(P58) Discharge Disposition of Hip Fracture patients with Alzheimer’s Dementia

Introduction/

Objective: Alzheimer's dementia patients have a higher incidence of hip fractures compared to other older adults. Dementia and hip fractures are associated with significant morbidity and mortality. There has been evidence to show that there may be a regional diversity in healthcare expenditures and practices that may affect the mortality of these patients, but there are little data on how determinants affect hospitalization outcomes in AD admitted with hip fractures.
This study aimed to compare length of hospital stay, mortality rate, costs and discharge disposition in AD patients hospitalized with Hip fractures based on different regions of the USA.

Design/Methodology: From the 2018 National Inpatient Sample (NIS) data, we identified hospitalizations in adults aged >65 years. Using ICD10 codes, we selected adults >65 years of age with a diagnosis of Alzheimer’s Dementia who had a hip fracture. The primary outcome of this study was the disposition of patients who survived to hospital discharge and risk-adjusted rates of in-hospital mortality. By first fitting logistic regression models that considered patient-level covariates like age, race, gender, median household income, insurance type, comorbidities, and weekend vs. weekday admission as well as hospital-level covariates like hospital bed size, hospital location, and teaching status, risk-adjusted rates of in-hospital mortality and routine home discharge could be determined. All statistical analysis were performed by using SAS 9.4, SAS Institute Inc, Cary, NC, USA.

Results: Hospitalization outcomes among AD patients admitted with Hip Fractures in the 4 Census regions of the United States in 2018 were investigated and compared. Overall, an estimated 17,655 dementia patients were admitted with Hip Fractures in the United States in 2018. The mortality rate was 2.7%, the median length of stay was 5 days, the median cost of hospitalization was US$60,170, and the rate of routine home discharge was 2.9%. Most patients (84.4%) were transferred to Skilled Nursing Facilities (SNF), Intermediate Care Facilities (ICF) or another Type of Facility. There was a significant regional variation for all outcomes (p < 0.001); For example, compared to other parts of the country, the risk-adjusted rate of in-hospital mortality was highest in the West (3.7%) and lowest in the South (2.1%); and within each region, these mortalities were higher in rural locations (range: 2.3% to 4.7%) than in urban locations (range: 1.4% to 2.9%).

Conclusion/

Discussion: This study demonstrates a significant geographical variance in hospital outcomes for AD patients with hip fractures in the USA, including in-patient mortality, length of stay (LOS), hospitalization cost, and discharge disposition. Studies of this kind will help policymakers and caregivers standardize the care given to older adults who experience the debility brought on by hip fractures and are therefore more susceptible to increased morbidity and death.