J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 9, Number 1, January 2017, pages 23-29

Predictors of Transition to Hospice Care Among Hospitalized Older Adults With a Diagnosis of Dementia in Texas: A Population-Based Study

**Table 1.** The Demographics and Health Insurance Characteristics of Older Adult Hospitalizations With a Diagnosis of Dementia, 2001 - 2010
Group	n = 889,008
^aPercent figures are rounded. ^bGender was masked in 33,297 hospitalizations. The denominator used to derive gender percentages for the cohort was based on hospitalizations with available gender designation (n = 855,711) .
Age (years, n (%))^a
65 - 79	334,226 (37.6)
≥ 80	554,782 (62.4)
Female (n (%))^{a, b}	550,987 (64.4)
Race/ethnicity (n (%))^a
White	590,806 (66.5)
Hispanic	141,202 (15.9)
Black	107,746 (12.1)
Other	47,502 (5.3)
Missing	2,035 (0.2)
Health insurance (n (%))^a
Private	79,428 (8.9)
Medicare	774,847 (87.2)
Medicaid	16,065 (1.8)
Uninsured	12,971 (1.5)
Other	5,304 (0.6)
Missing	393 (0.04)

Table 1. The Demographics and Health Insurance Characteristics of Older Adult Hospitalizations With a Diagnosis of Dementia, 2001 - 2010

Group

n = 889,008

^aPercent figures are rounded. ^bGender was masked in 33,297 hospitalizations. The denominator used to derive gender percentages for the cohort was based on hospitalizations with available gender designation (n = 855,711) .

Age (years, n (%))^a

65 - 79

334,226 (37.6)

≥ 80

554,782 (62.4)

Female (n (%))^{a, b}

550,987 (64.4)

Race/ethnicity (n (%))^a

White

590,806 (66.5)

Hispanic

141,202 (15.9)

Black

107,746 (12.1)

Other

47,502 (5.3)

Missing

2,035 (0.2)

Health insurance (n (%))^a

Private

79,428 (8.9)

Medicare

774,847 (87.2)

Medicaid

16,065 (1.8)

Uninsured

12,971 (1.5)

Other

5,304 (0.6)

Missing

393 (0.04)

**Table 2.** Comorbid Conditions of Older Adult Hospitalizations With a Diagnosis of Dementia, 2001 - 2010
Group	n = 889,008
Deyo-Charlson index-based comorbidities (n (%))
Congestive heart failure	218,508 (24.6)
Peripheral vascular disease	104,925 (11.8)
Lung disease	188,171 (21.3)
Cerebrovascular disease	139,289 (15.7)
Connective tissue disease	15,955 (1.8)
Diabetes mellitus	232,916 (26.2)
Renal disease	110,728 (12.5)
Liver disease	17,656 (2.0)
Malignancy	41,048 (4.6)
HIV infection	980 (0.1)

Table 2. Comorbid Conditions of Older Adult Hospitalizations With a Diagnosis of Dementia, 2001 - 2010

Group

n = 889,008

Deyo-Charlson index-based comorbidities (n (%))

Congestive heart failure

218,508 (24.6)

Peripheral vascular disease

104,925 (11.8)

Lung disease

188,171 (21.3)

Cerebrovascular disease

139,289 (15.7)

Connective tissue disease

15,955 (1.8)

Diabetes mellitus

232,916 (26.2)

Renal disease

110,728 (12.5)

Liver disease

17,656 (2.0)

Malignancy

41,048 (4.6)

HIV infection

980 (0.1)

**Table 3.** Organ Failure and Use of Mechanical Ventilation Among Older Adult Hospitalizations With a Diagnosis of Dementia, 2001 - 2010
Group	n = 889,008
Type of organ failure (n (%))
Respiratory	49,481 (5.6)
Cardiovascular	40,678 (4.6)
Renal	77,173 (8.7)
Hepatic	3,758 (0.4)
Hematological	26,438 (3.0)
Metabolic	16,527 (1.9)
Neurological	66,422 (7.5)
Number of failing organs (n (%))
1	166,418 (18.7)
2	37,556 (4.2)
3	9,067 (1.0)
≥ 4	2,924 (0.3)
Mechanical ventilation (n (%))	15,373 (1.7)

Table 3. Organ Failure and Use of Mechanical Ventilation Among Older Adult Hospitalizations With a Diagnosis of Dementia, 2001 - 2010

Group

n = 889,008

Type of organ failure (n (%))

Respiratory

49,481 (5.6)

Cardiovascular

40,678 (4.6)

Renal

77,173 (8.7)

Hepatic

3,758 (0.4)

Hematological

26,438 (3.0)

Metabolic

16,527 (1.9)

Neurological

66,422 (7.5)

Number of failing organs (n (%))

166,418 (18.7)

37,556 (4.2)

9,067 (1.0)

≥ 4

2,924 (0.3)

Mechanical ventilation (n (%))

15,373 (1.7)

**Table 4.** Logistic Regression Analysis of the Factors Associated With Discharge to Hospice Among Older Adult Hospitalizations With a Diagnosis of Dementia, 2001 - 2010
Covariate	Adjusted odds ratio	95% confidence interval	P
^aAge 65 - 79 years was used as referent. ^bWhite race was used as referent. ^cCommercial insurance was used as referent. ^dHuman immunodeficiency virus. ^eLack of organ failure was used as referent. ^fModeled with the number of failing organs.
Age ≥ 80 years^a	1.78	1.73 - 1.82	< 0.0001
Race/ethnicity^b
Black	0.67	0.65 - 0.70	< 0.0001
Hispanic	0.80	0.78 - 0.82	< 0.0001
Other	0.81	0.78 - 0.85	< 0.0001
Health insurance^c
No health insurance	0.86	0.79 - 0.94	0.0008
Medicaid	0.41	0.37 - 0.46	0.0001
Medicare	0.68	0.66 - 0.70	< 0.0001
Other	0.68	0.59 - 0.78	0.0001
Chronic comorbidity
Congestive heart failure	1.35	1.32 - 1.38	< 0.0001
Peripheral vascular disease	1.30	1.27 - 1.34	0.0001
Cerebrovascular disease	1.17	1.14 - 1.20	< 0.0001
Lung disease	0.90	0.87 - 0.92	< 0.0001
Liver disease	1.12	1.05 - 1.20	0.0008
Diabetes	0.78	0.76 - 0.80	< 0.0001
Renal disease	1.15	1.12 - 1.18	< 0.0001
Malignancy	3.72	3.61 - 3.84	< 0.0001
HIV infection^d	1.26	0.95 - 1.68	0.1033
Type of organ failure
Respiratory	2.54	2.46 - 2.63	< 0.0001
Cardiovascular	1.41	1.36 - 1.47	< 0.0001
Renal	2.13	2.07 - 2.19	< 0.0001
Hepatic	1.58	1.35 - 1.86	< 0.0001
Hematological	1.16	1.10 - 1.22	< 0.0001
Metabolic	1.54	1.46 - 1.62	< 0.0001
Neurological	1.52	1.48 - 1.57	< 0.0001
Number of failing organs^e
1	2.02	1.97 - 2.07	< 0.0001
2	3.46	3.33 - 3.59	< 0.0001
3	4.77	4.48 - 5.07	< 0.0001
≥ 4	6.18	5.61 - 6.82	< 0.0001
Mechanical ventilation^f	1.12	1.06 - 1.18	0.0001

Table 4. Logistic Regression Analysis of the Factors Associated With Discharge to Hospice Among Older Adult Hospitalizations With a Diagnosis of Dementia, 2001 - 2010

Covariate

Adjusted odds ratio

95% confidence interval

^aAge 65 - 79 years was used as referent. ^bWhite race was used as referent. ^cCommercial insurance was used as referent. ^dHuman immunodeficiency virus. ^eLack of organ failure was used as referent. ^fModeled with the number of failing organs.

Age ≥ 80 years^a

1.78

1.73 - 1.82

< 0.0001

Race/ethnicity^b

Black

0.67

0.65 - 0.70

< 0.0001

Hispanic

0.80

0.78 - 0.82

< 0.0001

Other

0.81

0.78 - 0.85

< 0.0001

Health insurance^c

No health insurance

0.86

0.79 - 0.94

0.0008

Medicaid

0.41

0.37 - 0.46

0.0001

Medicare

0.68

0.66 - 0.70

< 0.0001

Other

0.68

0.59 - 0.78

0.0001

Chronic comorbidity

Congestive heart failure

1.35

1.32 - 1.38

< 0.0001

Peripheral vascular disease

1.30

1.27 - 1.34

0.0001

Cerebrovascular disease

1.17

1.14 - 1.20

< 0.0001

Lung disease

0.90

0.87 - 0.92

< 0.0001

Liver disease

1.12

1.05 - 1.20

0.0008

Diabetes

0.78

0.76 - 0.80

< 0.0001

Renal disease

1.15

1.12 - 1.18

< 0.0001

Malignancy

3.72

3.61 - 3.84

< 0.0001

HIV infection^d

1.26

0.95 - 1.68

0.1033

Type of organ failure

Respiratory

2.54

2.46 - 2.63

< 0.0001

Cardiovascular

1.41

1.36 - 1.47

< 0.0001

Renal

2.13

2.07 - 2.19

< 0.0001

Hepatic

1.58

1.35 - 1.86

< 0.0001

Hematological

1.16

1.10 - 1.22

< 0.0001

Metabolic

1.54

1.46 - 1.62

< 0.0001

Neurological

1.52

1.48 - 1.57

< 0.0001

Number of failing organs^e

2.02

1.97 - 2.07

< 0.0001

3.46

3.33 - 3.59

< 0.0001

4.77

4.48 - 5.07

< 0.0001

≥ 4

6.18

5.61 - 6.82

< 0.0001

Mechanical ventilation^f

1.12

1.06 - 1.18

0.0001