Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 28;16(1):e0246153.
doi: 10.1371/journal.pone.0246153. eCollection 2021.

Dementia and the risk of short-term readmission and mortality after a pneumonia admission

Susanne Boel Graversen  1   2 , Henrik Schou Pedersen  1 , Annelli Sandbaek  2   3 , Catherine Hauerslev Foss  4 , Victoria Jane Palmer  5 , Anette Riisgaard Ribe  1
Affiliations

Dementia and the risk of short-term readmission and mortality after a pneumonia admission

Susanne Boel Graversen et al. PLoS One. .

Abstract

Background: At time of discharge after a pneumonia admission, care planning for older persons with dementia is essential. However, care planning is limited by lack of knowledge on the short-term prognosis.

Aim: To investigate 30-day mortality and readmission after hospital discharge for pneumonia in persons with versus without dementia, and to investigate how these associations vary with age, time since discharge, and medication use.

Methods: Using the Danish registries, we investigated 30-day mortality and readmission in persons (+65 years) discharged after pneumonia in 2000-2016 (N = 298,872). Adjusted mortality rate ratios (aMRRs) and incidence rate ratios (aIRRs) were calculated for persons with versus without dementia, and we investigated if these associations varied with use of benzodiazepines, opioids, and antipsychotics, and with age and time since discharge.

Results: Among 25,948 persons with dementia, 4,524 died and 5,694 were readmitted within 30 days. The risk of 30-day mortality was 129% higher (95% CI 2.21-2.37) in persons with versus without dementia after adjustment for sociodemographic characteristics, admission-related factors, and comorbidities. Further, the highest mortality risk was found in persons with both dementia and use of antipsychotics (aMRR: 3.39, 95% CI 3.19-3.59); 16% of deaths in this group could not be explained by the independent effect of each exposure. In those with dementia, the highest aMRRs were found for the youngest and for the first days after discharge. The risk of 30-day readmission was 7% higher (95% CI 1.04-1.10) in persons with versus without dementia. In those with dementia, the highest aIRRs were found for the first days after discharge.

Conclusions: Dementia was associated with higher short-term mortality after pneumonia, especially in users of antipsychotics, and with slightly higher readmission, especially in the first days after discharge. This is essential knowledge in the care planning for persons with dementia who are discharged after a pneumonia admission.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Unadjusted mortality rates and adjusted mortality rate ratios for patients with dementia (without medication use), patients with use of benzodiazepines, opioids or antipsychotics (without dementia), and patients with both or neither exposures, plotted as a function of age.
Abbreviations: aMRR: adjusted mortality rate ratios. MRRs adjusted for sex, age, calendar period, cohabitation status, length of stay, type of pneumonia diagnosis, time since discharge, somatic comorbidities, psychiatric comorbidities, and alcohol/substance abuse.
Fig 2
Fig 2. Unadjusted mortality rates and adjusted mortality rate ratios for patients with dementia, (without medication use), patients with use of benzodiazepines, opioids or antipsychotics (without dementia), and patients with both or neither exposures, plotted as a function of days since discharge.
Abbreviations: aMRR: adjusted mortality rate ratios. MRRs adjusted for sex, age, calendar period, cohabitation status, length of stay, type of pneumonia diagnosis, time since discharge, somatic comorbidities, psychiatric comorbidities, and alcohol/substance abuse.
Fig 3
Fig 3. Unadjusted readmission rates and adjusted incidence (readmission) rate ratios for patients with dementia (without medication use), patients with use of benzodiazepines, opioids or antipsychotics (without dementia), and patients with both or neither exposures, plotted as a function of age.
Abbreviations: aIRR: adjusted incidence (readmission) rate ratios. IRRs adjusted for sex, age, calendar period, cohabitation status, length of stay, type of pneumonia diagnosis, time since discharge, somatic comorbidities, psychiatric comorbidities, and alcohol/substance abuse.
Fig 4
Fig 4. Unadjusted readmission rates and adjusted incidence (readmission) rate ratios for patients with dementia (without medication use), patients with use of benzodiazepines, opioids or antipsychotics (without dementia), and patients with both or neither exposures, plotted as a function of days since discharge.
Abbreviations: aIRR: adjusted incidence (readmission) rate ratios. IRRs adjusted for sex, age, calendar period, cohabitation status, length of stay, type of pneumonia diagnosis, time since discharge, somatic comorbidities, psychiatric comorbidities, and alcohol/substance abuse.
See this image and copyright information in PMC

References

    1. Torres A, Peetermans WE, Viegi G, Blasi F. Risk factors for community-acquired pneumonia in adults in Europe: A literature review. Thorax. 2013. November 1;68(11):1057–65. Available from: http://thorax.bmj.com/ 10.1136/thoraxjnl-2013-204282 - DOI - PMC - PubMed
    1. Vergis EN, Brennen C, Wagener M, Muder RR. Pneumonia in long-term care: a prospective case-control study of risk factors and impact on survival. Arch Intern Med. 2001;161(19):2378–81. 10.1001/archinte.161.19.2378 - DOI - PubMed
    1. Dang TT, Eurich DT, Weir DL, Marrie TJ, Majumdar SR. Rates and risk factors for recurrent pneumonia in patients hospitalized with community-acquired pneumonia: population-based prospective cohort study with 5 years of follow-up. Clin Infect Dis. 2014. July 1;59(1):74–80. 10.1093/cid/ciu247 - DOI - PMC - PubMed
    1. Jo T, Yasunaga H, Sasabuchi Y, Michihata N, Morita K, Yamauchi Y, et al. Association between dementia and discharge status in patients hospitalized with pneumonia. BMC Pulm Med. 2017. December 6;17(1):128 Available from: http://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-017-0473-8 - DOI - PMC - PubMed
    1. Golüke NMS, van de Vorst IE, Vaartjes IH, Geerlings MI, de Jonghe A, Bots ML, et al. Risk factors for in-hospital mortality in patients with dementia. Maturitas. 2019. November 1;129:57–61. Available from: 10.1016/j.maturitas.2019.08.007 - DOI - PubMed

Publication types