Hospitalization outcomes among older adults living undiagnosed or unaware of dementia

INTRODUCTION: Many persons with dementia are undiagnosed or unaware of dementia, which may affect hospitalization outcomes. METHODS: We evaluated differences in length of stay, days not at home, discharge destination, and 30-day readmissions over 1 year in 6296 older adults in the National Health and Aging Trends Study with linked Medicare claims. Multivariable-adjusted models compared outcomes across no dementia, undiagnosed dementia, unaware but diagnosed with dementia, and aware and diagnosed with dementia. RESULTS: Persons with undiagnosed dementia had longer length of stay and were more likely to be discharged to a facility (44.8% vs. 19.3%) compared to no dementia; differences persisted in multivariable models. Persons undiagnosed or unaware experienced outcomes similar to persons aware and diagnosed except for more 30-day readmissions in the undiagnosed (adjusted odds ratio [95% confidence interval] 2.05 [1.01, 4.16]). DISCUSSION: Persons undiagnosed or unaware of dementia experience worse hospitalization outcomes, suggesting potential clinically significant implications of unrecognized dementia. Highlights: Persons with undiagnosed versus no dementia have worse hospitalization outcomes. Persons with undiagnosed dementia have more 30-day readmissions compared to persons diagnosed. Lack of clinician or family recognition of dementia may adversely affect hospitalization outcomes.