Determinants of multiple acute hospital admission for older adults living with dementia

Abstract

Background: The rising prevalence of dementia among older adults leads to complex care needs as the condition progresses. These needs place growing pressures on health and social care services through higher costs, workforce shortages and resource constraints, leading to an increased risk of acute hospitalisation. Where evolving care needs are not recognised and addressed appropriately, older adults with dementia are more likely to be readmitted to hospital within six months of discharge. Such readmissions are commonly associated with cognitive and functional decline, and increased mortality. Yet evidence remains limited regarding how physical, psychosocial, and system-level determinants influence these hospitalisations. This thesis addresses this gap by identifying the determinants of hospital readmissions among older adults living with dementia.
Method: An explanatory sequential mixed methods study was conducted. First, a scoping review mapped the psychosocial determinants of hospital readmissions in dementia, as identified from existing literature. Second, a retrospective cohort study of anonymised electronic primary care records in England (n=30,527) was conducted to identify the clinical determinants of 180-day hospital readmission using logistic regression. Predictors of one-year mortality following readmission were identified using Cox proportional hazards regression. Lastly, 28 qualitative interviews were conducted to explore the experiences and perceptions of supporting older adults with dementia during hospitalisations from family caregivers, paid caregivers, and healthcare professionals, using reflexive thematic analysis. Quantitative and qualitative findings were integrated to generate insights of multiple hospital admissions in dementia.
Results: Hospital readmissions among older adults with dementia were associated with increased vulnerability to declining health, multimorbidity and dependence on care services. Quantitative analysis of primary care records identified an increased risk of hospital readmission following discharge, alongside associations with multiple long-term conditions and healthcare utilisation. One-year mortality following readmission was also associated with multimorbidity, antipsychotic medication, and residential care. Qualitative findings highlighted delays in care processes, difficulties in recognising and responding to deterioration and evolving care needs, and limited clarity regarding future care preferences and prognosis during hospitalisation.
Conclusion: This thesis has identified the physical, psychosocial, and system-level determinants of hospital readmissions for older adults with dementia and how they may interact. By integrating quantitative and qualitative findings, this study provides a comprehensive understanding of the impact of hospital readmission on individuals, caregivers, and healthcare professionals. These insights can inform the development of responsive care practices and policies aimed to reduce the risk of readmission and adverse health outcomes for people living with dementia.

Date of Award	Jul 2026
Original language	English
Awarding Institution	University of Brighton
Supervisor	Naji Tabet (Supervisor), Khalid Ali (Supervisor) & Elizabeth Ford (Supervisor)