Cognitive impairment, no dementia and hospitalizations - the role of formal and informal care: A population-based cohort study.

BACKGROUND

Dementia is associated with higher rates of hospitalization. However, it remains unclear whether cognitive impairment, no dementia is associated with increased risk of avoidable hospitalizations that can be prevented with timely and effective outpatient care and non-avoidable hospitalizations, which are less amenable to prevention. We aimed to examine the association of cognitive impairment, no dementia with hospitalizations and time to first hospitalization and further explore whether care use may modulate this association.

METHODS

From the Swedish National study on Aging and Care in Kungsholmen, 3009 older adults free from dementia (aged ≥60 years at baseline) were followed for up to 16 years to detect hospitalizations. Cognitive impairment, no dementia was diagnosed based on a neuropsychological test battery. Hospitalizations were identified through the National Patient Register and categorized as avoidable hospitalizations (overall and due to chronic or acute conditions) or non-avoidable hospitalizations. Information on formal and informal care use at baseline was obtained through interviews. Data were analyzed using flexible parametric survival models and Laplace regression models.

RESULTS

At baseline, 701 (23.3%) participants had cognitive impairment, no dementia. Over the follow-up (median 10.78 [IQR 4.57-13.75] years), 877 (29.2%) and 2257 (75.0%) experienced avoidable hospitalizations and non-avoidable hospitalizations. Cognitive impairment, no dementia was related to higher risk of overall avoidable hospitalization (HR 1.18, 95% CI 1.01-1.37) with similar directions for avoidable hospitalization due to chronic (HR 1.16, 95% CI 0.96-1.39) and acute (HR 1.12, 95% CI 0.89-1.42) conditions, although slightly attenuated. There was no significant association between cognitive impairment, no dementia and non-avoidable hospitalization (HR 0.99, 95% CI 0.90-1.09). People with cognitive impairment, no dementia experienced their first avoidable hospitalization 1.11 years (95% CI -2.07,-0.15) earlier and first non-avoidable hospitalization 0.86 years (95% CI -1.54,-0.18) earlier compared to cognitively intact participants. In stratified analysis, the association between cognitive impairment, no dementia and avoidable hospitalization was buffered by formal (HR 0.62, 95% CI 0.44-0.88) care use.

CONCLUSIONS

Our findings suggest that people free from dementia but with mild cognitive symptoms were at higher risk of avoidable hospitalization, emphasizing the importance of comprehensive disease management in outpatient care. Formal care use appeared to attenuate this risk, highlighting the need for accessible and coordinated care services tailored to cognitive impairment, even in its mild forms.