Do Older Adults With Dementia Have Increased Colonoscopy-Related Issues?

While older adults with dementia do not demonstrate increased colonoscopy-related complications, they tend to display higher rates of general complications compared with patients without dementia, according to study findings published in Digestive Diseases and Sciences. 

With the rise in the older adult population in the United States, it becomes increasingly important to study chronic conditions prevalent in this population. Researchers conducted a population-based study to assess colonoscopy use among patients diagnosed with dementia compared with patients without dementia in the older adult population. 

Study participants aged 60 years and older underwent a colonoscopy procedure defined by the International Classification of Diseases, 10th edition, Clinical Modification (ICD-10-CM). Dementia was defined using the Elixhauser Comorbidity Software. 

The analysis was conducted separately in patients with and without dementia. Of the 55,015 participants who underwent colonoscopy, 4323 were diagnosed with dementia. The average age of patients with dementia was 80.08 years and without dementia was 73.69 years.

In the dementia group, 59.6% were women compared with 53.9% among those without dementia. A total of 67.1% of patients in the dementia group were White, compared with 72.6% of those without dementia. 

Patients with obesity and dementia had a lower proportion of colonoscopies (9.23%) compared with those with obesity without dementia (16.6%). Patients with dementia were more likely to undergo an emergent colonoscopy (95.39%) compared with those without dementia (87.7%). 

There were no significant differences in colonoscopy-related complications between patients with and without dementia. However, patients with dementia reported higher rates of other complications, including renal or acute kidney injury (P =.0042), pulmonary issues or pneumonia (P =.003), cerebrovascular accidents (P =.0063), and sepsis (P <.0001).

Among patients with Medicare, those with dementia (91.2%) were more likely to undergo colonoscopy compared with those without dementia (78.9%). 

Participants with dementia had a significantly increased hospital length of stay (LOS) compared with patients without dementia (6 days vs 5 days; P <.0001). In addition, patients with dementia had higher estimated hospital costs compared with those without dementia ($55,808 vs $47,912; P <.0001). 

The multivariable regression showed that patients with dementia were 69% less likely to have had a routine discharge compared with nondementia patients (odds ratio [OR], 0.31; 95% CI, 0.28-0.34). 

Patients on Medicare (OR, 0.70; 95% CI, 0.56-0.87) and Medicaid (OR 0.67; 95% CI, 0.46-0.97) were less likely to have routine discharge compared with patients with private insurance. Patients on Medicare also had a greater likelihood of a longer LOS (relative risk [RR], 1.23; 99% CI, 1.04-1.42).

“This study also raises important questions about informed decision-making as demented patients are less likely to decide on their own and rely on others (family, friends, healthcare power of attorney, etc.) to make decisions on their behalf,” study authors noted.

Study limitations include the inability to assess differences in colonoscopy procedures, the lack of information regarding readmissions, and the inability to determine coexisting polypharmacy and frailty factors. 

This article originally appeared on Gastroenterology Advisor