P9: Preventable adverse events and related outcomes among people with dementia in hospital settings: Scoping review

Abstract

Background: Hospital-related negative outcomes such as reduced functional ability and mortality are significantly more frequent in people with dementia compared to other groups. Although these can result from preventable adverse events (AE) related to care standards (e.g., in-hospital falls or infection), researchers usually link such outcomes with the dementia itself. To date, it is unclear whether and the extent to which negative outcomes in hospitalised people with dementia are partly or fully due to the occurrence of AE.

Aim: To explore the AE endured by people with dementia in hospital settings and to determine whether and the extent to which these are associated with negative outcomes.

Methods: A scoping review was undertaken in line with Arksey and O’Malley’s framework in PUBMED, Web of Science, CINAHL, and Scopus in October 2023. Primary studies in English, Spanish, or Portuguese published in peer-reviewed journals were eligible.

Results: Of the 1,976 retrieved documents, 16 were included. Considering all studies and AE together, people with dementia had between 2.8 to 5.2 times higher risk of having an AE compared to people without dementia. In non- surgical settings, the most frequently reported AE were falls, delirium, and infections, while in surgical settings, these included postoperative delirium, infections, and other complications. Longer hospital stay, increased healthcare costs, higher risk of discharge to residential care (vs. home), and increased mortality were significantly more frequent in people with dementia. The link between the AE and negative outcomes was explored in three studies: longer hospital stay was linked to having endured a fall, delirium, or pneumonia as AE; higher risk of 90- day readmission was linked to having had delirium, and higher mortality was found in those with a hip fracture due to an in-hospital fall.

Conclusions: AE are more common in people with dementia compared to other hospitalised groups and may be largely responsible for the negative outcomes found in this population. However, current evidence is limited and does not allow for this relationship to be confidently established. Future research should further explore such associations with the goal to improve care and safety for people with dementia in hospital settings.