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Dementia ICU

ICU Admission Means Trouble for Alzheimer's and Dementia Patients

By Jonathan Springston, Editor, Relias Media

Older patients living with Alzheimer’s disease and related dementia (ADRD) are less likely to be discharged from an ICU after admission compared to other patients without those conditions. ADRD patients who are discharged home from the ICU are almost twice as likely to die within the same month.

In an observational study, researchers examined data collected in Optum’s Clinformatics Data Mart Database between 2016 and 2019. They were looking for adults older than age 67 years who were living with ADRD, were continuously enrolled in Medicare Advantage, and experienced a first ICU admission in 2018. Investigators studied discharge locations (home vs. other facilities) and mortality rates (within the same calendar month of discharge and within 12 months after discharge).

Among more than 145,000 patients who met the criteria, 10.5% were living with ADRD and were likely to be older, women, and managing more comorbid conditions. Only 37.6% of patients with ADRD were discharged home vs. 68.6% of patients without ADRD. Death in the same month as discharge (19.9% vs. 10.3%) and death in the 12 months after discharge (50.8% vs. 26.2%) were twice as common among patients with ADRD.

In addition to its observational design, another weakness is the fact the authors did not compare the varying degrees of disease state (mild vs. severe). Additionally, researchers did not study level of care during ICU stay nor after discharge, the cause of death, or other unobserved underlying differences in health between the two, among other admitted flaws. Nevertheless, this work suggests more attention should be paid to these patients facing an ICU admission.

“These observations raise questions about whether treatment plans should be adjusted proactively to include strategies to diminish the likelihood of an ICU admission, such as vigilance with comorbid disease management, or patient, family, and caregiver involvement in early discussions about palliative care,” the authors concluded. “Further research on discharge rates and mortality risks of patients with ADRD is needed, as well as research on how to best stratify the type and severity of ADRD for exploring post-ICU outcomes.”

For more on this and related subjects, be sure to read the latest issues of Critical Care Alert, ED Management, Emergency Medicine Reports, Medical Ethics Advisor, and Neurology Alert.