Affiliations: [a] Network Aging Research, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany
| [b] Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Baden-Wuerttemberg, Germany
| [c] Medical Faculty, University of Heidelberg, Baden-Wuerttemberg, Germany
| [d] PMV Research Group, Department of Child and Adolescent Psychiatry, University of Cologne, Cologne, North Rhine-Westphalia, Germany
| [e] Center for Geriatric Medicine, University of Heidelberg, Agaplesion Bethanien Krankenhaus Heidelberg, Baden-Wuerttemberg, Germany
Correspondence:
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Correspondence to: Tobias Möllers, MSc, Network Aging Research, University of Heidelberg, Bergheimer Straße 20, Heidelberg 69115, Germany. E-mail: [email protected].
Abstract: BACKGROUND:Hospital care of older adults, especially of those with dementia, is associated with a high risk of complications and increased mortality. Adverse events are often triggered by hospital-related factors, hence the time spent in hospitals should be limited. There is little knowledge of the specific factors influencing hospitalizations of older persons. OBJECTIVES:To assess the duration of length of stay (LOS) and risk factors of increased LOS, and, specifically, the role of delirium and neuropsychiatric symptoms (NPS) among a large sample of older adults with and without dementia in Germany. METHODS:A claims data based dynamic retrospective cohort study from 2004 to 2015 was conducted. People with dementia (PWD) were identified using ICD-10 codes and the application of diagnostic measures. A control group without diagnosis of dementia (CG) were matched in a 3: 1 ratio. Multivariate methods were used to investigate the factors associated with LOS. RESULTS:7,139 PWD and 21,417 controls were included. PWD had longer hospitalizations (first LOS: +4.3 days; second LOS: +0.2 days) than the CG. Diagnosis of delirium was associated with LOS, both for PWD (first LOS: +9.6 days; second LOS: +5.3 days) and CG (first LOS: +13.7 days; second LOS: +7.2 days). CONCLUSION:Major determinants of LOS were similar in PWD and the CG. The strongest association was found for the presence of delirium and NPS. Future research should focus on prevention and intervention strategies that may reduce the impact of delirium as well as NPS on the length of stay especially for PWD.
Keywords: Claims data, dementia, hospitalization, neuropsychiatric symptoms, observational study
