Claire Dawson
Dementia is a collection of symptoms that include memory loss, language problems, and other cognitive issues severe enough to interfere with daily life. Persons living with dementia (PLWD) are at an increased risk of hospitalization due to various reasons, including infections, falls, cardiovascular issues, and behavioral problems. Hospitalization can be harmful to people with dementia, leading to higher societal costs and potential negative outcomes such as worsening cognitive status, delirium, and functional decline. Understanding the reasons for hospitalization among PLWD is crucial for developing effective interventions to reduce admissions and improve patient care.
| Characteristics | Values |
|---|---|
| Percentage of PLWD hospitalized over 12 months | 34.4% |
| Mean age | 80.4 years |
| Percentage of female patients | 70.5% |
| Top causes of hospitalization | Neuropsychiatric, falls, infections, cardiovascular, GI |
| Most common caregiver-reported causes of hospitalization | Infections, falls |
| Other common caregiver-reported causes of hospitalization | Cardiovascular/pulmonary problems, behavioral impairment |
| Average number of routine medications | 13.2 |
| Average number of baseline medical comorbidities | 9.7 |
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Infection
Hospitalization due to infection may increase a person's likelihood of developing dementia later in life. Research has shown that people hospitalized with an infection are more likely to be diagnosed with dementia years later compared to those who were not hospitalized with infections.
There is a bidirectional relationship between infection and dementia. Firstly, people with dementia are more susceptible to infections due to their weakened immune system. Poor nutrition and staying in one place for extended periods can cause skin breakdown or pressure sores, which can become infected. As people with dementia age, their immune system becomes less effective in fighting infections.
Secondly, infections can increase the risk of cognitive decline and dementia. Hospitalization for common infections such as pneumonia, urinary tract infections, and sepsis has been associated with a higher risk of dementia. The types of infections most associated with dementia include blood and circulatory infections, urinary infections, and hospital-acquired infections (HAIs). HAIs are infections contracted in a healthcare facility, such as an acute care hospital or a skilled nursing care facility.
In addition to the type and frequency of infections, the severity of the infection may also play a role in dementia risk. For example, the worse the sepsis, the greater the risk of developing dementia. Certain infections, such as herpes, syphilis, Lyme disease, and gum disease, have also been linked to an increased risk of dementia, although the causal relationship is not yet fully understood.
The link between infection and dementia may be explained by the impact of infections on brain inflammation and cognitive function. Infection-related brain inflammation can amplify the processes underlying cognitive decline, leading to delirium or acute mental confusion. Additionally, the immune system changes that occur during infection-related delirium are similar to those observed in Alzheimer's disease, further highlighting the role of the immune system in dementia onset and progression.
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Cardiovascular issues
Vascular dementia is a general term for problems with reasoning, planning, judgment, memory, and other thought processes caused by brain damage from impaired blood flow to the brain. Vascular dementia is mostly caused by cardiovascular diseases such as high blood pressure, stroke, or heart problems. Cardiovascular issues can lead to vascular dementia in the following ways:
Firstly, unhealthy arteries are thought to play a role in both heart disease and cognitive problems. Conditions such as high blood pressure, high cholesterol, diabetes, and atherosclerosis (hardening of the arteries) can reduce blood flow to the brain, causing vascular dementia. These conditions can increase the chances of a clot or bleed in the blood vessels in the brain, leading to reduced circulation and depriving the brain of vital oxygen and nutrients.
Secondly, lifestyle choices that increase the risk of cardiovascular diseases also increase the risk of vascular dementia. An unhealthy diet, physical inactivity, smoking, and excessive alcohol consumption can worsen heart health and blood circulation, making it harder to control blood sugar and increasing the risk of vascular dementia.
Thirdly, certain genetic factors can also contribute to the development of vascular dementia. For example, CADASIL (cerebral autosomal dominant arteriopathy with sub-cortical infarcts and leukoencephalopathy) is a genetic disorder that can lead to multiple smaller strokes from middle age onwards, eventually resulting in vascular dementia. People from certain ethnic groups, such as Black African, Black Caribbean, or South Asian backgrounds, may have a higher risk of cardiovascular diseases and, consequently, vascular dementia.
Finally, cardiovascular issues can complicate heart recovery and treatment for people with dementia. Studies have shown that people with dementia, even those with mild cognitive impairments, are less likely to receive invasive procedures to treat heart disease. Dementia can interfere with adhering to a medical treatment plan, and episodes of delirium, along with hospitalization, can accelerate cognitive decline.
In summary, cardiovascular issues can lead to vascular dementia by causing impaired blood flow to the brain and increasing the risk of clots or bleeds in the brain's blood vessels. Additionally, lifestyle choices, genetic factors, and complications during heart recovery can contribute to the development or acceleration of vascular dementia.
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Neuropsychiatric causes
Dementia is a general term for the loss of memory, language, and problem-solving and other thinking abilities that are severe enough to interfere with daily life. Alzheimer's disease accounts for 60-80% of cases. The abnormal brain changes that occur in people with dementia can cause neuropsychiatric issues that may lead to hospitalisation.
Older patients with dementia are at a higher risk of delirium, which can be difficult to differentiate from dementia at the time of hospital intake. The stress of hospitalisation can also cause or worsen neuropsychiatric symptoms in people with dementia. They are more likely to wander, exhibit agitated and aggressive behaviours, and experience functional decline that does not resolve following discharge.
Hospitalisation can be particularly harmful to people with dementia, and it often results in poorer outcomes and higher societal costs. People with dementia are also at an increased risk of hospitalisation due to higher levels of functional impairment. Evidence-based care management approaches and interventions that target specific complications may help to reduce hospitalisations in this vulnerable population.
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Falls
People with dementia may struggle to navigate their environment due to impaired vision and cognitive function. They might misinterpret what they see, struggle with distinguishing between similar colours, or experience illusions and misperceptions. As a result, they may fail to identify hazards such as loose rugs, unsteady footstools, or electrical cords on the floor, increasing their risk of falling. Additionally, they may wander, leading to fatigue and a higher risk of falling or getting lost.
The risk of falling is also influenced by the living environment. Seniors with dementia from lower-income neighbourhoods in Canada are more likely to be hospitalized for falls than those from affluent areas. This disparity could be due to factors such as walkability, access to care, the safety of dwellings, and the ability to afford modifications or assistance. Creating dementia-friendly environments with good lighting, clear pathways, and the use of contrasting colours can help prevent falls.
To reduce the risk of falling, it is important to address the underlying risk factors associated with dementia. This includes ensuring adequate lighting in the home, removing trip hazards, and keeping pathways clear. For those with dementia, footwear that is secure yet easy to take on and off, such as shoes with Velcro fasteners, is recommended. Remote care technology, such as fall alert bracelets or auto detectors, can also be beneficial in case of emergencies.
Hospitalization may be necessary if a fall results in serious injuries, such as fractures, or other medical complications. Falls can lead to disability, functional dependence, and even premature death, making it crucial to implement preventive measures and provide appropriate care for individuals with dementia to minimize the risk of falling.
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Behavioural impairment
Persons living with dementia (PLWD) are at an increased risk of hospitalization and higher hospital-associated health care costs. Hospitalization is often harmful to people with dementia, and results in poorer outcomes, including worsening cognitive status.
The stress of hospitalization can also worsen the cognition of people with Mild Cognitive Impairment (MCI). This can cause an increase in behavioural issues, as patients with dementia may show symptoms of dementia for the first time in hospital, or exhibit a decline in function that does not resolve following discharge.
Hospitalized participants with dementia also took more routine medications at baseline and had more baseline medical comorbidities, particularly cardiovascular disease. This suggests that behavioural issues arising from dementia can be compounded by other health issues, which increase the risk of hospitalization.
Overall, behavioural impairment due to dementia can lead to hospitalization, and this can be further exacerbated by the stress of being in hospital and other health issues.
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Frequently asked questions
Persons living with dementia (PLWD) are at an increased risk of hospitalization due to higher medical complications and healthcare costs.
Infections and falls are the most common caregiver-reported reasons for hospitalization. Other reasons include cardiovascular/pulmonary problems and behavioral impairment.
Dementia is associated with increased rates of hospitalization and often poorer outcomes, including worsening cognitive status. Hospitalization may also worsen the cognition of people with mild cognitive impairment.
Yes, studies have shown that the relative risk of hospitalization for people with dementia compared to those without is higher.
Hospitalization is often harmful to people with dementia and results in high societal costs. It can lead to delirium, falls, dehydration, inadequate nutrition, untreated pain, and medication-related problems.
