Associations between Cognitive Function, Hospitalizations and Costs in Nursing Homes: A Cross-sectional Study

ABSTRACT

In an Australian nursing home population, associations between cognitive function and 12-month hospitalizations and costs were examined. Participants with dementia had 57% fewer hospitalizations compared to those without dementia, with 41% lower mean hospitalization costs; poorer cognition scores were also associated with fewer hospitalizations. The cost per admission for those with dementia was 33% greater due to longer hospital stays (5.5 days versus 3.1 days for no dementia, p = .05). People with dementia were most frequently hospitalized for fractures. These findings have policy implications for increasing investment in accurate and timely diagnosis of dementia and fall and fracture prevention strategies to further reduce associated hospitalization costs.

KEYWORDS:

• Dementia
• cognitive impairment
• hospitalizations
• costs
• nursing homes

Acknowledgments

The authors sincerely thank the INSPIRED study participants and their family members for their participation and interest in the study. The assistance of facility staff, care worker researchers, facility pharmacists and data collectors in data collection in each state and facility is gratefully acknowledged. Non-Author members of the study team are thanked for their input into study management, data collection and data coordination of the INSPIRED study.

Author contributions

ESG was responsible for the preparation of data, analysis of data and drafting of the manuscript, SMD contributed substantially to drafting of the manuscript, SLH and EL contributed to analysis and drafting of the manuscript, CW was responsible for intellectual input to the manuscript and MC is the lead investigator of the INSPIRED Study and contributed to the design of the study and was also responsible for intellectual input of the manuscript. All authors read, edited and approved the final manuscript.

Key Points

• People living in nursing homes are at high risk of hospitalization.

• Australians in care with dementia had fewer hospitalizations than those without.

• Hospital cost and length of stay was greater for people in care with dementia.

• Fractures were the most common reason for hospitalization for those with dementia.

• Falls prevention programs could reduce hospitalizations and costs of dementia care.

Disclosure statement

The Authors declare that there is no conflict of interest.

Statement of ethics

Human research ethics approval was obtained from the Flinders University Social and Behavioural ethics committee (references, 6594, 6732, 6753) and by federal and state custodians of hospital data: the Department of Veterans’ Affairs Human Research Ethics Committee (reference, E015/014), the SA Department for Health and Ageing Human Research Ethics Committee (reference, SSA/16/SAH/29), the Department of Health WA Human Research Ethics Committee (reference, 2015/59), the Queensland Department of Health (reference, RD006096), and the NSW Population and Health Services Research Ethics Committee (reference, HREC/15/CIHS/35). Self-consent by patients to participation was obtained when possible; for participants with more severe cognitive impairment, proxy consent for participation was provided (usually by a close family member).

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

This work was supported by funding provided by the National Health and Medical Research Council (NHMRC) Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People (CDPC) (grant number GNT9100000). The contents of the published materials are solely the responsibility of the Administering Institution, Flinders University, and the individual authors identified, and do not reflect the views of the NHMRC or any other Funding Bodies or the Funding Partners.