospital-acquired complications in older people with dementia: a matched cohort study

IF 6.7 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Medical Journal of Australia Pub Date : 2024-09-27 DOI:10.5694/mja2.52462

Danielle Ní Chróinín, Vicki Deane, Rinsy Pulikotil Zachariah, Katrina Stott, Bernadette Shepherd, Margaret Perkins, Leesa Giang, Rozina Shekhar, Vaulina Vueti, Mandana Mayahi-Neysi, Amy Montgomery, Kaye Rolls, Steven A Frost

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Abstract

Objectives

To investigate whether the likelihood of hospital-acquired complications for older people in Australia differs by whether they have dementia.

Study design

Matched cohort study.

Setting, participants

People aged 60 years or older with dementia who were admitted to five public hospitals in the South Western Sydney Local Health District, New South Wales, 1 January 2010 to 31 December 2020, and people without dementia admitted during the same period, matched by age, sex, number of medical conditions, and presence of selected specific medical conditions, emergency admission status, history of falls, and admission from a nursing home.

Main outcome measures

Hospital-acquired complications (falls, pressure injuries, delirium, pneumonia, venous thromboembolism, new incontinence, malnutrition, in-hospital death), by dementia status.

Results

A total of 217 459 people aged 60 years or older were admitted to the five hospitals during the study period. The mean age of the 11 393 patients with dementia (83 years; standard deviation [SD], 7.5 years) was higher than that of the 206 065 patients without dementia (73 years; SD, 8.9 years), and the proportion of women slightly larger (55% v 50%). Median hospital length of stay was longer for people with dementia (nine days; interquartile range [IQR], 4–19 days) than for people without dementia (three days; IQR, 1–9 days), and the number of in-hospital deaths higher (768, 7% v 584, 5%). After propensity score-based matching, the risks of falls (odds ratio [OR], 4.7; 95% confidence interval [CI], 3.8–5.7), pressure injury (OR, 1.4; 95% CI, 1.1–1.8), delirium (OR, 2.4; 95% CI, 2.0–3.0), and pneumonia (OR, 1.3; 95% CI, 1.01–1.7) were higher for people with dementia than for those without dementia; differences between the two groups in the risks of venous thromboembolism, malnutrition, and incontinence were not statistically significant.

Conclusions

Given the greater risk of many hospital-acquired complications for people with dementia, targeted models of person-centred care are needed to ensure the best outcomes for these patients.

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老年痴呆症患者在医院获得并发症的可能性：一项匹配队列研究。

研究目的研究设计：匹配队列研究：研究地点、参与者：2010年1月1日至2020年12月31日期间在新南威尔士州悉尼西南地方卫生区的五家公立医院住院的60岁或以上患有痴呆症的老年人，以及同期住院的未患有痴呆症的老年人：按痴呆状态分列的医院获得性并发症（跌倒、压伤、谵妄、肺炎、静脉血栓栓塞、新的大小便失禁、营养不良、院内死亡）：研究期间，五家医院共收治了 217 459 名 60 岁或以上的老人。其中，11 393 名痴呆症患者的平均年龄（83 岁；标准差 [SD]，7.5 岁）高于 206065 名非痴呆症患者的平均年龄（73 岁；标准差，8.9 岁），女性患者的比例略高（55% 对 50%）。痴呆症患者的中位住院时间（9天；四分位数间距[IQR]，4-19天）长于非痴呆症患者（3天；四分位数间距[IQR]，1-9天），院内死亡人数也更高（768人，7%；584人，5%）。经过倾向评分匹配后，跌倒（几率比 [OR]，4.7；95% 置信区间 [CI]，3.8-5.7）、压伤（OR，1.4；95% CI，1.1-1.8）、谵妄（OR，2.4；95% CI，2.0-3.0）和肺炎（OR，1.3；95% CI，1.两组患者在静脉血栓栓塞症、营养不良和大小便失禁风险方面的差异无统计学意义：鉴于痴呆症患者发生许多医院并发症的风险更大，因此需要有针对性的以人为本的护理模式，以确保这些患者获得最佳治疗效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Medical Journal of Australia 医学-医学：内科

CiteScore

9.40

自引率

5.30%

发文量

410

审稿时长

3-8 weeks

期刊介绍： The Medical Journal of Australia (MJA) stands as Australia's foremost general medical journal, leading the dissemination of high-quality research and commentary to shape health policy and influence medical practices within the country. Under the leadership of Professor Virginia Barbour, the expert editorial team at MJA is dedicated to providing authors with a constructive and collaborative peer-review and publication process. Established in 1914, the MJA has evolved into a modern journal that upholds its founding values, maintaining a commitment to supporting the medical profession by delivering high-quality and pertinent information essential to medical practice.