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. 2018 Jul;66(6):1137-1143.
doi: 10.1111/jgs.15355. Epub 2018 Mar 20.

Lower Postsurgical Mortality for Individuals with Dementia with Better-Educated Hospital Workforce

Elizabeth M White  1 , Jessica G Smith  1 , Rebecca L Trotta  2 , Matthew D McHugh  1
Affiliations

Lower Postsurgical Mortality for Individuals with Dementia with Better-Educated Hospital Workforce

Elizabeth M White et al. J Am Geriatr Soc. 2018 Jul.

Abstract

Objectives: To investigate whether care in a hospital with more nurses holding at least a Bachelor of Science in Nursing (BSN) degree is associated with lower mortality for individuals with Alzheimer's disease and related dementias (ADRD) undergoing surgery ADRD.

Design: Cross-sectional data from 2006-07 Medicare claims were linked with the Multi-State Nursing Care and Patient Safety Survey of nurses in 4 states.

Setting: Adult, nonfederal, acute care hospitals in California, Florida, New Jersey, and Pennsylvania (N=531).

Participants: Medicare beneficiaries aged 65 and older with and without ADRD undergoing general, orthopedic, or vascular surgery (N=353,333; ADRD, n=46,163; no ADRD, n=307,170).

Measurements: Thirty-day mortality and failure to rescue (death after a complication).

Results: Controlling for hospital, procedure, and individual characteristics, each 10% increase in the proportion of BSN nurses was associated with 4% lower odds of death (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.93-0.98) for individuals without ADRD, but 10% lower odds of death (OR=0.90, 95% CI=0.87-0.94) for those with ADRD. Each 10% increase in the proportion of nurses holding a BSN degree or higher was associated with 5% lower odds of failure to rescue (OR=0.95, 95% CI=0.92-0.98) for individuals without ADRD but 10% lower odds of failure to rescue (OR=0.90, 95% CI=0.87-0.94) for those with ADRD.

Conclusion: Individuals undergoing surgery who have coexisting ADRD are more likely to die within 30 days of admission and die after a complication than those without ADRD. Having more BSN nurses in the hospital improves the odds of good outcomes for all individuals and has a much greater effect in individuals with ADRD.

Keywords: dementia; mortality; nurse education; workforce.

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Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Panel A Predicted probabilities of 30 day mortality for surgical patients with and without Alzheimer’s disease and related dementias at varying levels of BSN staffing Panel B: Predicted probabilities of failure-to-rescue for surgical patients with and without Alzheimer’s disease and related dementias at varying levels of BSN staffing
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References

    1. Bail K, Goss J, Draper B, et al. The cost of hospital-acquired complications for older people with and without dementia: A retrospective cohort study. BMC Health Serv Res. 2015;15:1–9. - PMC - PubMed
    1. Beatty JA, Majumdar SR, Tyrrell GJ, et al. Prognostic factors associated with mortality and major in-hospital complications in patients with bacteremic pneumococcal pneumonia: Population-based study. Medicine (Baltimore) 2016;95:1–6. - PMC - PubMed
    1. Dewing J, Dijk S. What is the current state of care for older people with dementia in general hospitals? A literature review. Dementia. 2016;15:106–124. - PubMed
    1. Paranji S, Paranji N, Wright S, et al. A nationwide study of the impact of dysphagia on hospital outcomes among patients with dementia. Am J Alzheimers Dis Other Demen. 2017;32:5–11. - PMC - PubMed
    1. Beydoun MA, Beydoun HA, Gamaldo AA, et al. Nationwide inpatient prevalence, predictors, and outcomes of Alzheimer’s disease among older adults in the United States, 2002–2012. J Alzheimers Dis. 2015;48:361–375. - PMC - PubMed

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