Graversen Susanne Boel, Pedersen Henrik Schou, Sandbaek Annelli, Foss Catherine Hauerslev, Palmer Victoria Jane, Ribe Anette Riisgaard
Research Unit for General Practice, Aarhus, Denmark.
Department of Public Health, Aarhus University, Aarhus, Denmark.
PLoS One. 2021 Jan 28;16(1):e0246153. doi: 10.1371/journal.pone.0246153. eCollection 2021.
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.
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.
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.
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.
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.
在肺炎患者住院出院时，为患有痴呆症的老年人制定护理计划至关重要。然而，护理计划因缺乏对短期预后的了解而受到限制。
调查患有和未患有痴呆症的患者肺炎出院后30天的死亡率和再入院情况，并研究这些关联如何随年龄、出院时间和药物使用情况而变化。
利用丹麦的登记数据，我们调查了2000年至2016年因肺炎出院的65岁及以上患者的30天死亡率和再入院情况（N = 298,872）。计算了患有和未患有痴呆症患者的调整后死亡率比值（aMRRs）和发病率比值（aIRRs），并研究了这些关联是否因使用苯二氮卓类药物、阿片类药物和抗精神病药物以及年龄和出院时间而有所不同。
在25,948名患有痴呆症的患者中，4,524人在30天内死亡，5,694人再次入院。在对社会人口统计学特征、入院相关因素和合并症进行调整后，患有痴呆症的患者30天死亡风险比未患有痴呆症的患者高129%（95% CI 2.21 - 2.37）。此外，在同时患有痴呆症和使用抗精神病药物的患者中发现了最高的死亡风险（aMRR：3.39，95% CI 3.19 - 3.59）；该组中16%的死亡无法用每种暴露的独立影响来解释。在患有痴呆症的患者中，最年轻的患者以及出院后的头几天aMRRs最高。患有痴呆症的患者30天再入院风险比未患有痴呆症的患者高7%（95% CI 1.04 - 1.10）。在患有痴呆症的患者中，出院后头几天aIRRs最高。
痴呆症与肺炎后的短期死亡率较高有关，尤其是在使用抗精神病药物的患者中，并且再入院率略高，尤其是在出院后的头几天。这是为肺炎住院后出院的痴呆症患者制定护理计划的重要知识。
