Abstract
Hospital readmissions have significant quality of care and policy implications for patients and health care providers. The Hospital Readmission Reduction Program financially penalizes hospitals for excessive readmission rates related to index admissions for heart failure, myocardial infarct, chronic obstructive pulmonary disorder, and pneumonia. Research suggests that initiatives to decrease readmissions should target high-risk subgroups. Older adults with dementia are known to be at an increased risk of negative outcomes when transferred between care settings. However, there is a lack of research addressing the relationship between dementia and hospital readmissions. The purpose of this retrospective study was to investigate readmission rates and predictive factors of older adults with and without dementia for the key diagnoses of heart failure, myocardial infarct, chronic obstructive pulmonary disorder, and pneumonia. A nationally representative sample of 389,198 discharge records was extracted from the 2013 Nationwide Readmission Database. Significant differences were found (p<.001) when comparing patient characteristics of older adults with and without dementia who were readmitted within 30 days of discharge. Older adults with dementia had an increased readmission rate and were more likely to be readmitted than older adults without dementia. Predictive factors were calculated using a generalized linear model with dementia included as an interactive effect. Dementia significantly modified the relationship between readmissions and several factors. Classifying older adults with dementia as a high-risk sub-group for readmissions is supported by the findings of this study. Development of strategies to reduce pneumonia readmissions that are tailored to individuals with dementia should be considered.