Outcomes and cost analysis of patients with dementia in the intensive care unit: a population-based cohort study

Background Dementia is a neurological syndrome affecting the growing elderly population. While patients with dementia are known to require significant hospital resources, little is known regarding the outcomes and costs of patients admitted to the intensive care unit (ICU) with dementia. Methods We...

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Bibliographic Details
Published in:BMC health services research 2023-10, Vol.23 (1), p.1-1124, Article 1124
Main Authors: Dziegielewski, C, Fernando, SM, Milani, C, Mahdavi, R, Talarico, R, Thompson, LH, Tanuseputro, P, Kyeremanteng, K
Format: Article
Language:English
Subjects:
Activities of daily living
Acute care
Aged
Analysis
Cognitive ability
Cohort analysis
Comorbidity
Cost analysis
Costs
Dementia
Economic aspects
Health care expenditures
Health care policy
Healthcare expenditure
Hospital patients
Hospitals
Intensive care
Long term health care
Medical economics
Medical research
Medicine, Experimental
Palliative care
Patient admissions
Patient outcomes
Personal health
Regression analysis
Statistical analysis
Variables
Citations: Items that this one cites
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Summary:Background Dementia is a neurological syndrome affecting the growing elderly population. While patients with dementia are known to require significant hospital resources, little is known regarding the outcomes and costs of patients admitted to the intensive care unit (ICU) with dementia. Methods We conducted a population-based retrospective cohort study of patients with dementia admitted to the ICU in Ontario, Canada from 2016 to 2019. We described the characteristics and outcomes of these patients alongside those with dementia admitted to non-ICU hospital settings. The primary outcome was hospital mortality but we also assessed length of stay (LOS), discharge disposition, and costs. Results Among 114,844 patients with dementia, 11,341 (9.9%) were admitted to the ICU. ICU patients were younger, more comorbid, and had less cognitive impairment (81.8 years, 22.8% had [greater than or equal to] 3 comorbidities, 47.5% with moderate-severe dementia), compared to those in non-ICU settings (84.2 years, 15.0% had [greater than or equal to] 3 comorbidities, 54.1% with moderate-severe dementia). Total mean LOS for patients in the ICU group was nearly 20 days, compared to nearly 14 days for the acute care group. Mortality in hospital was nearly three-fold greater in the ICU group compared to non-ICU group (22.2% vs. 8.8%). Total healthcare costs were increased for patients admitted to ICU vs. those in the non-ICU group ($67,201 vs. $54,080). Conclusions We find that patients with dementia admitted to the ICU have longer length of stay, higher in-hospital mortality, and higher total healthcare costs. As our study is primarily descriptive, future studies should investigate comprehensive goals of care planning, severity of illness, preventable costs, and optimizing quality of life in this high risk and vulnerable population. Keywords: Dementia, Intensive care, Acute care, Costs, Healthcare expenditure
ISSN:1472-6963
1472-6963
DOI:10.1186/s12913-023-10095-5