A Nationwide Study of the Impact of Dysphagia on Hospital Outcomes Among Patients With Dementia.
OBJECTIVE
To assess the impact of dysphagia on clinical and operational outcomes in hospitalized patients with dementia.


METHODS
Retrospective cohort study.


METHODS
2012 Nationwide Inpatient Sample.


METHODS
All patients discharged with a diagnosis of dementia (N = 234,006) from US hospitals in 2012.


METHODS
Univariate and multivariate regression models, adjusting for stroke and patient characteristics, to assess the impact of dysphagia on the prevalence of comorbidities, including pneumonia, sepsis, and malnutrition; complications, including mechanical ventilation and death; and operational outcomes, including length of stay (LOS) and total charges for patients with dementia.


RESULTS
Patients having dementia with dysphagia (DWD) had significantly higher odds of having percutaneous endoscopic gastrostomy placement during the admission (odds ratio [OR]: 13.68, 95% confidence interval [CI]: 12.53-14.95, P < .001), aspiration pneumonia (OR: 6.27, 95% CI: 5.87-6.72, P < .001), pneumonia (OR: 2.84, 95% CI: 2.67-3.02, P < .001), malnutrition (OR: 2.5, 95% CI: 2.27-2.75, P < .001), mechanical ventilation (OR: 1.69, 95% CI: 1.51-1.9, P < .001), sepsis (OR: 1.52, 95% CI: 1.39-1.67, P < .001), and anorexia (OR: 1.29, 95% CI: 1.01-1.65, P = .04). Mean LOS was 2.16 days longer (95% CI: 1.98-2.35, P < .001), mean charge per case was US$10,703 higher (95% CI: US$9396-US$12,010, P < .001), and the odds of being discharged to a skilled nursing, rehabilitation, or long-term facility was 1.59 times higher (95% CI: 1.49-1.69, P < .001) in the DWD cohort compared to patients having dementia without dysphagia.


CONCLUSIONS
Dysphagia is a significant predictor of worse clinical and operational outcomes including a 38% longer LOS and a 30% increase in charge per case among hospitalized patients with dementia. Although these findings may not be surprising, this new evidence might bring heightened awareness for the need to more thoughtfully support patients with dementia and dysphagia who are hospitalized.
1 Divisions of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, Baltimore, MD, USA.
Suchitra
S
Paranji
1 Divisions of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, Baltimore, MD, USA.
Neethi
N
Paranji
2 General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, Baltimore, MD, USA.
Scott
S
Wright
1 Divisions of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University, Baltimore, MD, USA.
Shalini
S
Chandra
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003680:Deglutition Disorders / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D003704:Dementia / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
NIS; cost; dementia; dysphagia; resource utilization