Transforming Advanced Illness in Dementia Patients

Topic: Addressing the Needs of Specific Patient Populations

Patients with Advanced Illness (AI), based on a LACE Advanced Illness Score (a tool which calculates risk of readmission) of ≥10, have been found to have a higher risk of readmission or death. Investigators hypothesized that early identification of patients with AI upon hospital admission would enable staff to improve outcomes by providing care which is more specific, including a Geriatric and Palliative consult and a family meeting with a social worker, resulting in decreased utilization, earlier Goals of Care Discussions, and greater satisfaction.

Methodology:

All patients admitted with a diagnosis of dementia are given the LACE as standard of care. Patients with a LACE with a score of ≥10 were referred to the study team. Demographics, LACE score results, LOS, referrals and 90-day outcomes were collected. Descriptive statistics (means ± standard deviations or medians and interquartile range for continuous data; frequencies and percentages for categorical data) were calculated. Patient groups by Lace score, age, and gender were compared using SPSS.

Results:

In all, 138 patients were included, average age 84.5, 46% male. Average LACE score was 12.2 (SD: 1.9), average LOS 10 days (SD: 9.5), average days from admission to evaluation 4.3 (SD: 3.8), average post-consult LOS was 5.7 days (SD: 8.2).

Patients with a LACE of ≥12 had longer LOS (days): 14.1 vs. 8.9 (p=0.03); longer time between admission and evaluation (days): 5.9 vs. 3.9 (p=0.03); and longer post-consult LOS (days): 8.0 vs. 4.8 (p=0.14).

Similarly, patients who received a consult in ≥four days (vs.

No significant differences were found between age groups (≤85 vs. >85), or gender for LOS, time between admission and evaluation (days), and post-consult LOS (days).

Conclusion:

Early identification of dementia patients with AI upon hospital admission has helped us provide higher quality of care. Improving outcomes and management for individuals with moderate to advanced dementia receiving care within our health system has shown to reduce readmission rates, reduce length of stay, increase early goals of care discussions, and reduced deaths in hospital setting.

Author

Co-authors

  • Alexander Rimar, MD
  • Dawn Ofer
  • Jinny Caldentey, MD
  • Kathleen Cascio
  • Kathleen Kilcullen, NP
  • Sony Modayil, DO

If you need assistance, please use the customer support form.