Your browser doesn't support javascript.
Treatment intensity and mortality among COVID-19 patients with dementia: A retrospective observational study.
Barnato, Amber E; Birkmeyer, John D; Skinner, Jonathan S; O'Malley, A James; Birkmeyer, Nancy J O.
  • Barnato AE; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.
  • Birkmeyer JD; Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.
  • Skinner JS; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.
  • O'Malley AJ; Sound Physicians, Tacoma, Washington, USA.
  • Birkmeyer NJO; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.
J Am Geriatr Soc ; 70(1): 40-48, 2022 01.
Article in English | MEDLINE | ID: covidwho-1450565
ABSTRACT

BACKGROUND:

We sought to determine whether dementia is associated with treatment intensity and mortality in patients hospitalized with COVID-19.

METHODS:

This study includes review of the medical records for patients >60 years of age (n = 5394) hospitalized with COVID-19 from 132 community hospitals between March and June 2020. We examined the relationships between dementia and treatment intensity (including intensive care unit [ICU] admission and mechanical ventilation [MV] and care processes that may influence them, including advance care planning [ACP] billing and do-not-resuscitate [DNR] orders) and in-hospital mortality adjusting for age, sex, race/ethnicity, comorbidity, month of hospitalization, and clustering within hospital. We further explored the effect of ACP conversations on the relationship between dementia and outcomes, both at the individual patient level (effect of having ACP) and at the hospital level (effect of being treated at a hospital with low <10%, medium 10%-20%, or high >20% ACP rates).

RESULTS:

Ten percent (n = 522) of the patients had documented dementia. Dementia patients were older (>80 years 60% vs. 27%, p < 0.0001), had a lower burden of comorbidity (3+ comorbidities 31% vs. 38%, p = 0.003), were more likely to have ACP (28% vs. 17%, p < 0.0001) and a DNR order (52% vs. 22%, p < 0.0001), had similar rates of ICU admission (26% vs. 28%, p = 0.258), were less likely to receive MV (11% vs. 16%, p = 0.001), and more likely to die (22% vs. 14%, p < 0.0001). Differential treatment intensity among patients with dementia was concentrated in hospitals with low, dementia-biased ACP billing practices (risk-adjusted ICU use 21% vs. 30%, odds ratio [OR] = 0.6, p = 0.016; risk-adjusted MV use 6% vs. 16%, OR = 0.3, p < 0.001).

CONCLUSIONS:

Dementia was associated with lower treatment intensity and higher mortality in patients hospitalized with COVID-19. Differential treatment intensity was concentrated in low ACP billing hospitals suggesting an interplay between provider bias and "preference-sensitive" care for COVID-19.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / Dementia / COVID-19 / Intensive Care Units Type of study: Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male Language: English Journal: J Am Geriatr Soc Year: 2022 Document Type: Article Affiliation country: Jgs.17463

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiration, Artificial / Dementia / COVID-19 / Intensive Care Units Type of study: Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male Language: English Journal: J Am Geriatr Soc Year: 2022 Document Type: Article Affiliation country: Jgs.17463