{"doi":"10.1111/jgs.18699","title":"“Preventable hospitalizations” in older adults with dementia: Are they really preventable?","abstract":"The concept of preventable hospitalization originated to characterize hospital admissions resulting from lack of timely access to primary care. Initially a measure of access to primary care among marginalized communities,1 the concept has since become ingrained as a quality of care measure, including for persons with dementia.2 An analysis of preventable hospitalizations within the Adult Changes in Thought (ACT) cohort found that, among those with and without a research-derived diagnosis of dementia, rates were significantly higher among those with dementia,3 consistent with other analyses.4, 5 Yet why dementia might be associated with increased risk of admission is unclear. To begin to examine these questions, we conducted a retrospective review of medical records from a subset of ACT participants who experienced preventable hospitalization. We focused on admissions for congestive heart failure (CHF) or bacterial pneumonia (BP), the most common chronic and acute preventable admission conditions.3 Participants were drawn from the ACT cohort, a population-based study of aging and dementia risk.6 We identified those hospitalized for CHF or BP on/after January 1, 2006 using principal discharge diagnosis International Classification of Disease codes. For each diagnosis, a random sample of 15 participants with ACT-diagnosed dementia and 15 age-matched participants without dementia were selected, yielding a total sample of 60. We conducted a chart review (Supplementary Text S1) of ambulatory, urgent, emergency department, and admission records to inform three questions: (1) Could admission have been prevented through more timely receipt of care? (2) Among those with dementia, did dementia elevate admission risk and, if so, how? (3) Among those with dementia, was admission risk moderated by whether clinicians recognized cognitive impairment? Charts were independently reviewed by the authors with discussion to resolve differences. Group Health Research Institute and Michigan Medicine IRBs approved the study. Two of the sample of 60 lacked outpatient records, yielding a final sample of 29 CHF (14 without, 15 with dementia) and 29 BP (15 without, 14 with dementia) admissions. Mean age was 88.3 years (standard deviation 7.5); 58.6% were female (Table 1). Delayed care was uncommon (15/58 [25.9%; 95% confidence interval (CI) 15.3%, 39.0%]); representative cases are presented in Table 2). Among those without dementia, evidence from eight of 29 admissions (8/29 [27.6%; CI 12.7%, 47.2%]) suggested that ambulatory care was delayed. Among those with dementia, a similar proportion experienced delay (7/29 [24.1%; CI 10.3%, 43.5%]). Patients or families introduced care delays through time lapse between symptom onset and contacting the clinician. For example, an 80-year-old (with dementia) was brought to see her primary care physician (PCP) by her daughter; with “cough and general malaise over the last few days … unable to get up and go to the dining room …” There was no prior contact with the PCP for these symptoms. There was no apparent mechanism whereby dementia contributed to risk of preventable hospitalization. Recognition of dementia (i.e., a diagnosis present in clinical documentation) did not appear to contribute to delayed care or otherwise increase admission risk. In this preliminary study, we found that about one-quarter of hospitalizations for CHF or BP may have been preventable via earlier receipt of medical care. Among these, delays were as often attributable to older adults and their care supports (family or congregate living facility) as to their clinicians. Preventability was similar regardless of dementia status. Among those with (research-diagnosed) dementia, care delays did not seem any more likely among those whose dementia was undocumented in the medical record. While a majority of hospitalizations reviewed did not appear preventable, one quarter may have been. Efforts to reduce hospitalizations of persons with dementia, wheth","journal":"Journal of the American Geriatrics Society","year":2023,"id":414472,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9606,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":711042,"name":"Elizabeth A. Phelan","orcid":null,"position":1,"is_corresponding":false},{"id":335343,"name":"Donovan T. Maust","orcid":"0000-0003-4740-2640","position":0,"is_corresponding":true}],"reference_count":9,"raw_metadata":null,"created_at":"2026-07-19T01:22:05.177070Z","pmid":"38018496","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}