SHM Converge Scientific Abstract ePoster Gallery-The Experience of Nursing Home Residents Transferred to the Hospital

Pdf Summary

This study examined what nursing home residents with Alzheimer’s disease or related dementias (ADRD) experience when transferred to the hospital. Researchers reviewed electronic health record data from 10,195 skilled nursing facility residents with an ADRD diagnosis who were hospitalized between January 2013 and July 2023.<br /><br />The typical patient was 84 years old, 61% were female, 71% were White, and 89% had Medicare. Hospitalizations were often serious: the median stay was 5 days, and 4.1% of patients died in the hospital. Common admission diagnoses included behavioral disturbances, sepsis, fractures, heart disease, urinary tract infection, kidney failure, COVID-19, and pneumonia.<br /><br />Many patients experienced burdensome care during hospitalization. About 69% required a sitter, 58% received neuropsychiatric medications, 39% received ADRD medications despite limited effectiveness, 34% had a Foley catheter inserted, 21% developed delirium, and 20% were admitted to the ICU. Restraints were used in 5.9%, long-term feeding tubes were inserted in 4.9%, mechanical ventilation occurred in 4.4%, and 4.2% fell while hospitalized.<br /><br />Advance care planning and supportive consultations were uncommon: 45% had a DNR order, while only 5% received palliative care consultation, 2.4% geriatrics consultation, and 1.1% hospice consultation.<br /><br />The authors conclude that hospital transfers for nursing home residents with ADRD are frequently distressing and involve substantial interventions with limited benefit. They recommend earlier palliative care, geriatrics, and hospice involvement—ideally before transfer or within the first 24 hours of hospitalization—to reduce unnecessary burden and improve end-of-life care.

Asset Subtitle

Matthew A. Pappas

Meta Tag

Author List Ardeshir Z. Hashmi, David Harris, Jeffrey Kovach, Jordan Alpert, Luke Kim, Matthew A. Pappas, Michael B. Rothberg, Nicholas Casacchia, Silvia Perez-Protto

Category Research

Concept Alzheimer Disease and Related Dementias

Concept Hospitalization

Concept Postgraduate Medical Residents

Concept Burdensome Intervention

Concept Delirium

Distinguished Non-Finalist

Presenter Organization Cleveland Clinic, Department of Hospital Medicine

Presenting Author Matthew A. Pappas

Track Geriatrics

Keywords

Alzheimer's disease

dementia

nursing home residents

hospital transfer

skilled nursing facility

hospitalization

delirium

palliative care

advance care planning

end-of-life care

Alzheimer Disease and Related Dementias

Hospitalization

Postgraduate Medical Residents

Burdensome Intervention

Delirium