More and more dementia patients hospitalized

NEW YORK Wed Nov 16, 2011 5:25pm EST

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NEW YORK (Reuters Health) - A new analysis of elderly dementia patients has found that by 2050, between three and seven million may be hospitalized each year, up from just over one million a few years ago.

That's worrisome both because the health care system is already strained, researchers say, and because the aggressive care given in hospitals might not be the best option for those patients.

"This is the perfect nexus of 'do no harm' and 'be fiscally restrained,'" said Dr. Marya Zilberberg, from the University of Massachusetts in Amherst, who worked on the study.

"We are sending elderly demented patients into the hospital more often than we should, and it's not pleasant for them," Zilberberg, also of EviMed Research Group, told Reuters Health.

Between 2000 and 2008, the researchers calculated, the number of hospitalizations of Americans 85 and older with dementia rose from 700,000 to 1.2 million annually, reaching a rate of about 21,000 for every 100,000 elderly.

With the predicted growth in both the number of aging Americans and the proportion struck by dementia, in forty years as many as seven million could be hospitalized each year, Zilberberg's team wrote in a letter published in the Archives of Internal Medicine this week.

"It's shocking," said Dr. Ladislav Volicer, who studies aging at the University of South Florida in Tampa and wasn't part of the new work. "There is certainly the need to decrease hospitalization."

The researchers call for expanded use of nursing homes and hospice care instead of putting the graying heads in hospitals, where they are more likely to be confined to their bed and may have to be restrained.

"Based on the paper itself, I can't say, 'This percent of the patients can be treated right in hospice care,'" Zilberberg said.

Still, she added, "Yes, there should be more care taken in terms of their comfort and in terms of appropriate and timely end-of-life discussion and measures and support of the family."

Dr. Susan Mitchell, who didn't work on the study, said most hospitalizations in older patients with dementia are due to infections such as pneumonia.

"The default is to treat them with the most aggressive care possible, including hospitalization," said Mitchell, from the Institute for Aging Research and Harvard Medical School in Boston.

But, she added, "For the run-of-the-mill pneumonia, I'd say most reasonable nursing homes can provide that care."

To avoid trips to the hospital, Mitchell and Zilberberg agree that nursing homes will need to start getting adequate compensation from Medicare to treat patients with dementia who come down with infections. Now, nursing facilities have more of an incentive to send those patients to acute care, rather than to handle the cases themselves.

In the meantime, families should realize they have a choice in where their loved ones are treated, Mitchell said.

Volicer added that it's important for families -- and elderly patients, if possible -- to plan in advance for care toward the end of life.

"You have to talk to the families but explain to them that the hospital is not appropriate for people with advanced dementia, especially older people with advanced dementia, because hospitalization is decreasing their functioning and producing (discomfort)," Volicer told Reuters Health.

For many of those families, "The goal of care is primarily comfort or palliative care," Mitchell said. "Almost always a hospitalization is not in keeping with that goal."

SOURCE: bit.ly/saPLTA Archives of Internal Medicine, online November 14, 2011.

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