Impact of interhospital transfer on patients with Alzheimer’s disease and other related dementias

Published in the journal Alzheimer’s and Dementia. Here is a link to the article.

Regenstrief Institute authors: Kathleen Unroe M.D., MHA, Malaz Boustani, M.D., MPH

Abstract

Older adults are often transferred from one emergency department (ED) to another hospital for speciality care, but little is known about whether those transfers positively impact patients, particularly those with Alzheimer’s disease and other related dementias (ADRD). In this study we aimed to describe the impact of interhospital transfer on older adults with and without ADRD. In a retrospective review of electronic medical records, we collected data on demographics, insurance type, initial code status, intensive care, length of stay, specialist consult, procedure within 48 hours, and discharge disposition for older adults (≥65 years). We included older adults with at least one ED visit, who were transferred to a tertiary care hospital. With logistic regression, we estimated odds of death, intensive care stay, or procedure within 48 hours by ADRD diagnosis. Patients with ADRD more often received a geriatrics (p < 0.001) or palliative care consult (p = 0.038). They were less likely to be full code at admission (p < 0.001) or to be discharged home (p < 0.001). Patients living with ADRD less often received intensive care or a procedure within 48 hours of transfer (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.22-2.88). Patients with ADRD were less likely to receive intensive care unit admission or specialist procedures after transfer. Further study is indicated to comprehensively understand patient-centered outcomes.

Authors

Nancy Glober¹, Alexandra LaShell¹, Nicholas Montelauro¹, Lindsay Troyer¹, Michael Supples², Kathleen Unroe¹, Christopher Tainter³, Greg Faris¹, Mikita Fuchita⁴, Malaz Boustani¹

Author Affiliations

¹Indiana University School of Medicine Indianapolis Indiana USA.

²Department of Emergency Medicine Wake Forest School of Medicine Winston-Salem North Carolina USA.

³University of California at San Diego La Jolla California USA.

⁴University of Colorado Hospital Aurora Colorado USA.