Medicare patients with dementia 20 percent more likely to be readmitted

April 29, 2014, Lifespan

A review of more than 25,000 admissions of Medicare beneficiaries to Rhode Island hospitals has found that patients with a documented diagnosis of dementia are nearly 20 percent more likely to be readmitted within 30 days than those without dementia. The study by Rhode Island Hospital researchers is published online in advance of print in the journal Archives of Gerontology and Geriatrics.

"Persons with may have difficulties comprehending and following important discharge instructions, (e.g. medication changes, decision making, self care)," said principal investigator Lori Daiello, PharmD, of the Alzheimer's Disease and Memory Disorders Center at Rhode Island Hospital. "In addition, many patients with dementia have multiple medical conditions, so it's not surprising that this group of vulnerable older adults might be at a higher risk of being readmitted to the hospital shortly after discharge."

Daillo added, "Because dementia often goes undiagnosed, or is not documented in a patient's medical record, we believe that the current findings may underestimate readmission rates and risks in this population."

Dementia is often co-morbid with conditions such as pneumonia, heart failure, chronic obstructive pulmonary disease (COPD), and urinary tract infections, which have been associated with preventable hospitalizations. Preventable readmissions have been recognized as an indicator of hospital quality, a source of increased cost, and are now tied to Medicare reimbursements.

In 2010, the Patient Protection and Affordable Care Act imposed penalties related to hospital readmission rates. The initial phase went into effect in October 2012 and reduces Medicare payments for readmissions within 30 days of discharge related to three common hospital discharge diagnoses: acute myocardial infarction (heart attack), pneumonia, and congestive . Penalties will increase and the list of conditions will expand in fiscal year 2015.

"Our results indicate that a diagnosis of dementia may be a marker of vulnerability for rapid rehospitalization and may suggest a role for specialized initiatives aimed at lowering ," Daiello said. "Developing effective interventions to prevent unnecessary readmissions is critically important because hospitalizations are often destabilizing events for persons with dementia and consequently place undue burden on our patients, their families and caregivers, and ultimately on our healthcare systems due to financial penalties and reduced Medicare reimbursements."

Successful transitions from hospital to home frequently require that patients be involved in complex decision-making, altering medication regimens, and adjusting familiar routines. Negotiating this path is challenging, even for cognitively intact adults. Patients with dementia may be unable to accomplish some or all of these tasks successfully, yet little is known about the impact of dementia on transitions from to home.

"Our results suggest that a better understanding of the peridischarge period for patients with dementia may inform initiatives aimed at decreasing readmissions for hospitalized elderly ," Daiello said.

Explore further: Role of chronic medical conditions in readmissions

Related Stories

Role of chronic medical conditions in readmissions

December 23, 2013
Researchers cite identification and monitoring of known underlying chronic medical conditions as opportunities to reduce readmission rates and improve patient safety.

Hospitals serving elderly poor more likely to be penalized for readmissions

January 8, 2014
Hospitals that treat more poor seniors who are on both Medicaid and Medicare tend to have higher rates of readmissions, triggering costly penalties from the Centers for Medicare and Medicaid Services (CMS), finds a new study ...

Community demographics linked to hospital readmissions

April 11, 2014
Nearly 60 percent of the variation in hospital readmission rates appears to be associated with where the hospital is located rather than on the hospital's performance, finds a new study in Health Services Research.

Top hospitals reduce readmissions by preventing complications across all diagnoses

November 20, 2013
Checking back into the hospital within 30 days of discharge is not only bad news for patients, but also for hospitals, which now face financial penalties for high readmissions. The key to reducing readmissions may be focusing ...

Improved staffing cuts medicare patient readmissions

January 4, 2013
(HealthDay)—Hospital nurses with good work environments who are caring for fewer patients have significantly fewer elderly Medicare patients with heart failure, acute myocardial infarction (MI), and pneumonia who are readmitted ...

Cognitive impairment common among community and nursing-home resident elderly

April 7, 2014
More than 70% of elderly Medicare beneficiaries experience cognitive impairment or severe dementia near the end-of-life and may need surrogate decision makers for healthcare decisions. Advance care planning for older adults ...

Recommended for you

Not being aware of memory problems predicts onset of Alzheimer's disease

February 15, 2018
Doctors who work with individuals at risk of developing dementia have long suspected that patients who do not realize they experience memory problems are at greater risk of seeing their condition worsen in a short time frame, ...

Researchers successfully reverse Alzheimer's disease in mouse model

February 14, 2018
A team of researchers from the Cleveland Clinic Lerner Research Institute have found that gradually depleting an enzyme called BACE1 completely reverses the formation of amyloid plaques in the brains of mice with Alzheimer's ...

Poor fitness linked to weaker brain fiber, higher dementia risk

February 14, 2018
Scientists have more evidence that exercise improves brain health and could be a lifesaving ingredient that prevents Alzheimer's disease.

Compound prevents neurological damage, shows cognitive benefits in mouse model of Alzheimer's disease

February 7, 2018
The supplement nicotinamide riboside (NR) – a form of vitamin B3 – prevented neurological damage and improved cognitive and physical function in a new mouse model of Alzheimer's disease. The results of the study, conducted ...

Positive attitudes about aging reduce risk of dementia in older adults

February 7, 2018
Research has shown that older persons who have acquired positive beliefs about old age from their surrounding culture are less likely to develop dementia. This protective effect was found for all participants, as well as ...

One in five older adults experience brain network weakening following knee replacement surgery

February 7, 2018
A new University of Florida study finds that 23 percent of adults age 60 and older who underwent a total knee replacement experienced a decline in activity in at least one region of the brain responsible for specific cognitive ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.