Emergency Hospital Admissions of Elderly Patients with Dementia: General Characteristics, Outcome, and Areas of Improvement at an Accident and Emergency Department

Abstract

Aim: Age-related disorders, such as dementia, are relevant for healthcare services and health systems worldwide. The prevalence of dementia across European countries is estimated to exceed 7 %, and may rise over time. Those patients are at increased risk for hospital admission and prolonged hospitalization, and such care increases the cost for the healthcare system. Less is known regarding patients with dementia in Greece that visit the Accident and Emergency departments (A&E) in general hospitals. The present retrospective study aimed to address this issue. Subjects and methods: The sample of patients and the control group were traced in the A&E department of the University Hospital of Ioannina, Northwest Greece. The study sample consisted of 100 patients with dementia, aged > 65 years and 100 matched controls. The median age of patients with dementia was 85 years, for the control group 83 years, and 63 % were females. In most cases the diagnosis had been made by primary care physicians, and in of patients 21 % by neurologists/psychiatrists. Results: In both groups a median of 2 comorbidities was recorded, with hypertension, heart failure and dyslipidaemia being the most common. Fever and falls were the most common reasons for dementia patients visiting the A&E department. Infection was the most common diagnosis in dementia patients, whereas in 17 % of cases no diagnosis was made and no interventions were needed. The probability of admission after an A&E visit was significantly higher for the dementia group, whereas there were no differences regarding length of hospital stay between patients and controls. Conclusions: The results of the study are in line with international research and highlight the need for the establishment of a national register for patients with dementia, that would enable information exchange between primary and tertiary care and would enable proper diagnosis, management and discharge arrangements.