TY - JOUR
T1 - Dementia and Outcomes of Mechanical Ventilation
AU - Lagu, Tara
AU - Zilberberg, Marya D.
AU - Tjia, Jennifer
AU - Shieh, Meng Shiou
AU - Stefan, Mihaela
AU - Pekow, Penelope S.
AU - Lindenauer, Peter K.
N1 - Funding Information:
The authors would like to thank Vida Rastegar and Lauren Williams for their help with making tables, proofreading, and manuscript submission. The authors would like to thank Hilary Price for her assistance with creating the figure. Conflict of Interest: The authors have no conflicts of interest. The study was conducted with funding from the Tufts University School of Medicine Charlton Grant Research Program and from the Center for Quality of Care Research at Baystate Medical Center. Dr. Lagu is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award K01HL114745. Dr. Stefan is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award K01HL114631. Author Contributions: Drs. Lagu and Lindenauer had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Lagu, Lindenauer, Zilberberg, Stefan, Tjia: study concept. Lagu: data acquisition. Lagu, Lindenauer, Shieh, Stefan, Zilberberg, Tjia, Pekow: data analysis and interpretation. Lagu: drafting the manuscript. Lagu, Lindenauer, Shieh, Stefan, Zilberberg, Tjia, Pekow: critical review of manuscript for important intellectual content. Sponsor's Role: The content of the presented manuscript is solely the responsibility of the authors. The Tufts University School of Medicine and the National Institutes of Health had no role in the design, conduct, analysis, interpretation of data, or preparation, review, or approval of the manuscript.
Publisher Copyright:
© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Objectives: To describe the effect of dementia on hospital outcomes of individuals requiring invasive mechanical ventilation (IMV). Design: Retrospective cohort study. Setting: 2011 Nationwide Inpatient Sample. Participants: Hospitalized individuals with and without dementia undergoing IMV. Measurements: The adjusted predicted probability of undergoing IMV was examined in individuals with and without dementia. Then the dataset was limited to individuals who received IMV, and a multivariable logistic regression model was created in which dementia was the primary predictor and mortality was the outcome. Results: Of the 13,816,586 hospitalizations of older adults in the United States in 2011, 2,204,506 (16%) with a dementia diagnosis code were identified. Individuals with dementia had statistically significantly lower predicted probability of undergoing IMV (5.7%, 95% confidence interval (CI) = 5.6–5.8% than those without (6.5%, 95% CI = 6.4–6.6%). When the dataset was limited to individuals undergoing IMV, those with dementia were older (mean age 80 vs 76, P <.001) and had a higher combined Gagne comorbidity score (4.4 vs 4.1, P <.001) than those without. In a multivariable model, dementia was associated with greater likelihood of survival to hospital discharge (odds ratio (OR) = 0.79, P <.001). Individuals with dementia also had shorter mean length of stay (12.5 ± 0.2 vs 13.1 ± 0.2, P =.01) and lower cost per hospitalization for survivors ($37,213 vs $44,557, P <.001). Conclusion: Older critically ill adults with dementia undergoing IMV had better in-hospital outcomes than those without dementia. Because a lower adjusted percentage of individuals with dementia underwent IMV, it is likely that patient selection drove outcome differences. These findings suggest that individuals, families, and clinicians are carefully considering prognosis, quality of life, and appropriate use of intensive care unit resources when deciding whether to use IMV in individuals with dementia.
AB - Objectives: To describe the effect of dementia on hospital outcomes of individuals requiring invasive mechanical ventilation (IMV). Design: Retrospective cohort study. Setting: 2011 Nationwide Inpatient Sample. Participants: Hospitalized individuals with and without dementia undergoing IMV. Measurements: The adjusted predicted probability of undergoing IMV was examined in individuals with and without dementia. Then the dataset was limited to individuals who received IMV, and a multivariable logistic regression model was created in which dementia was the primary predictor and mortality was the outcome. Results: Of the 13,816,586 hospitalizations of older adults in the United States in 2011, 2,204,506 (16%) with a dementia diagnosis code were identified. Individuals with dementia had statistically significantly lower predicted probability of undergoing IMV (5.7%, 95% confidence interval (CI) = 5.6–5.8% than those without (6.5%, 95% CI = 6.4–6.6%). When the dataset was limited to individuals undergoing IMV, those with dementia were older (mean age 80 vs 76, P <.001) and had a higher combined Gagne comorbidity score (4.4 vs 4.1, P <.001) than those without. In a multivariable model, dementia was associated with greater likelihood of survival to hospital discharge (odds ratio (OR) = 0.79, P <.001). Individuals with dementia also had shorter mean length of stay (12.5 ± 0.2 vs 13.1 ± 0.2, P =.01) and lower cost per hospitalization for survivors ($37,213 vs $44,557, P <.001). Conclusion: Older critically ill adults with dementia undergoing IMV had better in-hospital outcomes than those without dementia. Because a lower adjusted percentage of individuals with dementia underwent IMV, it is likely that patient selection drove outcome differences. These findings suggest that individuals, families, and clinicians are carefully considering prognosis, quality of life, and appropriate use of intensive care unit resources when deciding whether to use IMV in individuals with dementia.
KW - critical care resources
KW - dementia
KW - mechanical ventilation
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U2 - 10.1111/jgs.14344
DO - 10.1111/jgs.14344
M3 - Article
C2 - 27604038
AN - SCOPUS:84992111544
SN - 0002-8614
VL - 64
SP - e63-e66
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 10
ER -