Dementia is a known public health priority worldwide. In the United Kingdom (UK) there are currently more than 910,000 people living with the condition and this number is projected to more than double, to two million people by 2051.
As part of her PhD, Bria Browne, a student at Brighton and Sussex Medical School and Living Well with Dementia theme at the Applied Research Collaboration Kent, Surrey Sussex (ARC KSS), undertook a literature review that looked at the determinants of hospital readmissions among older people living with dementia.
The study, Exploring the determinants of hospital admissions in older people with dementia, highlights how older adults with dementia are disproportionately susceptible to multiple hospital readmissions within a short timeframe, significantly impacting their cognitive function, quality of life, and overall health outcomes. The review emphasises the intricate interplay of physical and psychosocial factors contributing to these readmissions.
Physical factors identified include:
- How people with dementia, who are dependent on caregivers for mobility assistance, were 59% more likely to be readmitted to hospital within 30 days.
- Those who were dependent on self-care from caregivers were 73% more likely to have a 30-day hospital readmission.
- And, for people with long-term conditions such as cardiovascular disease and chronic urinary tract infections. The risk of hospital readmissions was: 57% with one long-term condition; 70% with two or three long-term conditions; and 80% with four or five long-term conditions.
The research indicates that individuals with dementia, facing these challenges, are at a significantly higher risk of hospital readmissions.
In addition, the study delves into the psychosocial determinants of hospital readmissions, including:
- Inadequate discharge planning.
- Poor communication among healthcare staff of different disciplines working well together, including poor communication between hospital and care home staff.
- Socioeconomic disadvantages among ethnic minority people with dementia.
Frequent use of antipsychotic medication in older people with dementia discharged to nursing homes, was found to be a physical and psychosocial factor, due to its limited management of behavioural and psychological symptoms of dementia, and physical side effects of reduced mobility, resulting in a cycle of increased care needs.
These findings underscore the importance of holistic and culturally-sensitive approaches to care for individuals living with dementia.
Kath Sykes, ARC KSS Implementation Lead, Living Well with Dementia theme, says:
"Ageing with dementia creates additional challenges and the impact of this is already evident. The Chief Medical Officer's annual report of 2023 highlights the strain on the health and care system, in particular in rural and coastal areas like Kent Surrey and Sussex, where more older adults live, and where delivering health and care is geographically more challenging.
"We regularly hear from individuals with dementia, their caregivers, and healthcare professionals highlighting the difficulties in accessing proactive support, primary care, and social care services, whether through public or private avenues. This lack of accessibility often culminates in crisis situations, with individuals requiring acute hospital attendance or admission, scenarios that could potentially have been prevented with timely, integrated care provided in their homes.
"That's why proactive support and integrated care in community settings are essential for preventing avoidable hospital admissions among people with dementia. Effective discharge planning and collaboration among healthcare professionals from different disciplines are crucial elements in this endeavour.
"This research serves as a vital step towards improving outcomes and experiences for individuals living with dementia, while alleviating the strain on the health and care system. It highlights the urgent need for targeted interventions and policy reforms to address the complex needs of this vulnerable population."
Bria Browne received an honourable mention from Dr Lade Smith, CBE, President of the Royal College of Psychiatrists, during her keynote speech at the British Geriatric Conference last autumn for her significant contribution to understanding health inequalities affecting ethnic minority older people.
