Dementia and poor continuity of primary care delay hospital discharge in older adults: a population-based study from 2001 to 2016

Objectives: Delayed discharge – remaining in acute care longer than medically necessary – reflects less than optimal use of hospital care resources and can have negative implications for patients. We studied 1) the change over time in delayed discharge in people with and without dementia, and 2) the association of delayed discharge with discharge destination and with the continuity of primary care prior to urgent admission.
Design: A retrospective population-based study.
Setting and participants: Delayed discharge after urgent admission and length of delayed discharge were studied in all hospital users aged ≥70 years with at least one urgent admission in British Columbia, Canada, in years 2001/02, 2005/06, 2010/11 and 2015/16 (N=276,299).
Methods: Linked administrative data provided by Population Data BC were analyzed using generalized estimating equations (GEE) logistic regression analysis and negative binomial regression analyses.
Results: Delayed discharge increased among people with dementia and decreased among people without dementia, while the length of delay decreased among both. Dementia was the strongest predictor of delayed discharge (OR 4.76, [95% CI: 4.59,4.93]), while waiting for long-term care placement (IRR 1.56, [95% CI: 1.50,1.62]) and dementia (IRR 1.50, [95% CI: 1.45,1.54]) predicted a higher number of days of delay. Continuity and quantity of care with the same physician prior to urgent admission was associated with a decreased risk of delayed discharge especially in people with dementia.
Conclusions and implications: This study demonstrates the need for better system integration and patient-centered care especially for people with dementia. Population aging will likely increase the number of patients at risk of delayed discharge. Delayed discharge is associated with both the patient’s complex needs and the inability of the system to meet these needs during and after urgent care. Sufficient investments are needed in both primary care and long-term care resources in order to reduce delayed discharges.