Determinants of hospital readmissions in older people with dementia: A narrative review

Abstract

Introduction Over 50% of hospitalised older people with dementia have multimorbidity, and are at an increased risk of hospital readmission within 30 days from discharge. Between 20-40% of these readmissions may be preventable. Current research focuses on the physical causes of readmissions. However, older people with dementia have additional psychosocial factors that are likely to increase the risk of readmissions. This narrative review aimed to identify psychosocial determinants for hospital readmissions, within the context of known physical factors. Methods Electronic databases MEDLINE, EMBASE, CINAHL and PsychInfo were searched from inception until July 2022. Quantitative and qualitative studies in English including adults aged 65 years and over with dementia, their care workers and informal carers were considered if they investigated hospital readmissions. An inductive approach was adopted to map the determinants of readmissions. Identified themes were described as narrative categories. Results Sixteen studies including 7,194,878 participants met our inclusion criteria from a total of 4736 articles. Fifteen quantitative studies included observational cohorts and randomised controlled trial designs, and one study was qualitative. Nine studies were based in the USA, and one study each from Taiwan, Australia, Canada, Sweden, Japan, Denmark, and The Netherlands. Large hospital and insurance records provided data on over 2 million patients in one American study. Physical determinants included reduced mobility and accumulation of long-term conditions. However, identified psychosocial determinants were restricted to inadequate hospital discharge planning, limited interdisciplinary collaboration, and socioeconomic inequalities among ethnic minorities. Other important psychosocial factors such as loneliness, poverty and mental well-being, were not included in the studies. Conclusion Poorly defined roles and responsibilities of health and social care professionals and poor communication during care transitions increase the risk of readmission in older people with dementia. These identified psychosocial determinants are likely to significantly contribute to readmissions. Frequent use of antipsychotic medications might also explain the interplay between physical and psychosocial determinants. However, future research should also focus on the understanding of the interaction between a host of psychosocial and physical determinants, and multidisciplinary interventions across care settings to reduce hospital readmissions.