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Treatment intensity and mortality among COVID‐19 patients with dementia: A retrospective observational study
Background We sought to determine whether dementia is associated with treatment intensity and mortality in patients hospitalized with COVID‐19. Methods This study includes review of the medical records for patients >60 years of age (n = 5394) hospitalized with COVID‐19 from 132 community hospital...
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| Published in: | Journal of the American Geriatrics Society (JAGS) 2022-01, Vol.70 (1), p.40-48 |
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| container_title | Journal of the American Geriatrics Society (JAGS) |
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| creator | Barnato, Amber E. Birkmeyer, John D. Skinner, Jonathan S. O'Malley, A. James Birkmeyer, Nancy J. O. |
| description | Background
We sought to determine whether dementia is associated with treatment intensity and mortality in patients hospitalized with COVID‐19.
Methods
This study includes review of the medical records for patients >60 years of age (n = 5394) hospitalized with COVID‐19 from 132 community hospitals between March and June 2020. We examined the relationships between dementia and treatment intensity (including intensive care unit [ICU] admission and mechanical ventilation [MV] and care processes that may influence them, including advance care planning [ACP] billing and do‐not‐resuscitate [DNR] orders) and in‐hospital mortality adjusting for age, sex, race/ethnicity, comorbidity, month of hospitalization, and clustering within hospital. We further explored the effect of ACP conversations on the relationship between dementia and outcomes, both at the individual patient level (effect of having ACP) and at the hospital level (effect of being treated at a hospital with low: 20% ACP rates).
Results
Ten percent (n = 522) of the patients had documented dementia. Dementia patients were older (>80 years: 60% vs. 27%, p |
| doi_str_mv | 10.1111/jgs.17463 |
| format | article |
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We sought to determine whether dementia is associated with treatment intensity and mortality in patients hospitalized with COVID‐19.
Methods
This study includes review of the medical records for patients >60 years of age (n = 5394) hospitalized with COVID‐19 from 132 community hospitals between March and June 2020. We examined the relationships between dementia and treatment intensity (including intensive care unit [ICU] admission and mechanical ventilation [MV] and care processes that may influence them, including advance care planning [ACP] billing and do‐not‐resuscitate [DNR] orders) and in‐hospital mortality adjusting for age, sex, race/ethnicity, comorbidity, month of hospitalization, and clustering within hospital. We further explored the effect of ACP conversations on the relationship between dementia and outcomes, both at the individual patient level (effect of having ACP) and at the hospital level (effect of being treated at a hospital with low: <10%, medium 10%–20%, or high >20% ACP rates).
Results
Ten percent (n = 522) of the patients had documented dementia. Dementia patients were older (>80 years: 60% vs. 27%, p < 0.0001), had a lower burden of comorbidity (3+ comorbidities: 31% vs. 38%, p = 0.003), were more likely to have ACP (28% vs. 17%, p < 0.0001) and a DNR order (52% vs. 22%, p < 0.0001), had similar rates of ICU admission (26% vs. 28%, p = 0.258), were less likely to receive MV (11% vs. 16%, p = 0.001), and more likely to die (22% vs. 14%, p < 0.0001). Differential treatment intensity among patients with dementia was concentrated in hospitals with low, dementia‐biased ACP billing practices (risk‐adjusted ICU use: 21% vs. 30%, odds ratio [OR] = 0.6, p = 0.016; risk‐adjusted MV use: 6% vs. 16%, OR = 0.3, p < 0.001).
Conclusions
Dementia was associated with lower treatment intensity and higher mortality in patients hospitalized with COVID‐19. Differential treatment intensity was concentrated in low ACP billing hospitals suggesting an interplay between provider bias and “preference‐sensitive” care for COVID‐19.]]></description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/jgs.17463</identifier><identifier>PMID: 34480354</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>advance care planning ; Advance Care Planning - statistics & numerical data ; Advance directives ; Aged ; Aged, 80 and over ; Comorbidity ; COVID-19 ; COVID-19 - mortality ; COVID-19 - therapy ; Dementia ; Dementia - complications ; Dementia - mortality ; Dementia disorders ; Female ; Hospital Mortality - trends ; Hospitalization ; Hospitals ; Humans ; intensive care ; Intensive Care Units - statistics & numerical data ; Male ; Mechanical ventilation ; Medical records ; Mortality ; Observational studies ; Patients ; Respiration, Artificial - statistics & numerical data ; Resuscitation Orders ; Retrospective Studies</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 2022-01, Vol.70 (1), p.40-48</ispartof><rights>2021 The American Geriatrics Society.</rights><rights>2022 American Geriatrics Society and Wiley Periodicals LLC</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3883-9d2d9ea30a6c4c4762203f814b39f6efae190f0d88905e2b2510f38d873cb7c23</citedby><cites>FETCH-LOGICAL-c3883-9d2d9ea30a6c4c4762203f814b39f6efae190f0d88905e2b2510f38d873cb7c23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34480354$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Barnato, Amber E.</creatorcontrib><creatorcontrib>Birkmeyer, John D.</creatorcontrib><creatorcontrib>Skinner, Jonathan S.</creatorcontrib><creatorcontrib>O'Malley, A. James</creatorcontrib><creatorcontrib>Birkmeyer, Nancy J. O.</creatorcontrib><title>Treatment intensity and mortality among COVID‐19 patients with dementia: A retrospective observational study</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description><![CDATA[Background
We sought to determine whether dementia is associated with treatment intensity and mortality in patients hospitalized with COVID‐19.
Methods
This study includes review of the medical records for patients >60 years of age (n = 5394) hospitalized with COVID‐19 from 132 community hospitals between March and June 2020. We examined the relationships between dementia and treatment intensity (including intensive care unit [ICU] admission and mechanical ventilation [MV] and care processes that may influence them, including advance care planning [ACP] billing and do‐not‐resuscitate [DNR] orders) and in‐hospital mortality adjusting for age, sex, race/ethnicity, comorbidity, month of hospitalization, and clustering within hospital. We further explored the effect of ACP conversations on the relationship between dementia and outcomes, both at the individual patient level (effect of having ACP) and at the hospital level (effect of being treated at a hospital with low: <10%, medium 10%–20%, or high >20% ACP rates).
Results
Ten percent (n = 522) of the patients had documented dementia. Dementia patients were older (>80 years: 60% vs. 27%, p < 0.0001), had a lower burden of comorbidity (3+ comorbidities: 31% vs. 38%, p = 0.003), were more likely to have ACP (28% vs. 17%, p < 0.0001) and a DNR order (52% vs. 22%, p < 0.0001), had similar rates of ICU admission (26% vs. 28%, p = 0.258), were less likely to receive MV (11% vs. 16%, p = 0.001), and more likely to die (22% vs. 14%, p < 0.0001). Differential treatment intensity among patients with dementia was concentrated in hospitals with low, dementia‐biased ACP billing practices (risk‐adjusted ICU use: 21% vs. 30%, odds ratio [OR] = 0.6, p = 0.016; risk‐adjusted MV use: 6% vs. 16%, OR = 0.3, p < 0.001).
Conclusions
Dementia was associated with lower treatment intensity and higher mortality in patients hospitalized with COVID‐19. Differential treatment intensity was concentrated in low ACP billing hospitals suggesting an interplay between provider bias and “preference‐sensitive” care for COVID‐19.]]></description><subject>advance care planning</subject><subject>Advance Care Planning - statistics & numerical data</subject><subject>Advance directives</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Comorbidity</subject><subject>COVID-19</subject><subject>COVID-19 - mortality</subject><subject>COVID-19 - therapy</subject><subject>Dementia</subject><subject>Dementia - complications</subject><subject>Dementia - mortality</subject><subject>Dementia disorders</subject><subject>Female</subject><subject>Hospital Mortality - trends</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>intensive care</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Male</subject><subject>Mechanical ventilation</subject><subject>Medical records</subject><subject>Mortality</subject><subject>Observational studies</subject><subject>Patients</subject><subject>Respiration, Artificial - statistics & numerical data</subject><subject>Resuscitation Orders</subject><subject>Retrospective Studies</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp10btOwzAUBmALgWi5DLwAssQCQ1rfkjhsVYECQmLgskZOcgKucim20yobj8Az8iQYCgxIeLEsfeeX7R-hA0pG1K_x_MmOaCwivoGGNOQsCAUNN9GQEMICGVExQDvWzgmhjEi5jQZcCEl4KIaouTegXA2Nw7px0FjteqyaAtetcar6OtVt84Snt49XZ--vbzTBC-W0H7B4pd0zLuBzWqtTPMEGnGntAnKnl4DbzIJZetw2qsLWdUW_h7ZKVVnY_9530cPF-f30Mri5nV1NJzdBzqXkQVKwIgHFiYpykYs4YozwUlKR8aSMoFRAE1KSQsqEhMAyFlJSclnImOdZnDO-i47XuQvTvnRgXVprm0NVqQbazqYsjBIe80gKT4_-0HnbGX9jryIax0wKQbw6WavcP9AaKNOF0bUyfUpJ-llC6ktIv0rw9vA7sctqKH7lz697MF6Dla6g_z8pvZ7drSM_AE16kdg</recordid><startdate>202201</startdate><enddate>202201</enddate><creator>Barnato, Amber E.</creator><creator>Birkmeyer, John D.</creator><creator>Skinner, Jonathan S.</creator><creator>O'Malley, A. James</creator><creator>Birkmeyer, Nancy J. O.</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>202201</creationdate><title>Treatment intensity and mortality among COVID‐19 patients with dementia: A retrospective observational study</title><author>Barnato, Amber E. ; Birkmeyer, John D. ; Skinner, Jonathan S. ; O'Malley, A. James ; Birkmeyer, Nancy J. O.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3883-9d2d9ea30a6c4c4762203f814b39f6efae190f0d88905e2b2510f38d873cb7c23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>advance care planning</topic><topic>Advance Care Planning - statistics & numerical data</topic><topic>Advance directives</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Comorbidity</topic><topic>COVID-19</topic><topic>COVID-19 - mortality</topic><topic>COVID-19 - therapy</topic><topic>Dementia</topic><topic>Dementia - complications</topic><topic>Dementia - mortality</topic><topic>Dementia disorders</topic><topic>Female</topic><topic>Hospital Mortality - trends</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>intensive care</topic><topic>Intensive Care Units - statistics & numerical data</topic><topic>Male</topic><topic>Mechanical ventilation</topic><topic>Medical records</topic><topic>Mortality</topic><topic>Observational studies</topic><topic>Patients</topic><topic>Respiration, Artificial - statistics & numerical data</topic><topic>Resuscitation Orders</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Barnato, Amber E.</creatorcontrib><creatorcontrib>Birkmeyer, John D.</creatorcontrib><creatorcontrib>Skinner, Jonathan S.</creatorcontrib><creatorcontrib>O'Malley, A. James</creatorcontrib><creatorcontrib>Birkmeyer, Nancy J. O.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Barnato, Amber E.</au><au>Birkmeyer, John D.</au><au>Skinner, Jonathan S.</au><au>O'Malley, A. James</au><au>Birkmeyer, Nancy J. O.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment intensity and mortality among COVID‐19 patients with dementia: A retrospective observational study</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2022-01</date><risdate>2022</risdate><volume>70</volume><issue>1</issue><spage>40</spage><epage>48</epage><pages>40-48</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><abstract><![CDATA[Background
We sought to determine whether dementia is associated with treatment intensity and mortality in patients hospitalized with COVID‐19.
Methods
This study includes review of the medical records for patients >60 years of age (n = 5394) hospitalized with COVID‐19 from 132 community hospitals between March and June 2020. We examined the relationships between dementia and treatment intensity (including intensive care unit [ICU] admission and mechanical ventilation [MV] and care processes that may influence them, including advance care planning [ACP] billing and do‐not‐resuscitate [DNR] orders) and in‐hospital mortality adjusting for age, sex, race/ethnicity, comorbidity, month of hospitalization, and clustering within hospital. We further explored the effect of ACP conversations on the relationship between dementia and outcomes, both at the individual patient level (effect of having ACP) and at the hospital level (effect of being treated at a hospital with low: <10%, medium 10%–20%, or high >20% ACP rates).
Results
Ten percent (n = 522) of the patients had documented dementia. Dementia patients were older (>80 years: 60% vs. 27%, p < 0.0001), had a lower burden of comorbidity (3+ comorbidities: 31% vs. 38%, p = 0.003), were more likely to have ACP (28% vs. 17%, p < 0.0001) and a DNR order (52% vs. 22%, p < 0.0001), had similar rates of ICU admission (26% vs. 28%, p = 0.258), were less likely to receive MV (11% vs. 16%, p = 0.001), and more likely to die (22% vs. 14%, p < 0.0001). Differential treatment intensity among patients with dementia was concentrated in hospitals with low, dementia‐biased ACP billing practices (risk‐adjusted ICU use: 21% vs. 30%, odds ratio [OR] = 0.6, p = 0.016; risk‐adjusted MV use: 6% vs. 16%, OR = 0.3, p < 0.001).
Conclusions
Dementia was associated with lower treatment intensity and higher mortality in patients hospitalized with COVID‐19. Differential treatment intensity was concentrated in low ACP billing hospitals suggesting an interplay between provider bias and “preference‐sensitive” care for COVID‐19.]]></abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>34480354</pmid><doi>10.1111/jgs.17463</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of the American Geriatrics Society (JAGS), 2022-01, Vol.70 (1), p.40-48 |
| issn | 0002-8614 1532-5415 |
| language | eng |
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| source | Wiley-Blackwell Read & Publish Collection |
| subjects | advance care planning Advance Care Planning - statistics & numerical data Advance directives Aged Aged, 80 and over Comorbidity COVID-19 COVID-19 - mortality COVID-19 - therapy Dementia Dementia - complications Dementia - mortality Dementia disorders Female Hospital Mortality - trends Hospitalization Hospitals Humans intensive care Intensive Care Units - statistics & numerical data Male Mechanical ventilation Medical records Mortality Observational studies Patients Respiration, Artificial - statistics & numerical data Resuscitation Orders Retrospective Studies |
| title | Treatment intensity and mortality among COVID‐19 patients with dementia: A retrospective observational study |
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