Trends of hospital admissions and mortality of patients with dementia: descriptive study in Lombardy

Abstract Background In 2017 the amount of people globally affected by dementia was estimated about 50 million and is predicted to increase to 132 million by 2050. Coping with dementia is one of the most important challenges of governmental organizations’ agenda. The objective of this study is to analyse the hospital admissions trends and monitor the overall mortality in a population of older patients with dementia over the last two decades in northern Italy. Methods This study is based on the healthcare utilization database of the Lombardy region (Italy), considering on hospital discharge records and death registry flows. Primary or secondary diagnosis at admission of dementia was coded according to the ICD9-CM. We carried out descriptive analyses of hospital admissions’ data from 1 Jan 1999 to 31 Dec 2020 of older patients aged 65 or more. We then conducted a temporal analysis of mortality rate over the study period. Results A total of 15,683,024 hospital admissions occurred during the study period. Over the last two decades, the prevalence of dementia among patients admitted to acute care hospitals remained around 1.1-1.3%. Considering the total of 183,268 patients with dementia over the study period, the average age at admission increased from 80.2 in 1999 to 83.3 years old in 2020, whereas annual mortality rate increased from about 1,950 to 3,230 deaths per 10,000 person-years. The mortality rate ratio of patients with versus without dementia fluctuated between 1.28 and 1.70. Conclusions Our findings suggest that there is an ever-greater appropriateness of hospitalizations over the last two decades, supported by out-of-hospital care that led patients to hospitalization in increasingly late and serious phases of the disease. The present study has a great future potential as well as limitations, due to the dependence on a correct coding of cases by clinicians according to the ICD9-CM system. Key messages • We observed an increased mortality among older people with dementia admitted to hospital over the last two decades. • Our descriptive study, based on the Lombardy regional healthcare database, provides evidence of an increasing appropriateness of hospitalizations.


Background:
Typ1 Diabetes (T1D) us a complicated condition that requires constant monitoring and making many decisions.Living with T1D means to check blood sugar levels, inject oneself insulin, and be careful what you eat.In the life of a young adult there are a lot of things going on and youngsters don't want to control themselves all day and night.They want to rebel and feel free.Methods: Teenagers living with T1D are actively involved in the research process from data collection to data interpretation.Following the photo voice method the teenagers documented their everyday life with T1D by photographs and recordings (Summer 2021), and discussed their need and resources in group discussions.The visual and audio-data was structured on a muti-touchscreen for which a software was developed during the project.From the inductively formed categories, measures were derived together with the young people and transferred into an action plan, which was presented and discussed with decision-makers.

Results:
During the photo voice process, the teenagers identified 26 categories (i.e.nutrition, coping strategies, autonomy, etc.) that were important for describing their life with diabetes and there categories were categorized into 4 dimension: psychosocial, time, subject and space.The project-team used a systematic action planning process to develop 9 goals for an action plan to improve their life with T1D.They presented their action plan to local political leaders and stakeholders from different setting, such as health care and youth work.The responses during the stakeholder dialog were positively and there was agreement to achieve the defined goals.

Conclusions:
The photo-voice method was helpful in immersing the participants in the lives of young people with type 1 diabetes.Structuring and organizing the visual-and audio-data together was beneficial for the participatory process.Together, an action plan could be developed and discussed with decision makers.

Key messages:
The photo voive method using digital tools (like smartphones and multitouchscreen) is a route to empower young people and give them a voice.The participating patients are experts for their bodies and the disease and should be perceived and taken seriously as such. Abstract

Background:
In 2017 the amount of people globally affected by dementia was estimated about 50 million and is predicted to increase to 132 million by 2050.Coping with dementia is one of the most important challenges of governmental organizations' agenda.
The objective of this study is to analyse the hospital admissions trends and monitor the overall mortality in a population of older patients with dementia over the last two decades in northern Italy.

Methods:
This study is based on the healthcare utilization database of the Lombardy region (Italy), considering on hospital discharge records and death registry flows.Primary or secondary diagnosis at admission of dementia was coded according to the ICD9-CM.We carried out descriptive analyses of hospital admissions' data from 1 Jan 1999 to 31 Dec 2020 of older patients aged 65 or more.We then conducted a temporal analysis of mortality rate over the study period.

Results:
A total of 15,683,024 hospital admissions occurred during the study period.Over the last two decades, the prevalence of dementia among patients admitted to acute care hospitals remained around 1.1-1.3%.Considering the total of 183,268 patients with dementia over the study period, the average age at admission increased from 80.2 in 1999 to 83.3 years old in 2020, whereas annual mortality rate increased from about 1,950 to 3,230 deaths per 10,000 person-years.The mortality rate ratio of patients with versus without dementia fluctuated between 1.28 and 1.70.

Conclusions:
Our findings suggest that there is an ever-greater appropriateness of hospitalizations over the last two decades, supported by out-of-hospital care that led patients to hospitalization in increasingly late and serious phases of the disease.The present study has a great future potential as well as limitations, due to the dependence on a correct coding of cases by clinicians according to the ICD9-CM system.

Key messages:
We observed an increased mortality among older people with dementia admitted to hospital over the last two decades.
Our descriptive study, based on the Lombardy regional healthcare database, provides evidence of an increasing appropriateness of hospitalizations. iii468 European Journal of Public Health, Volume 32 Supplement 3, 2022