DESK REVIEWS | 07.04.06. Do hospitals track dementia-related admissions?
DESK REVIEW | 07.04.06. Do hospitals track dementia-related admissions?
The health information systems in Brazil track the number of people living with dementia who have been hospitalised nationally via SUS. The notification of dementia-related admissions is not mandatory, which means that people living with dementia are likely to have their secondary causes for hospitalisation registered, such as infection, stroke, or dehydration, for example, instead of dementia as being the main cause. This creates an underestimation of the number of people living with dementia who have been hospitalised. In addition, the high number of people living with dementia who are currently undiagnosed (77%) (Nakamura et al., 2015), and the difficulty in differentiating acute delirium from dementia, might also have an effect on the absolute numbers of hospitalisation related to dementia.
The more advanced the age group is, the higher the number of admissions related to dementia. For instance: in the age group 50-59, a total of 50 admissions occurred; between 60 and 69 years old, this number increased to 293, in the age group 70-79 the number was 835, and for the age group 80 plus, the number reached 1,769 admissions. A total number of 13,723 admissions occurred between January 2008 and November 2019 (Brazilian Ministry of Health, 2019n). The study from Santos et al. (2017) using data from the same public source shows an even smaller number – a total of 9,843 hospitalisations of older people (aged 60+) living with dementia over the period between 2008 and 2014 nationally. In this study, dementia was the main cause of hospital deaths (33%) compared to other mental disorders.
Brazilian Ministry of Health. (2019n). TabNet Win32 3.0: Morbidade Hospitalar do SUS – por local de internação—Brasil. http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sih/cnv/niuf.def
Nakamura, A., Opaleye, D., Tani, G., & Ferri, C. P. (2015). Dementia underdiagnosis in Brazil. The Lancet, 385(9966), 418–419. https://doi.org/10.1016/S0140-6736(15)60153-2
Santos, D. F. B. dos, Carvalho, E. B. de, Nascimento, M. do P. S. S. do, Sousa, D. M. de, & Carvalho, H. E. F. de. (2017). ATENÇÃO À SAÚDE DO IDOSO POR CUIDADORES INFORMAIS NO CONTEXTO DOMICILIAR: REVISÃO INTEGRATIVA. SANARE – Revista de Políticas Públicas, 16(2). https://doi.org/10.36925/sanare.v16i2.1181
Some hospitals do track dementia related admissions. Only a few tertiary referral hospitals maintain dementia registries that record and report on the dementia patients that have been seen in these specialist memory/cognitive disorders clinics. These centres typically conduct scientific studies that report on clinical profiles and risk factors of dementia or specific subtypes of dementia (Alladi et al., 2011; Alladi et al., 2014; Bharath et al., 2017; Nair et al., 2012; Tripathi et al., 2012). However, these registries do not periodically report the numbers of persons with dementia evaluated in the clinics.
Alladi, S., Mekala, S., Chadalawada, S.K., Jala, S., Mridula, R., Kaul, S., 2011. Subtypes of Dementia: A Study from a Memory Clinic in India. Dement. Geriatr. Cogn. Disord. 32, 32–38. https://doi.org/10.1159/000329862
Alladi, S., Shailaja, M., Mridula, K.R., Haritha, C.A., Kavitha, N., Khan, S.A., Divyaraj, G., Kaul, S., 2014. Mild Cognitive Impairment: Clinical and Imaging Profile in a Memory Clinic Setting in India. Dement. Geriatr. Cogn. Disord. 37, 113–124. https://doi.org/10.1159/000354955
Bharath, S., Sadanand, S., Kumar, K.J., Balachandar, R., Joshi, H., Varghese, M., 2017. Clinical and neuropsychological profile of persons with mild cognitive impairment, a hospital based study from a lower and middle income country. Asian J. Psychiatr. 30, 185–189. https://doi.org/10.1016/j.ajp.2017.10.007
Nair, G., Van Dyk, K., Shah, U., Purohit, D.P., Pinto, C., Shah, A.B., Grossman, H., Perl, D., Ganwir, V., Shanker, S., Sano, M., 2012. Characterizing Cognitive Deficits and Dementia in an Aging Urban Population in India. Int. J. Alzheimers. Dis. 2012, 1–8. https://doi.org/10.1155/2012/673849
Tripathi, M., Vibha, D., Gupta, P., Bhatia, R., Srivastava, M.V.P., Vivekanandhan, S., Bhushan Singh, M., Prasad, K., Dergalust, S., Mendez, M.F. (2012). Risk factors of dementia in North India: a case–control study. Aging Ment. Health 16, 228–235. https://doi.org/10.1080/13607863.2011.583632
While all hospitals are required to track and register the main causes of hospitalisation, most of the times dementia is not stated as a main cause and therefore tend not be registered. This creates a situation where it is likely that dementia-related hospital admissions are considerably underestimated.