No Clear Mortality Benefit Found for Hospitalizing Dementia Patients
A new study from Kyoto University and UCLA challenges assumptions about the value of hospital admission for persons with dementia (PWD), finding no clear evidence that admission reduces mortality while noting a significant increase in downstream healthcare costs.
A Causal Look at Hospitalization
Researchers used Medicare data and an innovative instrumental variable approach based on physician admission propensity to isolate the causal effect of hospital admissions on health outcomes.
Key Findings on Mortality and Function
- Mortality: The study found no evidence that hospital admission affected 30- or 90-day mortality rates following an emergency room visit.
- Physical & Cognitive Function: Among long-term nursing home residents with dementia, the study did not find evidence of a decline in physical or cognitive function after hospital admission. The authors caution, however, that this result may be due to a small sample size.
The Cost of a Different Care Trajectory
The most pronounced effect was on spending. Healthcare spending for admitted patients was approximately $2,500 higher 30 days after an emergency room visit, with similar patterns observed at 90 days.
"Health care spending was approximately $2,500 higher for admitted patients 30 days after an emergency room visit, mainly due to home healthcare and nursing facility care."
This increase was primarily driven by post-acute care, specifically home healthcare and nursing facility care, suggesting that hospitalization alters a patient's care trajectory, increasing downstream utilization.
Implications for Care Decisions
The findings do not suggest that hospital admission is inappropriate for persons with dementia. However, for borderline cases, the authors propose that alternatives such as home-based acute care or structured outpatient follow-up could be considered to avoid the high downstream spending without sacrificing patient outcomes.