Colonoscopy Utilization in Elderly Dementia Patients: Characteristics, Complications, and Charges in a National Matched-Cohort Analysis

Abstract

Abstract Background It is projected that the elderly population will continue to increase. Many will develop chronic conditions such as dementia. Aims Our aims are to describe the utilization of colonoscopy among dementia patients and compare outcomes in those with and without dementia. Methods This population-based analysis utilized the National Inpatient Sample (NIS) during 2019. Patients with dementia over the age of 60 years receiving colonoscopy were identified utilizing the Elixhauser comorbidity measure and ICD-10 codes. Propensity score matching was used to correct for effects of uneven features of the clinical outcomes. Multivariate regression analysis was used to assess the effect of patient factors. Results Initially, 50,692 patients without dementia were compared with 4,323 patients with dementia. Dementia patients were more likely to be female, older, less likely white, had lower income, and more likely to be on Medicare. In the matched comparison (4,176 in each group), complications analysis showed dementia patients did not have higher colonoscopy-related complications. They did have higher rates of other complications including renal/AKI (p = 0.0042), pulmonary/pneumonia (p = 0.003), cerebrovascular accidents (p = 0.0063), and sepsis (< 0.0001). Dementia patients were also less likely to have routine discharges (< 0.0001), had longer hospital stays (< 0.0001), and higher hospital costs (< 0.0001). Conclusions Elderly dementia patients have similar colonoscopy-related complications as patients without dementia. However, they do have higher complications in general. The decision whether to perform colonoscopy in this patient population is multifactorial. A careful assessment of a dementia patient’s history can help with this decision.