Hospital admissions raise healthcare costs for dementia patients

Researchers from Kyoto University and the University of California, Los Angeles found that hospital admissions for persons with dementia do not clearly increase 30 or 90-day mortality rates. While admission didn’t impact survival, it was linked to approximately $2,500 in additional healthcare spending over 30 days, primarily driven by nursing facility and home healthcare costs.

How was the effect of hospital admission measured?

A team of researchers sought to solve a specific conundrum: whether hospital stays cause poor outcomes or if sicker patients simply have worse outcomes because they are more likely to be admitted. Ryo Ikesu, the corresponding author, noted that sicker patients often appear to have worse outcomes even when admission isn’t the cause.

To remove this bias, the team used Medicare data and an instrumental variable approach. They compared patients seen by emergency physicians with a high tendency to admit patients against those seen by physicians with a lower admission tendency, treating the physician assignment as essentially random.

Did You Know? Persons with dementia in the United States visit the emergency room and are hospitalized at higher rates than older adults without dementia.

What are the consequences of hospital stays for patients with dementia?

The study found no clear evidence that hospital admission affected mortality rates at the 30 or 90-day mark. However, it significantly altered the financial trajectory of care. Admitted patients saw healthcare spending increase by about $2,500 in the 30 days following an emergency room visit.

Taking part in dementia research

This spending spike was mainly due to increased use of home healthcare and nursing facility care. Similar spending patterns were observed for the 90-day period, suggesting that the act of admission changes a patient’s subsequent care path.

Expert Insight: Samantha Carter suggests that the primary stake here isn’t necessarily survival, but the “care trajectory.” The data indicates a trade-off where the immediate perceived safety of a hospital stay may trigger a cascade of costly downstream services, such as nursing facility care, that might not have occurred otherwise.

What may happen next for borderline hospital cases?

These findings suggest that for “borderline cases” where the need for admission is uncertain, medical providers may consider different paths. A possible next step could involve a shift toward home-based acute care or increased outpatient follow-up to avoid unnecessary admissions.

While the researchers didn’t find evidence that hospital admission caused a decline in physical or cognitive function for long-term nursing home residents with dementia, Ikesu noted this could be due to a small sample size. Future evaluations of these specific populations may be likely to provide more clarity.

Frequently Asked Questions

Did hospital admission increase the risk of death for persons with dementia?
No, the research found no clear evidence that hospital admission affected mortality rates at 30 or 90 days.

How much more does a hospital admission cost over 30 days?
Healthcare spending was about $2,500 higher for admitted patients compared to those not admitted, largely due to nursing facility and home healthcare costs.

Are hospital admissions considered inappropriate for people with dementia?
The findings do not indicate that admission is inappropriate, but they highlight an opportunity to consider alternatives like outpatient follow-up or home-based acute care for borderline cases.

Do you believe home-based acute care could be a viable alternative to hospital stays for seniors with dementia?