title: The influence of dementia on injury-related hospitalisations and outcomes in older adults.
abstract: BACKGROUND
  Injury is the most common reason for admission to hospital in people with dementia in Australia. However relatively little is known about the temporal trends and the hospital experience of people with dementia hospitalised for an injury. This population-based data linkage study compared the causes, temporal trends and health outcomes for injury-related hospitalisations in people with and without dementia.
  
  
  METHODS
  Hospitalisation and death data for 235,612 individuals aged 65 years and over admitted to hospital for an injury over the ten year period (2003-2012) in New South Wales, Australia were probabilistically linked. Descriptive statistics including chi square tests, observed and age-standardised admission rates and rate ratios (RRs) were calculated. Trends over time were analysed using negative binomial regression.
  
  
  RESULTS
  There were 331,432 injury-related hospitalisations over the study period. Both the observed (RR 3.16; 95% CI 3.13-3.19) and age-standardised admission rate ratios (RR 1.78; 95% CI 1.77-1.79) were higher for people with dementia. Age-standardised rates increased by 3.5% (95% CI 3.1-3.9) per annum over the study period for people without dementia. In contrast, for people with dementia, rates increased by 2.4% (95% CI 1.8-3.1) per annum until 2007 and then decreased by 3.1% (95% CI -4.4 to -1.7) per annum from 2007 onwards. Compared to people without dementia, a higher proportion of people with dementia were hospitalised as a result of a fall (90.9% vs 75.2%, p<0.0001), sustained a fracture (57.2% vs 52.1%, p<0.0001), notably hip fracture (30.7% vs 14.7%, p<0.0001), had longer mean hospital lengths of stay (LOS) (16.5 vs 13.6 days), and higher 30-day mortality (8.7% vs 3.6% p<0.0001), although this pattern was not consistent across all injury types.
  
  
  CONCLUSIONS
  People with dementia are disproportionately represented in injury-related hospitalisations, experience longer hospital LOS and have poorer outcomes. Ninety percent of hospitalisations for people with dementia were as a result of a fall, highlighting the importance of developing and implementing effective fall-related preventive strategies in this high risk population.
authors.affiliation: Falls and Injury Prevention Group, Neuroscience Research Australia, UNSW, Australia. Electronic address: l.harvey@neura.edu.au.
authors.forename: Lara
authors.initials: L
authors.lastname: Harvey
authors.affiliation: Falls and Injury Prevention Group, Neuroscience Research Australia, UNSW, Australia; Australian Institute of Health Innovation, Macquarie University, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Mitchell
authors.affiliation: Dementia Collaborative Research Centre - Assessment and Better Care, UNSW, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, UNSW, Australia.
authors.forename: Henry
authors.initials: H
authors.lastname: Brodaty
authors.affiliation: Dementia Collaborative Research Centre - Assessment and Better Care, UNSW, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, UNSW, Australia.
authors.forename: Brian
authors.initials: B
authors.lastname: Draper
authors.affiliation: Falls and Injury Prevention Group, Neuroscience Research Australia, UNSW, Australia; Prince of Wales Clinical School, UNSW, Australia.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Close
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D017677:Age Distribution; D003704:Dementia / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology*; D006707:Homes for the Aged; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016247:Information Storage and Retrieval; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D017063:Outcome Assessment, Health Care
keywords: Dementia; Hospitalisations; Injury; Mortality; Prevalence; Probabilistic data linkage