Determinants of hospital readmissions in older people with dementia: a narrative review
Open accessPublished version of a preprint
Abstract
Introduction: Over 50% of hospitalised older people with dementia have multimorbidity, and are at an increased risk of hospital readmissions within 30 days of their discharge. Between 20-40% of these readmissions may be preventable. Current research focuses on the physical causes of hospital readmissions. However, older people with dementia have additional psychosocial factors that are likely to increase their risk of readmissions. This narrative review aimed to identify psychosocial determinants of hospital readmissions, within the context of known physical factors. Methods: Electronic databases MEDLINE, EMBASE, CINAHL and PsychInfo were searched from inception until July 2022 and followed up in February 2024. Quantitative and qualitative studies in English including adults aged 65 years and over with dementia, their care workers and informal carers were considered if they investigated hospital readmissions. An inductive approach was adopted to map the determinants of readmissions. Identified themes were described as narrative categories. Results: Seventeen studies including 7,194,878 participants met our inclusion criteria from a total of 6369 articles. Sixteen quantitative studies included observational cohort and randomised controlled trial designs, and one study was qualitative. Ten studies were based in the USA, and one study each from Taiwan, Australia, Canada, Sweden, Japan, Denmark, and The Netherlands. Large hospital and insurance records provided data on over 2 million patients in one American study. Physical determinants included reduced mobility and accumulation of long-term conditions. Psychosocial determinants included inadequate hospital discharge planning, limited interdisciplinary collaboration, socioeconomic inequalities among ethnic minorities, and behavioural and psychological symptoms. Other important psychosocial factors such as loneliness, poverty and mental well-being, were not included in the studies. Conclusion: Poorly defined roles and responsibilities of health and social care professionals and poor communication during care transitions, increase the risk of readmission in older people with dementia. These identified psychosocial determinants are likely to significantly contribute to readmissions. However, future research should focus on the understanding of the interaction between a host of psychosocial and physical determinants, and multidisciplinary interventions across care settings to reduce hospital readmissions.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
When healthcare professionals did not develop workarounds, patients were discharged into unsafe living situations, and readmissions were increased.
“When HCPs did not develop ‘workarounds’, patients were discharged into unsafe living situations, and readmissions were increased [90, 97] (CMOC20).”
From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [97]
The Results section on psychosocial determinants reports increased readmissions when older people with dementia were discharged to live alone or after short-term domiciliary care. It does not say that healthcare professionals failed to develop ‘workarounds,’ or establish that failure as the reason for discharge into unsafe living situations. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation
Tricco, A. C., Lillie, E., Zarin, W., O'Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., et al. (2018) · Annals of Internal Medicine · doi:10.7326/m18-0850 · Cited by 43,565 · see citing works
Scoping studies: towards a methodological framework
Arksey, H., & O'Malley, L. (2005) · International Journal of Social Research Methodology · doi:10.1080/1364557032000119616 · Cited by 36,742 · see citing works
Health equity in England: the Marmot review 10 years on
Marmot, M. (2020) · BMJ · doi:10.1136/bmj.m693 · Cited by 1,834 · see citing works
Identifying potentially preventable readmissions.
Goldfield, N., McCullough, E. C., Hughes, J. S., et al. (2008) · PubMed · Cited by 299 · see citing works
Giebel, C. M., Cannon, J., Hanna, K. L., Butchard, S., Eley, R., Gaughan, A., Komuravelli, A., Shenton, J., Callaghan, S., Tetlow, H., et al. (2020) · Aging & Mental Health · doi:10.1080/13607863.2020.1822292 · Cited by 276 · see citing works
Halfon, P., Eggli, Y., Prêtre-Rohrbach, I., et al. (2006) · Medical Care · doi:10.1097/01.mlr.0000228002.43688.c2 · Cited by 259 · see citing works
Transitions in Care for Older Adults with and without Dementia
Callahan, C. M., Arling, G., Tu, W., Rosenman, M. B., Counsell, S. R., Stump, T. E., & Hendrie, H. C. (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2012.03905.x · Cited by 253 · see citing works
Hospitalisation rates and predictors in people with dementia: a systematic review and meta-analysis
Shepherd, H., Livingston, G., Chan, J., & Sommerlad, A. (2019) · BMC Medicine · doi:10.1186/s12916-019-1369-7 · Cited by 232 · cited 2× · see citing works
“…of dementia (BPSD), may also contribute towards increased hospital readmissions in PLWD. People with dementia who live in areas of social and economic deprivation or live with depression or anxiety, are at a greater risk of avoidable healthcare outcomes including hospital readmissions [7, 8].”
BackgroundHospitalization in Community‐Dwelling Persons with Alzheimer's Disease: Frequency and Causes
Rudolph, J. L., Zanin, N. M., Jones, R. N., Marcantonio, E. R., Fong, T. G., Yang, F. M., Yap, L., & Inouye, S. K. (2010) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2010.02924.x · Cited by 203 · see citing works
Majoka, M. A., & Schimming, C. (2021) · Clinical Therapeutics · doi:10.1016/j.clinthera.2021.05.005 · Cited by 191 · see citing works
Using a biopsychosocial model of dementia as a tool to guide clinical practice
Spector, A. E., & Orrell, M. W. (2010) · International Psychogeriatrics · doi:10.1017/s1041610210000840 · Cited by 159 · see citing works
Causes of Hospital Admission for People With Dementia: A Systematic Review and Meta-Analysis
Toot, S., Devine, M., Akporobaro, A., & Orrell, M. W. (2013) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2013.01.011 · Cited by 143 · see citing works
Reasons for Hospital Admissions in Dementia Patients in Birmingham, UK, during 2002–2007
Natalwala, A., Potluri, R., Uppal, H., & Heun, R. (2008) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000171044 · Cited by 121 · see citing works
Briggs, R., Dyer, A. H., Nabeel, S., Collins, R., Doherty, J., Coughlan, T., O’Neill, D. J., & Kennelly, S. (2016) · QJM · doi:10.1093/qjmed/hcw114 · Cited by 115 · see citing works
Antipsychotic Use in Dementia: Is There a Problem and Are There Solutions?
Kirkham, J., Sherman, C., Velkers, C., Maxwell, C., Gill, S., Rochon, P., & Seitz, D. (2017) · The Canadian Journal of Psychiatry · doi:10.1177/0706743716673321 · Cited by 113 · see citing works
Tropea, J., LoGiudice, D., Liew, D., Gorelik, A., & Brand, C. A. (2016) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4491 · Cited by 97 · see citing works
Pain, aging and dementia: towards a biopsychosocial model
Gagliese, L., Gauthier, L. R., Narain, N., & Freedman, T. (2018) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2017.09.022 · Cited by 84 · see citing works
Association of dementia with early rehospitalization among Medicare beneficiaries
Daiello, L. A., Gardner, R., Epstein-Lubow, G., Butterfield, K., & Gravenstein, S. (2014) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2014.02.010 · Cited by 81 · see citing works
A scoping review of gaps and priorities in dementia care in Europe
Martin, A., O’Connor, S., & Jackson, C. (2020) · Dementia · doi:10.1177/1471301218816250 · Cited by 80 · see citing works
Vernooij-Dassen, M., Moniz-Cook, E., Verhey, F., Chattat, R., Woods, B., Meiland, F., Franco, M., Holmerova, I., Orrell, M., & de Vugt, M. (2021) · Aging & Mental Health · doi:10.1080/13607863.2019.1693968 · Cited by 80 · see citing works
Hospital readmission in persons with dementia: A systematic review
Ma, C., Bao, S., Dull, P., Wu, B., & Yu, F. (2019) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5140 · Cited by 74 · see citing works
Sharma, S., Mueller, C., Stewart, R., Veronese, N., Vancampfort, D., Koyanagi, A., Lamb, S. E., Perera, G., & Stubbs, B. (2018) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2018.03.009 · Cited by 72 · see citing works
Heterogeneity in Dementia: Challenges and Opportunities
Cohen‐Mansfield, J. (2000) · Alzheimer Disease & Associated Disorders · doi:10.1097/00002093-200004000-00002 · Cited by 67 · see citing works
Gustafsson, M. V., Sjölander, M., Pfister, B., Jonsson, J., Schneede, J., & Lövheim, H. (2017) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-017-2249-8 · Cited by 66 · see citing works
Kable, A., Chenoweth, L., Pond, D., & Hullick, C. (2015) · BMC Health Services Research · doi:10.1186/s12913-015-1227-z · Cited by 65 · see citing works
Psychosocial Correlates of Frailty in Older Adults
Freitag, S., & Schmidt, S. (2016) · Geriatrics · doi:10.3390/geriatrics1040026 · Cited by 64 · see citing works
Lin, P., Zhong, Y., Fillit, H. M., Cohen, J. T., & Neumann, P. J. (2017) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2017.08.010 · Cited by 61 · see citing works
Digital healthcare for dementia and cognitive impairment: A scoping review
Sohn, M., Yang, J., Sohn, J. Y., & Lee, J.-H. (2022) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2022.104413 · Cited by 60 · see citing works
Henderson, C., Thornicroft, G., & Glover, G. R. (1998) · The British Journal of Psychiatry · doi:10.1192/bjp.173.2.105 · Cited by 59 · see citing works
Afonso-Argilés, F. J., Meyer, G., Stephan, A., Comas, M., Wübker, A., Leino‐Kilpi, H., Lethin, C., Saks, K., Soto‐Martin, M., Sutcliffe, C., et al. (2020) · BMC Geriatrics · doi:10.1186/s12877-020-01835-x · Cited by 57 · see citing works
Gilmore-Bykovskyi, A. L., Roberts, T. J., King, B. J., Kennelty, K. A., & Kind, A. J. H. (2017) · The Gerontologist · doi:10.1093/geront/gnw085 · Cited by 56 · see citing works
Dementia and Risk of 30‐Day Readmission in Older Adults After Discharge from Acute Care Hospitals
Sakata, N., Okumura, Y., Fushimi, K., Nakanishi, M., & Ogawa, A. (2018) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15282 · Cited by 56 · see citing works
Cruz, A. M., Daum, C., Comeau, A. K., Salamanca, J. D. G., McLennan, L., Neubauer, N., & Liu, L. (2020) · Disability and Rehabilitation Assistive Technology · doi:10.1080/17483107.2020.1864671 · Cited by 50 · see citing works
Primary care continuity and potentially avoidable hospitalization in persons with dementia
Godard‐Sebillotte, C., Strumpf, E., Sourial, N., Rochette, L., Pelletier, E., & Vedel, I. (2021) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17049 · Cited by 50 · see citing works
Hospital admissions 2000–2014: A retrospective analysis of 288 096 events in patients with dementia
Bernardes, C., Massano, J., & Freitas, A. (2018) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2018.05.006 · Cited by 49 · see citing works
Dementia and Hospital Readmission Rates: A Systematic Review
Pickens, S. L., Naik, A. D., Catic, A., & Kunik, M. E. (2017) · Dementia and Geriatric Cognitive Disorders Extra · doi:10.1159/000481502 · Cited by 47 · see citing works
Adequacy of Discharge Plans and Rehospitalization among Hospitalized Dementia Patients
Cummings, S. M. (1999) · Health & Social Work · doi:10.1093/hsw/24.4.249 · Cited by 45 · see citing works
Motzek, T., Werblow, A., Tesch, F., Marquardt, G., & Schmitt, J. M. (2018) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2018.02.015 · Cited by 39 · see citing works
Watson, J., Giebel, C., Green, M., Darlington‐Pollock, F., & Akpan, A. (2021) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5419 · Cited by 39 · see citing works
Masterson‐Algar, P., Cheshire‐Allen, M., Hyde, M., Keating, N. C., & Windle, G. (2021) · Dementia · doi:10.1177/14713012211053971 · Cited by 39 · see citing works
Yorganci, E., Stewart, R. J., Sampson, E. L., & Sleeman, K. E. (2022) · Age and Ageing · doi:10.1093/ageing/afac098 · Cited by 37 · see citing works
Dementia and the risk of short-term readmission and mortality after a pneumonia admission
Graversen, S. B., Pedersen, H. S., Sandbaek, A., Foss, C. H., Palmer, V. J., & Ribe, A. R. (2021) · PLOS ONE · doi:10.1371/journal.pone.0246153 · Cited by 34 · see citing works
Watson, J. B., Green, M. A., Giebel, C. M., Darlington‐Pollock, F., & Akpan, A. (2022) · Aging & Mental Health · doi:10.1080/13607863.2022.2107176 · Cited by 32 · see citing works
Knox, S., Downer, B. G., Haas, A. M., Middleton, A., & Ottenbacher, K. J. (2020) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2019.12.021 · Cited by 27 · see citing works
The Impact of Admission Etiology on Recurrent or Frequent Admission
Chang, C., Lin, P., Chang, Y., Chen, N.-C., Huang, C., Lui, C., Huang, S., Chang, Y., Lee, C., & Lai, W.-A. (2015) · Medicine · doi:10.1097/md.0000000000002091 · Cited by 26 · see citing works
Multimorbidity in people living with dementia
Welsh, T. J. (2019) · Case Reports in Women s Health · doi:10.1016/j.crwh.2019.e00125 · Cited by 26 · see citing works
Disparities in 30‐day readmission rates among Medicare enrollees with dementia
Gilmore‐Bykovskyi, A., Zuelsdorff, M., Block, L., Golden, B., Kaiksow, F., Sheehy, A. M., Bartels, C. M., Kind, A. J. H., & Powell, W. R. (2023) · Journal of the American Geriatrics Society · doi:10.1111/jgs.18311 · Cited by 25 · see citing works
Wheatley, A., Poole, M., & Robinson, L. A. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-059437 · Cited by 22 · see citing works
Tannenbaum, R., Boltz, M. P., Ilyas, A., Gromova, V., Ardito, S., Bhatti, M., Mercep, G., Qiu, M., Wolf‐Klein, G. P., Tan, Z. S., et al. (2022) · Journal of Hospital Medicine · doi:10.1002/jhm.12921 · Cited by 19 · see citing works
Boltz, M. P., BeLue, R., Resnick, B. M., Kuzmik, A., Galik, E. M., Jones, J. R., Arendacs, R., Sinvani, L., Mogle, J. A., & Galvin, J. E. (2020) · Journal of Aging and Health · doi:10.1177/0898264320983210 · Cited by 16 · see citing works
Knox, S., Downer, B. G., Haas, A. M., & Ottenbacher, K. J. (2021) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2020.12.014 · Cited by 15 · see citing works
Ten-year trends in adverse drug reaction–related hospitalizations among people with dementia
Zaidi, A. S., Peterson, G. M., Bereznicki, L., et al. (2022) · Therapeutic Advances in Drug Safety · doi:10.1177/20420986221080796 · Cited by 15 · see citing works
Characteristics and Outcome Determinants of Hospitalized Older Patients with Cognitive Dysfunction
Chao, Y.-T., Kuo, F.-H., Lee, Y.-S., Huang, Y.-H., Weng, S.-C., Chou, Y.-Y., Lin, C.-S., & Lin, S.-Y. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19010584 · Cited by 14 · see citing works
Gungabissoon, U., Perera, G., Galwey, N. W., & Stewart, R. J. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-055447 · Cited by 14 · see citing works
Pneumonia Readmissions in Older Adults With Dementia
Knox, S. (2019) · Medical Care · doi:10.1097/mlr.0000000000001195 · Cited by 11 · see citing works
Readmission and adverse outcomes after percutaneous coronary intervention in patients with dementia
Park, D. Y., Hu, J., Alexander, K. P., & Nanna, M. G. (2022) · Journal of the American Geriatrics Society · doi:10.1111/jgs.18120 · Cited by 11 · see citing works
van de Vorst, I. E., Vaartjes, I., Bots, M. L., & Koek, H. L. (2019) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5044 · Cited by 8 · see citing works
Eyles, E., Redaniel, M. T., Purdy, S., Tilling, K., & Ben-Shlomo, Y. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06634-7 · Cited by 7 · see citing works
Lu, Y. Z., Huang, C.-W., Koyama, S., Taitano, M., Lee, E. A., Shen, E., & Nguyen, H. Q. (2023) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2023.104973 · Cited by 5 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [28]Duff C. Dementia: assessment, management and support for people living with dementia and their carers. 2018. 30011160
Cited by
Sorted by citations
Lawson, L., Cooper, M., Tolley, C., Hand, A., & Nazar, H. (2025) · BMC Geriatrics · doi:10.1186/s12877-025-06123-0 · Cited by 10 · see citing works
“When HCPs did not develop ‘workarounds’, patients were discharged into unsafe living situations, and readmissions were increased [90, 97]”
- Authors
- Browne, B., Ali, K., Ford, E., & Tabet, N.
- Affiliations
- Brighton and Sussex Medical School (GB)
- Corresponding author
- Browne, Bria
- Venue
- BMC Geriatrics
- Published
- 2024-04-12
- Volume
- 24
- Issue
- 1
- Pages
- 336-336
- ISSN
- 1471-2318 (ISSN-L)
- PMC
- PMC11015733
- OpenAlex
- W4394748807
- Cited by
- 18
- References
- 59
- Citations by year
- 2026: 10 · 2025: 7 · 2024: 1
- FWCI
- 1.44
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Geriatrics (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- NIHR ARC KSS
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- hospital readmission, dementia, older adults, psychosocial factors, multimorbidity, discharge planning, care transitions, interdisciplinary collaboration, behavioural and psychological symptoms, socioeconomic disparities, ethnic minorities, chronic disease, mobility
- MeSH terms
- Aged, Australia, Canada, Dementia, Humans, Patient Readmission, Databases, Factual
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
