The risk of delirium or dementia-related hospitalization among individuals living with dementia after long-term care entry: A population-based risk prediction model.

INTRODUCTION

Identifying individuals with dementia in long-term care facilities (LTCFs) at risk for delirium or dementia-related hospitalizations can support individualized risk mitigation.

METHODS

Using the Registry of Senior Australians (ROSA) Historical National Cohort (N = 207343 individuals with dementia in 2655 LTCFs), we identified predictors of delirium or dementia-related hospitalization within 365 days of LTCF entry and developed a risk prediction model using elastic net penalized regression and Fine-Gray model. Model discrimination using area under the receiver operating characteristics curve (AUC), calibration and clinical utility were assessed.

RESULTS

Within 365 days, 5.2% (N = 10709) of individuals had a delirium or dementia-related hospitalization. Forty predictors were identified, strongest included history of frequent emergency department presentations, physical violence history, being male, and prior delirium. Model AUC was 0.664 (95% confidence interval: 0.650-0.676) with reasonable calibration.

DISCUSSION

Our risk prediction model for delirium or dementia-related hospitalizations had moderate discrimination with reasonable calibration and clinical utility. Routinely collected data can inform risk profiling in LTCFs.

HIGHLIGHTS

Using a large population-based cohort of people living with dementia, we developed a risk prediction model for delirium or dementia-related hospitalization within 365 days of long-term care facility (LTCF) entry. Within 365 days after entry into LTCF, 5.2% of individuals living with dementia had a delirium or dementia-related hospitalization. The model demonstrated moderate discriminatory performance (area under the curve [AUC] = 0.664, 95% confidence interval [CI]: 0.650-0.676) and reasonable calibration in predicting delirium or dementia-related hospitalization risk. Our model showed net benefits within 2%-22% risk threshold ranges assessed via decision curve analysis . Risk stratification at LTCF entry may support clinicians and aged care providers in identifying high risk individuals and implementing targeted interventions to reduce delirium or dementia-related hospitalizations .