gms | German Medical Science

Background: Prevalence of dementia is increasing globally, and people with dementia (PwD) are at a higher risk of hospitalization than people without dementia. Since hospitals are often not equipped for the specific care demands of PwD, these patients are at a risk of functional decline and other adverse outcomes during admission. Main problems involve the interface between hos-pitals and domestic life. Specifically, there is a lack of planning, as well as of comprehensive assessment and counseling prior to discharge. Hospital discharges often come unexpected, preparation of domestic care arrangements is insufficient, and there is often no contact person to ensure continuity of care immediately after discharge. Additionally, PwD have a high rate of medication-related problems following discharge, which are a risk factor for early readmis-sion. Information about long-term adverse outcomes of PwD after hospitalization (readmis-sion, institutionalization and mortality) is crucial for effective decision making and develop-ment of preventive strategies to improve this interface.

Objectives: The objective of this study is to conduct a quantitative systematic review and a meta-analysis on the impact of a hospitalization on short- and long-term adverse outcomes for PwD. We additionally aimed to identify factors associated with these outcomes in hospitalized PwD as possible targets for effective preventive strategies.

Methods: The databases PubMed, CENTRAL (Cochrane Central Register of Controlled Trials) and ScienceDirect were searched in April 2017 for studies including search terms for dementia, hospital, readmission, institutionalization and mortality. Reasons for exclusion from this re-view were outcomes prior to discharge like in-hospital mortality, length of stay or other in-hospital outcomes. Studies conducted in settings other than acute hospitals were excluded as well. Studies were rejected if PwD represented only a small subgroup of the analyzed popula-tion or if the study type was a meta-analysis or a systematic review. Studies were only includ-ed in the meta-analysis if they provided a control-group. Yielded Abstracts were screened and relevant studies assessed by a quality criteria sheet. Results were summarized in a table. Meta-analysis was conducted with Review Manager 5.3 from Cochrane Collaboration.

Results: The search yielded 1108 articles of which 20 fulfilled inclusion criteria for this systematic review. Ten studies were eligible for meta-analysis. PwD had a significantly higher institu-tionalization- and mortality-rate after hospital discharge than did people without dementia. Results according to readmission-rate were inconsistent. Meta-analyses revealed that the mor-tality-rate of PwD was more than 1.5 times higher (33.8%, 218/646) than the mortality-rate of non-demented controls and the rate of institutionalization of PwD was significantly higher (Risk Ratio: 2.16 CI95% 1.31, 3.56) than of people without dementia. Relevant factors associ-ated with the examined outcomes were the stage of dementia, a higher number of medications and a deterioration in activities of daily living following admission.

Conclusion: Only a few studies have evaluated long-term outcomes of PwD after hospitalization. The chances of PwD to return to their original lives after hospital admission are considerably re-duced. Any unscheduled hospital admission should be prevented, if possible. Furthermore, hospitals should be better equipped for care of PwD. Furthermore, returns of PwD to domestic life should be facilitated.