Dementia and the risk of short-term readmission and mortality after a pneumonia admission.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Dementia*/mortality ; Dementia*/therapy ; Pneumonia*/mortality ; Pneumonia*/therapy ; Hospital Mortality* ; Patient Readmission* ; Registries*; Denmark/epidemiology ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Risk Factors

Background: At time of discharge after a pneumonia admission, care planning for older persons with dementia is essential. However, care planning is limited by lack of knowledge on the short-term prognosis.
Aim: To investigate 30-day mortality and readmission after hospital discharge for pneumonia in persons with versus without dementia, and to investigate how these associations vary with age, time since discharge, and medication use.
Methods: Using the Danish registries, we investigated 30-day mortality and readmission in persons (+65 years) discharged after pneumonia in 2000-2016 (N = 298,872). Adjusted mortality rate ratios (aMRRs) and incidence rate ratios (aIRRs) were calculated for persons with versus without dementia, and we investigated if these associations varied with use of benzodiazepines, opioids, and antipsychotics, and with age and time since discharge.
Results: Among 25,948 persons with dementia, 4,524 died and 5,694 were readmitted within 30 days. The risk of 30-day mortality was 129% higher (95% CI 2.21-2.37) in persons with versus without dementia after adjustment for sociodemographic characteristics, admission-related factors, and comorbidities. Further, the highest mortality risk was found in persons with both dementia and use of antipsychotics (aMRR: 3.39, 95% CI 3.19-3.59); 16% of deaths in this group could not be explained by the independent effect of each exposure. In those with dementia, the highest aMRRs were found for the youngest and for the first days after discharge. The risk of 30-day readmission was 7% higher (95% CI 1.04-1.10) in persons with versus without dementia. In those with dementia, the highest aIRRs were found for the first days after discharge.
Conclusions: Dementia was associated with higher short-term mortality after pneumonia, especially in users of antipsychotics, and with slightly higher readmission, especially in the first days after discharge. This is essential knowledge in the care planning for persons with dementia who are discharged after a pneumonia admission.

The authors have declared that no competing interests exist.

N Engl J Med. 2009 Oct 15;361(16):1529-38. (PMID: 19828530)
Dtsch Arztebl Int. 2018 Nov 2;115(44):733-740. (PMID: 30565543)
Biometrics. 2000 Jun;56(2):645-6. (PMID: 10877330)
Thorax. 2013 Nov;68(11):1057-65. (PMID: 24130229)
Dement Geriatr Cogn Disord. 2010;29(2):146-53. (PMID: 20150733)
Expert Rev Respir Med. 2014 Dec;8(6):661-3. (PMID: 25193249)
Scand J Public Health. 2011 Jul;39(7 Suppl):54-7. (PMID: 21775352)
Scand J Public Health. 2011 Jul;39(7 Suppl):30-3. (PMID: 21775347)
Psychiatr Serv. 2015 Feb 1;66(2):134-40. (PMID: 25642610)
BMJ Open. 2013 Jan 07;3(1):. (PMID: 23299110)
Med Care. 2004 Mar;42(3):200-9. (PMID: 15076819)
JAMA Psychiatry. 2015 Nov;72(11):1095-101. (PMID: 26444987)
Am Fam Physician. 2010 Mar 1;81(5):617-22. (PMID: 20187598)
CMAJ. 2017 Apr 10;189(14):E517-E518. (PMID: 28396327)
BMJ. 2008 Feb 2;336(7638):258-62. (PMID: 18187696)
Am J Epidemiol. 2016 Aug 1;184(3):199-210. (PMID: 27407085)
Br J Psychiatry. 2009 Jul;195(1):61-6. (PMID: 19567898)
Arch Intern Med. 2001 Oct 22;161(19):2378-81. (PMID: 11606155)
Med Care. 2019 Oct;57(10):766-772. (PMID: 31415343)
Clin Infect Dis. 2014 Jul 1;59(1):74-80. (PMID: 24729503)
JAMA. 2010 Jul 28;304(4):443-51. (PMID: 20664045)
Maturitas. 2019 Nov;129:57-61. (PMID: 31547914)
Clin Geriatr Med. 1998 Nov;14(4):699-726. (PMID: 9799475)
Dement Geriatr Cogn Disord. 2007;24(3):220-8. (PMID: 17690555)
Clin Epidemiol. 2019 Jul 12;11:563-591. (PMID: 31372058)
J Gerontol A Biol Sci Med Sci. 2005 Dec;60(12):1576-80. (PMID: 16424291)
Alzheimers Dement. 2019 Nov;15(11):1383-1391. (PMID: 31587994)
Am J Psychiatry. 2000 May;157(5):708-14. (PMID: 10784462)
Nutrients. 2019 Dec 26;12(1):. (PMID: 31888041)
J Am Board Fam Med. 2012 Mar;25 Suppl 1:S34-8. (PMID: 22403249)
PLoS One. 2015 Oct 13;10(10):e0140203. (PMID: 26461064)
Pain Pract. 2008 Jul-Aug;8(4):287-313. (PMID: 18503626)
J Am Med Dir Assoc. 2020 Dec;21(12):1869-1878.e10. (PMID: 33036912)
Eur J Epidemiol. 2014 Aug;29(8):541-9. (PMID: 24965263)
BMC Pulm Med. 2017 Oct 6;17(1):128. (PMID: 28985724)
Dement Geriatr Cogn Disord. 2012;34(5-6):292-9. (PMID: 23208125)
Int J Geriatr Psychiatry. 2018 Jun 26;:. (PMID: 29947150)
Intern Med. 2017;56(8):907-914. (PMID: 28420838)
Ann Intern Med. 2010 Apr 6;152(7):418-25, W139-40. (PMID: 20368647)
Cochrane Database Syst Rev. 2015 May 14;(5):CD009705. (PMID: 25972091)
J Alzheimers Dis. 2020;73(1):259-267. (PMID: 31771062)
J Trauma. 2010 Oct;69(4):821-5. (PMID: 20938268)
J Alzheimers Dis. 2019;69(3):807-816. (PMID: 31127778)
Scand J Public Health. 2011 Jul;39(7 Suppl):38-41. (PMID: 21775349)
J Intern Med. 2006 Apr;259(4):410-7. (PMID: 16594909)
Ann Intern Med. 2015 Jun 2;162(11):741-9. (PMID: 26030632)
Nat Rev Neurol. 2009 May;5(5):245-55. (PMID: 19488082)

Date Created: 20210128 Date Completed: 20210621 Latest Revision: 20231110

20260130

PMC7842970

10.1371/journal.pone.0246153

33507947