Dementia makes most things in life difficult, including hospital treatment. Although often essential for patients suffering from severe acute illnesses, hospital treatment can be confusing for patients. person with dementiaor disabled person. Compared to older adults without dementia, people with disabilities in the United States have higher rates of emergency room visits and hospitalizations. In such cases, the decision to admit requires a delicate balance between the potential benefits and risks of inpatient treatment.
Previous research suggests that people with disabilities who are admitted to hospital have higher mortality rates and spend more days away from home in the subsequent months than people with disabilities who are not hospitalized. However, a possible explanation for this is that hospitalized patients are already, in unmeasured ways, worse off than other patients.
Intrigued by this challenge, a team of researchers from Kyoto University and the University of California, Los Angeles, investigated whether hospitalization had a causal effect on health outcomes for people with dementia, and also examined the impact on subsequent health care spending.
An important issue in studying the effects of hospitalization is that sicker patients are more likely to be hospitalized, which can lead to worse outcomes for hospitalized patients, even if hospitalization itself is not the cause. ”
Ryo Ikesu Corresponding author
To address this bias, the team combined the data with Medicare data. Manipulated variable approach. This included the reasoning that different emergency physicians have different propensities to accept patients, and that the emergency physician assigned to a patient is essentially random and depends primarily on who is on shift. To estimate the causal effect of hospitalization while eliminating the effect of patient severity, the researchers compared patients seen by physicians with a high propensity to admit to those seen by physicians with a low propensity to admit.
Ultimately, the researchers found no clear evidence that hospitalization affected 30-day or 90-day mortality. However, compared with patients who were not hospitalized, medical expenditures were approximately $2,500 higher for hospitalized patients 30 days after an ED visit, primarily due to home health and nursing home care. This suggests that hospitalization can change a patient’s care trajectory and significantly increase subsequent expenditures. Researchers found a similar pattern for 90-day spending.
“Despite evidence suggesting a decline in physical and cognitive function in older adults after inpatient treatment, we found no evidence that hospitalization was associated with this decline in long-term nursing home residents with dementia, likely due to small sample size,” Ikes says.
These findings do not indicate that hospitalization is inappropriate for people with dementia, but rather highlight the opportunity to consider alternatives, such as acute home care and outpatient follow-up, for borderline cases where the need for hospitalization is uncertain.
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Reference magazines:
Ikesu, R., Others. (2026) The impact of hospitalization on health outcomes and healthcare expenditures for patients with dementia. Annual report of internal medicine. DOI: 10.7326/ANNALS-25-03725. https://www.acpjournals.org/doi/10.7326/ANNALS-25-03725
