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Cited by 34Pneumonia and Respiratory InfectionsDementia and Cognitive Impairment ResearchPharmaceutical Practices and Patient Outcomes

Dementia and the risk of short-term readmission and mortality after a pneumonia admission

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Graversen, Susanne Boel, Pedersen, Henrik Schou, Sandbaek, Annelli, Foss, Catherine Hauerslev, Palmer, Victoria Jane, Ribe, Anette Riisgaard·2021·PLOS ONE
DOI 10.1371/journal.pone.0246153PMC PMC7842970
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Abstract

Background: At time of discharge after a pneumonia admission, care planning for older persons with dementia is essential. However, care planning is limited by lack of knowledge on the short-term prognosis. Aim: To investigate 30-day mortality and readmission after hospital discharge for pneumonia in persons with versus without dementia, and to investigate how these associations vary with age, time since discharge, and medication use. Methods: Using the Danish registries, we investigated 30-day mortality and readmission in persons (+65 years) discharged after pneumonia in 2000–2016 (N = 298,872). Adjusted mortality rate ratios (aMRRs) and incidence rate ratios (aIRRs) were calculated for persons with versus without dementia, and we investigated if these associations varied with use of benzodiazepines, opioids, and antipsychotics, and with age and time since discharge. Results: Among 25,948 persons with dementia, 4,524 died and 5,694 were readmitted within 30 days. The risk of 30-day mortality was 129% higher (95% CI 2.21–2.37) in persons with versus without dementia after adjustment for sociodemographic characteristics, admission-related factors, and comorbidities. Further, the highest mortality risk was found in persons with both dementia and use of antipsychotics (aMRR: 3.39, 95% CI 3.19–3.59); 16% of deaths in this group could not be explained by the independent effect of each exposure. In those with dementia, the highest aMRRs were found for the youngest and for the first days after discharge. The risk of 30-day readmission was 7% higher (95% CI 1.04–1.10) in persons with versus without dementia. In those with dementia, the highest aIRRs were found for the first days after discharge. Conclusions: Dementia was associated with higher short-term mortality after pneumonia, especially in users of antipsychotics, and with slightly higher readmission, especially in the first days after discharge. This is essential knowledge in the care planning for persons with dementia who are discharged after a pneumonia admission.

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  • Underlying medical complaints masked by symptoms of confusion or BPSD had potential to be overlooked (under-triage), increasing risk of harm and readmission.

    “Consequently, underlying medical complaints masked by symptoms of confusion or BPSD had potential to be overlooked (known as under-triage), increasing risk of harm and readmission [56, 60, 76, 77].”

    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 [56]

    The Discussion (page not available) says cognitive decline in people with dementia can impair their ability to express symptoms, increasing the risk of inadequate diagnosis and treatment after discharge. It also reports higher readmission risk and suggests inpatient care factors may contribute. It does not say that confusion or BPSD masks medical complaints, or establish under-triage as a cause of readmission. (LLM, conf=0.85)

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  • In practice, admission and discharge procedures prioritise the admission diagnosis and do not adequately account for dementia symptoms (e.g. cognitive decline, BPSD).

    “Our findings suggest that in practice however, admission and discharge procedures prioritise the admission diagnosis, and do not adequately account for dementia symptoms (e.g. cognitive decline, BPSD) [47, 49, 56, 60, 76, 77, 90, 93].”

    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 [56]

    The Discussion suggests that inpatient care factors may not be sufficiently addressed before discharge for patients with dementia, and that cognitive decline during admission may contribute to inadequate diagnosis and treatment afterward. It does not say that admission and discharge procedures prioritise the admission diagnosis over dementia symptoms; that proposed priority is not established by this study of pneumonia admissions. (LLM, conf=0.84)

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  • Fragmentation between health and social care contributed to reduced responsibility for healthcare professionals in emergency departments to support social and non-urgent needs, likely increasing the patient's risk of under-triage.

    “Additionally, fragmentation between health and social care contributed to reduced responsibility for HCPs in emergency departments to support social and non-urgent needs, likely increasing the patient’s risk of under-triage (CMOC13) [47, 49, 56, 60, 76, 77, 82, 90, 93, 94].”

    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 [56]

    The Methods (Study design and setting; page not provided) describe Danish hospital and municipal care, while the Discussion addresses post-discharge diagnostic risks for people with dementia. Neither passage links fragmentation of health and social care to emergency-department responsibilities or under-triage. Searches for those terms and for social and non-urgent needs found no supporting passage in our copy. (LLM, conf=0.75)

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Research works printed but not linked: 2

  1. [38]Jensen-Dahm C, Christensen AN, Gasse C, Waldemar G. The Use of Opioids and Antipsychotics in Elderly with Dementia—Have Opioids Replaced Antipsychotics in Treating Behavioral Symptoms in Dementia? Malara A, editor. J Alzheimer’s Dis. 2020 1 7; 73(1): 259– 67. Available from: https://www.medra.org/servlet/aliasResolver?alias=iospress&doi=10.3233/JAD-190787 31771062 PMC7029326 · DOI
  2. [50]Jo T, Yasunaga H, Sasabuchi Y, Michihata N, Morita K, Yamauchi Y, et al Association between dementia and discharge status in patients hospitalized with pneumonia. BMC Pulm Med. 2017 10 6; 17(1). 10.1186/s12890-017-0473-8 28985724 PMC6389218 · DOI

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Authors
Graversen, S. B., Pedersen, H. S., Sandbaek, A., Foss, C. H., Palmer, V. J., & Ribe, A. R.
Affiliations
  • Aarhus University (DK)
  • Aarhus University Hospital (DK)
  • The University of Melbourne (AU)
Corresponding author
Graversen, Susanne Boel
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2021-01-28
Volume
16
Issue
1
Pages
e0246153
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0246153
PMC
PMC7842970
OpenAlex
W3124551314
Cited by
34
References
52
Citations by year
2026: 4 · 2025: 8 · 2024: 9 · 2023: 6 · 2022: 4 · 2021: 3
FWCI
3.96
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • General Practice Research Foundation of the Central Denmark Region
  • the Danish General Practice Fund
  • Public Health in Central Denmark Region - a collaboration between municipalities and the Central Denmark Region
  • the (Danish) Health Foundation
  • the Danish Foundation for Physicians (Lægefonden) under the A.P. Moeller Foundations
  • the Beckett Foundation
  • Knud Højgaards Fond
  • the Graduate School of Health Aarhus University
  • Helga og Peter Kornings Fond
  • Novo Nordisk Fonden
Topics
  • Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
dementia, pneumonia, hospital readmission, 30-day mortality, older adults, antipsychotic use, benzodiazepines, opioids, medication use, prognosis
MeSH terms
Aged, Aged, 80 and over, Dementia, Denmark, Female, Humans, Male, Patient Readmission, Pneumonia, Registries, Risk Factors, Hospital Mortality

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