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Linking electronic dementia care records to national inpatient data in dementia with Lewy bodies: Frequency, duration and cost implications of hospitalization and recording of delirium episodes
Author(s) -
Mueller Christoph,
FitzGerald James M,
Perera Gayan,
Rajamani Anto Praveen Rajkumar,
Bhattarai Manorama,
Price Annabel,
Ballard Clive,
Stewart Robert,
Aarsland Dag
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.039139
Subject(s) - dementia , delirium , dementia with lewy bodies , medicine , incidence (geometry) , pediatrics , cohort , population , emergency medicine , disease , psychiatry , physics , environmental health , optics
Background Increased hospitalization is a major component of dementia impact on individuals and cost but has rarely been studied in dementia with Lewy bodies (DLB). In particular episodes of delirium and related hospitalizations have been described as a prodrome of dementia with Lewy bodies. Our aims were to harness a novel linkage between dementia/mental health care records and national hospitalization data in England to (1) describe risk and duration of hospital admissions in patients with DLB and (2) to assess the incidence of delirium recording before and after a diagnosis of dementia is established in patients with DLB and compare findings to a matched cohort of patients with Alzheimer’s disease (AD). Method In a large database of mental health and dementia care in South London we identified 194 patients with DLB and 1:4 matched these with 776 patients diagnosed with AD on age, gender, and cognitive status. Result Rates of hospital admissions in the year after dementia diagnosis were significantly higher in patients with DLB compared to patients with AD or the catchment population. Patients with DLB had on average almost four additional hospital days per person‐year than patients with AD and incurred higher hospitalization‐related costs. Further, patients with DLB had significantly more episodes of delirium recorded in the year before dementia diagnosis than patients with AD. Whereas the incidence of recording of delirium episodes reduced substantially in patients with DLB after dementia diagnosis, it remained significantly higher than in patients with AD. Conclusion Patients with DLB are more frequently admitted to general hospital and utilize inpatient care to a substantially higher degree than patients with AD. Establishing a diagnosis of dementia reduces episodes classified as delirium in patients with DLB and might lead to fewer potentially harmful interventions as hospitalization or use of antipsychotic medication. These data highlight an opportunity to reduce hospital days and episodes classified (and treated) as delirium by identifying DLB earlier and providing more targeted care focused on the specific triggers for hospitalization and associations of prolonged stay.