Determinants of hospitalization and length of stay among people with dementia – An analysis of statutory health insurance claims data

• Published in: Archives of gerontology and geriatrics 2018-05, Vol.76, p.227-233
• Main Authors: Motzek, Tom, Werblow, Andreas, Tesch, Falko, Marquardt, Gesine, Schmitt, Jochen
• Format: Article
• Language: English
• Subjects: Acute hospital utilization; Aged; Aged, 80 and over; Claims data analysis; Dementia; Dementia - epidemiology; Female; Germany - epidemiology; Health service; Hospital; Hospitalization; Hospitalization - statistics & numerical data; Humans; Insurance, Health; Length of Stay; Male; Retrospective Studies
• ISSN: 0167-4943; 1872-6976
• DOI: 10.1016/j.archger.2018.02.015

•Individuals with dementia had higher risk for hospitalization and emergency admission compared to individuals without dementia. Higher odds for being admitted at least once were found for a diagnosis of diabetes mellitus and hypertension.•Individuals with dementia had higher hospitalization risks for care dependency and living outside of a metropolitan region compared to individuals without dementia. Among dementia patients, individuals with a recent diagnosis of dementia had a higher risk for admission.•The increased length of stay for people with dementia per year was mainly attributable to higher admission rates. Dementia is a crucial challenge in acute care hospitals. Using a retrospective claims data cohort, this paper explores dementia patients' acute hospitalization rates, risk factors, and length of stay. The study used claims data from AOK PLUS, the largest statutory health insurance service (SHI) in Saxony, a federal state of Germany. The analysis included 61,239 people with dementia and 183,477 control subjects, all 65 years and older. Control subjects were age, gender, and regionally matched in a 1:3 ratio. Negative binomial hurdle regression was used to compare differences in hospitalization for the year 2014. People with dementia had 1.49 times higher adjusted odds of being hospitalized at least once (95% confidence interval [CI], 1.46–1.52). Among those individuals hospitalized at least once, dementia increased the number of readmissions by 18% (95% CI, 1.15–1.20). Dementia patients also had a 1.74 times higher odds for at least one emergency admission compared to individuals without dementia (95% CI, 1.70–1.78). Dementia patients' admission risk factors included having care dependency, being recently diagnosed with dementia and living outside a metropolitan region. The increased length of stay for people with dementia per year was mainly attributable to higher admission rates. Dementia patients are at higher risk for hospitalization, especially if they live outside the metropolitan region. Healthcare systems need to respond to the challenges resulting from the predicted demographic developments and increasing burden of dementia in the general population.