A Systematic Review of Intervention Studies to Prevent Hospitalizations of Community-dwelling Older Adults With Dementia

Abstract

Objectives:To conduct a systematic literature review to determine if there were any intervention strategies that had any measurable effect on acute-care hospitalizations among community-dwelling adults with dementia.Design:Studies were identified by a professional research librarian and content experts.Setting:Community dwelling.Participants:Participants were diagnosed with dementia, severity ranging from mild to severe, and were recruited from health care and community agencies.Measurements:A study met the inclusion criteria if it: (a) was published in English; (b) included a control or comparison group; (c) published outcome data from the intervention under study; (d) reported hospitalization as one of the outcomes; (e) included community-dwelling older adults; and (f) enrolled participants with dementia. Ten studies met all inclusion criteria.Results:Of the 10 studies included, most assessed health services use (ie, hospitalizations) as a secondary outcome. Participants were recruited from a range of health care and community agencies, and most were diagnosed with dementia with severity ratings ranging from mild to severe. Most intervention strategies consisted of face-to-face assessments of the persons living with dementia, their caregivers, and the development and implementation of a care plan. A significant reduction in hospital admissions was not found in any of the included studies, although 1 study did observe a reduction in hospital days.Conclusions:The majority of studies included hospitalizations as a secondary outcome. Only 1 intervention was found to have an effect on hospitalizations. Future work would benefit from strategies specifically designed to reduce and prevent acute hospitalizations in persons with dementia.

Effect of the Goals of Care Intervention for Advanced Dementia

“…25 Transitional care interventions have excluded persons with dementia, and the GOC intervention provides initial evidence that this outcome can be improved. 26 …”

Distress Associated with Dementia-Related Psychosis and Agitation in Relation to Healthcare Utilization and Costs

“…A recent review of intervention studies to prevent hospitalization among adults with dementia found minimal impact (16), which may reflect the difficulty of identifying the most high-risk population (39). While the expanding population of patients with dementia and the spread of population-based and bundled payment strategies make identifying high-risk patient-caregiver dyads especially important, our findings suggest that identifying this high-risk group based solely on patient characteristics will not be successful.…”

“…Intervention studies to prevent hospitalization of older adults with dementia have had minimal impact (16), which may reflect a limited ability to target high-risk patient-caregiver dyads. Given both the wide variety of and pervasiveness of non-cognitive dementia symptoms, a more focused analysis of the role of specific BPSD to risk-stratify patient-caregiver dyads with dementia is critical.…”

Multimorbidity and functional impairment–bidirectional interplay, synergistic effects and common pathways

“…In a Canadian home care cohort of over 30 000 people with dementia, the risk for hospitalization and emergency department visits increased as the level of multimorbidity rose [86]. Hospital and emergency department visits are particularly detrimental for people with dementia because they are at heightened risk for cognitive and functional decline during and after hospitalization [87]. Increasing numbers of comorbidities were also associated with more primary care visits and prescriptions in a retrospective cohort of incident dementia patients diagnosed in primary care in the United Kingdom [88].…”