Abstract
Background
Evidence is lacking for differences between hospitalisation of people with dementia living in nursing homes and those living in the community. The objectives of this study were: 1) to describe the frequency of hospital admission among people with dementia in eight European countries living in nursing homes or in the community, 2) to examine the factors associated with hospital admissions in each setting, and 3) to evaluate the costs associated with it.
Methods
The present study is a secondary data analysis of the RightTimePlaceCare European project. A cross-sectional survey was conducted with data collected from people with dementia living at home or who had been admitted to a nursing home in the last three months, as well as from their caregivers. Data on hospital admissions, cognitive, functional and nutritional status, neuropsychiatric symptoms, comorbidity, polypharmacy, caregiver burden and falls were assessed using validated instruments. Multivariate regression models were used to investigate the factors associated with hospitalisation for each setting. Costs were estimated by multiplying quantities of resources used with the unit cost of each resource and inflated to the year 2019.
Results
The study sample comprised 1,700 people with dementia living in the community and nursing homes. Within three months, 13.8% and 18.5% of people living in nursing homes and home care, respectively, experienced ≥1 hospital admission. People living in nursing homes, the chance of hospital admission was higher among those with polypharmacy, while for those living at home, the chance was higher for those with unintentional weight loss, polypharmacy, falls, and those whose caregiver suffered from more severe burden. Globally, the estimated costs per person with dementia/year among participants living in a nursing home were lower than those receiving home care.
Conclusion
Admission to hospital is frequent among people with dementia, especially among those living in the community, and seems to impose a remarkable economic burden. The identification and establishment of an individualised care plan of those people with dementia with polypharmacy in nursing homes, and those with involuntary weight loss, accidental falls, polypharmacy and higher caregiver burden in the home care setting, might help preventing unnecessary hospital admissions.
Behavioural disturbances in patients with frontotemporal lobe degeneration focusing on caregiver burden at home and in nursing homes