Stage of Disease Among Hospitalized Persons Living With Dementia: A Multisite Study

OBJECTIVES: To examine dementia stage and factors associated with stage among hospitalized older adults with Alzheimer's disease and related dementias (ADRD). DESIGN: Secondary analysis of baseline data from the multisite ADRD-Palliative Care (ADRD-PC) clinical trial screening cohort. SETTING AND PARTICIPANTS: Five US medical centers; hospitalized adults aged ≥55 years with ADRD identified at admission. Dementia stage was classified using the Global Deterioration Scale (GDS) as mild (GDS 3-4), moderate (GDS 5-6), or severe (GDS 7). METHODS: Multinomial logistic regression identified demographic and clinical characteristics independently associated with dementia stage. Independent variables included age, race, admitting service (general medicine, subspecialty/surgery, intensive care unit), and dementia diagnosis; models were clustered by site. RESULTS: Among 6303 hospitalized patients with ADRD, 39.3% had mild dementia, 57.8% moderate, and 2.9% severe. Compared with those with mild dementia, individuals with moderate dementia had higher odds of being older [75-84 years: adjusted odds ratio (aOR), 1.34; 95% CI, 1.17-1.53; ≥85 years: aOR, 2.02; 95% CI, 1.76-2.33], Black (aOR, 1.45; 95% CI, 1.27-1.66), less often admitted to subspecialty/surgical services (aOR, 0.65; 95% CI, 0.58-0.73), and more often diagnosed with Alzheimer's disease (aOR, 1.85; 95% CI, 1.62-2.12). Individuals with severe dementia had higher odds of being Black (aOR, 2.43; 95% CI 1.72-3.43) or Asian (aOR, 2.95; 95% CI, 1.57-5.54), less often admitted to subspecialty/surgical services (aOR, 0.39; 95% CI, 0.26-0.58), and more often diagnosed with Alzheimer's disease (aOR, 2.67; 95% CI, 1.9-3.77). CONCLUSIONS AND IMPLICATIONS: Moderate-stage dementia was the most common stage among hospitalized patients with ADRD. Patients with moderate or severe dementia were more likely to be older, identify as Black, be admitted to general medical services, and have Alzheimer's disease. Staging and related characteristics may guide hospital-based interventions to improve care for people with ADRD.