Identifying Factors Associated With Prolonged Hospitalizations for Community-Dwelling Veterans Living With Dementia.

BACKGROUND

People living with dementia (PLWD) are more likely to be hospitalized and have longer hospital stays compared with the general population. Prolonged hospitalizations are associated with inpatient complications, functional decline, and mortality. This study aimed to identify patient-level factors associated with prolonged hospitalizations for PLWD.

METHODS

Secondary analysis of a stepped-wedge, cluster randomized trial that enrolled community-dwelling older adults hospitalized for at least 2 days at eight Veterans Health Administration hospitals between August 2017 and August 2019. A logistic regression model was used to identify patient-level factors associated with prolonged hospitalizations (≥ 21 days) for PLWD.

RESULTS

2612 individuals with dementia were included in this cohort. PLWD had a median length of stay of 6.0 days (IQR: 4.0-9.0) and 138 (5.3%) were admitted to the hospital for at least 21 days. Social vulnerability (OR: 1.74, 95% CI: 1.16, 2.61), higher Nosos chronic disease burden (OR: 1.06, 95% CI: 1.01, 1.10), and presence of delirium at admission (OR: 1.55, 95% CI: 1.07, 2.26) were associated with higher odds of prolonged hospitalization. In contrast, greater clinical frailty was associated with lower odds of prolonged hospitalization (overall p = 0.006).

CONCLUSIONS

Several patient-level factors present at time of admission are associated with prolonged hospitalizations for PLWD. These findings can inform early identification and tailored interventions for those at risk. Further research is needed to better characterize these relationships, particularly frailty.

TRIAL REGISTRATION: NCT03300336.