Which Care Setting Has the Best Record for Hospitalizations? You Might Be Surprised

Falls, hospitalizations, and emergency department visits are important indicators of care in residential care communities. A recent study investigated how dementia special care units compare to unspecialized care units in these measures. This article received the Outstanding Research Paper Award in the 2019 issue of Seniors Housing & Care Journal.

This study used data from a nationally representative sample of 5,143 cognitively impaired older adults living in dementia special care units (DSCU) or in non-DSCUs within a residential care community. Researchers compared residents in DSCUs and non-DSCUs for number of injurious falls, overnight hospitalizations over the past year, and emergency department visits over the past year. To account for other factors, they also examined resident demographics and health conditions, community care processes (i.e., influenza vaccine, medications prescribed to control behavior, and number of services used) and community characteristics, such as size, profit status, metropolitan area, and nursing staff.

The researchers found that there was a higher rate of injurious falls among DSCU residents (22%) compared to residents in non-DSCUs (17%). However, residents of DSCUs were not any more likely to have injurious falls than non-DSCU residents, once resident and community characteristics were accounted for. This may reflect more on severe conditions of DSCU residents, rather than lack of fall prevention strategies.

There were, however, significant differences in hospitalization and emergency department visit rates between the two groups. Even after adjusting for resident and community characteristics, cognitively impaired residents of non-DSCUs were 32% more likely to have been hospitalized and 27% more likely to have visited the emergency department over the past year, compared to DSCU residents.

While the researchers did not describe any implications, this information could be useful for senior living organizations. Falls, hospitalizations, and emergency department visits may be inevitable with this population, but DSCUs appear to be effective in limiting the number of these events. On the other hand, the mix of cognitively impaired and non-impaired older adults living in non-DSCUs may contribute to higher rates of hospitalizations and emergency department visits for older adults with cognitive impairment.


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Park-Lee E and Sengupta M. Injurious falls, hospitalizations, and emergency department visits among residential care residents with cognitive impairment: Adverse outcomes in dementia special care units (DSCU) versus non-DSCU settings. Seniors Housing & Care Journal (2019); 27: 3-15.

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