Background: Under-coding of dementia during hospital admissions is a global issue resulting in an inability to reliably identify all patients with dementia within hospital administrative datasets. This is of significant concern as it indicates a lack of active management in people with dementia. While under-coding of dementia is well established, there is sparse evidence on whether the dementia is recognised in subsequent hospitalisations amongst patients with a known admission for dementia.
Objective: (1) To describe patterns of dementia coding over the five-years after a first coded (i.e., index) admission for dementia, (2) to identify factors associated with lack of active management of dementia, and (3) to identify high risk patient sub-groups to inform future intervention studies to improve recognition and management of dementia.
Method: Retrospective study of dementia coding for 7,919 patients during hospitalisation in the five-years post-index admission for dementia in a regional local health district of New South Wales, Australia.
Results: Dementia was coded in 63.9% of patient episodes in the 12-months following a first hospital admission coded with dementia; this decreased to 53.7% at five-years following the index. Coded medical records indicated that patients were 20% more likely to have their dementia actively managed when it co-occurred with delirium (likelihood increased to 83.6% in the first 12-months and 73.7% at five-years post-index). Under-coding varied across conditions, with dementia more likely to be managed in admissions for falls and pneumonitis, and less likely for heart failure and pneumonia.
Conclusion: Persistent under-coding of dementia suggests a lack of active management of dementia in the hospital setting. Management progressively worsens (rather than improves) across subsequent admissions over time, particularly for heart failure, pneumonia, and UTI. These conditions highlight opportunities to focus and improve recognition and management of patients with dementia.