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

Colonoscopy Utilization in Elderly Dementia Patients: Characteristics, Complications, and Charges in a National Matched-Cohort Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Colonoscopy Utilization in Elderly Dementia Patients: Characteristics, Complications, and Charges in a National Matched-Cohort Analysis Faris Shweikeh, Gordon Hong, Kathleen Rogers, Mohamad Mouchli, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3874007/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Mar, 2024 Read the published version in Digestive Diseases and Sciences → Version 1 posted 7 You are reading this latest preprint version 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. Colonoscopy Elderly Dementia Outcomes National Introduction Colonoscopy is a common procedure used both diagnostically for colon cancer screening as well as therapeutically for acute gastrointestinal bleeding. Though generally considered safe, as with any invasive procedure, complications of bowel preparation, the procedure itself, and the sedation do occur and are all increased in older patients. Therefore, patient selection is particularly important taking into account potential benefits, risk factors and patient preference. Dementia describes a clinical syndrome that includes cognitive decline with resulting reduction in functional status. Specific pathologies include Alzheimer’s disease, Lewy Body and vascular dementia. Manifestations and outcomes vary depending on the diagnosis and dementia patients can represent a challenging patient population [ 1 ]. Hospitalized elderly patients with dementia have higher financial burden than those without dementia [ 2 , 3 ]. As hospital charges soar in this population, it becomes even more prudent to investigate the clinical tendencies, outcomes, and predictors of various procedures for inpatients. For common gastroenterology procedures, besides the direct risks of the procedure itself and the associated anesthesia, risks can go beyond that in the dementia population. With regards to colonoscopy specifically, previous research has shown that dementia is associated with less likelihood to utilize colorectal cancer screening, less likelihood to know that Medicare covers it, missed colonoscopy appointments, and suboptimal bowl preparation [ 4 , 5 ]. Previous studies in hospitalized patients with dementia have generally demonstrated worse outcomes. In a study by Ijaz et al., dementia patients admitted for heart failure or acute myocardial infarction were found to have significantly higher inpatient mortality and longer hospital lengths of stay (LOS) [ 6 ]. Similarly, Baral et al. found that patients with atrial fibrillation and dementia had greater risk of in-hospital mortality while also lower likelihood of undergoing cardiac procedures [ 7 ]. In regard to discharge disposition, patients with dementia also appear to fare worse. Lin et al. utilized a national database to evaluate for several common admission diagnoses and found dementia patients with enteritis, gastrointestinal (GI) bleed, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), pneumonia, and arrhythmia were less likely to be discharged to home [ 8 ]. Gastrointestinal bleeding patients specifically had an 82% reduction in likelihood in home discharge (aOR 0.18, 95% CI 0.18–0.19). This is compounded by the fact that the elderly and those with dementia face an increased risk of both upper and lower gastrointestinal disorders [ 3 ]. With increasing age of the population gastroenterologists increasingly face the challenges of performing procedures in patients with dementia [ 3 ]. In this study, we evaluate the outcomes of patients diagnosed with dementia undergoing colonoscopy in the inpatient setting utilizing the National Inpatient Sample (NIS), the largest all-payer database of in-patient care publicly available in the United States. We hypothesize that patients with dementia will serve as a challenge for the gastroenterologist performing this procedure because of higher likelihood of worse clinical outcomes. We will identify a potential problem in elderly patients and find ways towards better outcomes in this population. Methods This study utilized the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) during the year 2019. This database is sponsored by the Agency for Healthcare Research and Quality (AHQR). The NIS is the largest all-payer database of hospitalized patients in the United States with a large sample size allowing ideal analysis of association and comparisons between various conditions and procedures. This study was approved by the Cleveland Clinic Institutional Review Board (IRB) as an exempted study. Patients aged > 60 years who had received a colonoscopy identified via International Classification of Diseases, tenth edition, clinical modification (ICD-10-CM) procedure codes were included in the study. The following ICD-10-CM codes were used for colonoscopy: 0DJD8ZZ, 0DJD3ZZ, 0DJD4ZZ, 0DJD7ZZ, 0DJD8ZZ, 0DBE8ZX, 0DBF8ZX, 0DBG8ZX, 0DBH8ZX, 0DBK8ZX, 0DBL8ZX, 0DBM8ZX, and 0DBN8ZX. Presence of dementia as a comorbidity (along with other identifiable comorbidities) were identified using Elixhauser Comorbidity Software administered by AHRQ. Patient and hospital characteristics were collected for each hospitalization. Hospitalizations records were divided into 2 groups: elderly patients (i.e.> 60 years) without dementia and elderly patients with dementia. Demographic and clinical data were compared between the 2 groups. Factors and variables analyzed included sex, race, type of insurance coverage, hospital type, discharge disposition, length of stay, mortality, and comorbidities (see Tables 1-4). Table 1. Demographics and matching among elderly patients receiving colonoscopy with and without dementia. >60yo, received colonoscopy, Without Dementia (N=50,692) >60, received colonoscopy, With Dementia (N=4323) SD Before matching With Dementia Matched (N=4176) Without Dementia Matched (N=4176) SD after matching Patient characteristics Sex, Females, 27341 (53.94) 2575 (59.57) 0.114 2492 (59.67) 2492 (59.67) 0.000 Age, years Mean (SD) 73.69 (8.44) 80.08 (7.62) 0.794 80.13 (7.60) 80.23 (7.66) 0.013 Race n (%) White Black Hispanic Asian/Pacific Islander Other 36088 (72.66) 6966 (14.03) 3901 (7.85) 1337 (2.69) 1376 (2.77) 2848 (67.12) 777 (18.31) 383 (9.03) 122 (2.88) 113 (2.66) 0.115 0.116 0.042 0.011 0.006 2802 (67.10) 760 (18.20) 381 (9.12) 121 (2.90) 112 (2.68) 2899 (69.42) 709 (16.98) 349 (8.36) 126 (3.02) 93 (2.23) 0.050 0.032 0.027 0.007 0.007 Comorbidities DM 17731 (34.98) 1580 (36.55) 0.033 1521 (36.42) 1463 (35.03) 0.029 Hypertension 38857 (76.65) 3564 (82.44) 0.144 3448 (82.57) 3489 (83.55) 0.026 Pulmonary disease 12805 (25.26) 1047 (24.22) 0.024 1020 (24.43) 995 (23.83) 0.014 Obesity 8414 (16.60) 399 (9.23) 0.221 383 (9.17) 370 (8.86) 0.011 Depression 6236 (12.30) 815 (18.85) 0.181 784 (18.77) 717 (17.17) 0.042 Alcohol abuse 1940 (3.83) 110 (2.54) 0.073 107 (2.56) 99 (2.37) 0.012 Urgency Elective Non-elective/Emergent 6233 (12.31) 44413 (87.69) 199 (4.61) 4121 (95.39) 0.279 0.279 186 (4.45) 3990 (95.55) 160 (3.83) 4016 (96.17) 0.031 0.031 Income quartiles 1 – 47,999 48,000 – 60,999 61,000 – 81,999 82,000+ 14217 (28.47) 12701 (25.43) 12511 (25.05) 10507 (21.04) 1317 (30.91) 1062 (24.92) 1032 (24.22) 850 (19.95) 0.053 0.011 0.019 0.027 1287 (30.82) 1039 (24.88) 1010 (24.19) 840 (20.11) 1288 (30.84) 1067 (25.55) 1027 (24.59) 794 (19.01) 0.001 0.015 0.009 0.028 Region of Hospital Northeast Midwest South West 9871 (19.47) 12120 (23.91) 19339 (38.15) 9362 (18.47) 745 (17.23) 1031 (23.85) 1781 (41.20) 766 (17.72) 0.058 0.001 0.062 0.019 732 (17.53) 992 (23.75) 1712 (41.00) 740 (17.72) 690 (16.52) 1002 (23.99) 1733 (41.50) 751 (17.98) 0.027 0.006 0.010 0.007 Hospital Location and Teaching Status Rural Urban non-teaching Urban teaching 3826 (7.55) 9584 (18.91) 37282 (73.55) 301 (6.96) 989 (22.88) 3033 (70.16) 0.023 0.098 0.075 294 (7.04) 958 (22.94) 2924 (70.02) 283 (6.78) 948 (22.70) 2945 (70.52) 0.010 0.006 0.011 Bed size Small Medium Large 10490 (20.69) 15209 (30.00) 24993 (49.30) 917 (21.21) 1388 (32.11) 2018 (46.68) 0.013 0.045 0.053 868 (20.79) 1355 (32.45) 1953 (46.77) 879 (21.05) 1335 (31.97) 1962 (46.98) 0.006 0.010 0.004 Payer/Insurance Status Medicare Medicaid Private insurance Other 39977 (78.92) 2186 (4.32) 6911 (13.64) 1582 (3.12) 3940 (91.20) 116 (2.69) 207 (4.79) 57 (1.32) 0.349 0.089 0.310 0.123 3812 (91.28) 110 (2.63) 202 (4.84) 52 (1.25) 3887 (93.08) 94 (2.25) 153 (3.66) 42 (1.01) 0.067 0.025 0.058 0.023 Note: Percentages do not reflect missing values. Statistics presented as n (%) unless otherwise indicated in the table. SD = Standardized differences. Standardized difference <0.1 represents covariate balance. Note: Percentages do not reflect missing values. Statistics presented as n (%) unless otherwise indicated in the table. SD = Standardized differences. Standardized difference <0.1 represents covariate balance. Categorical variables are described by frequencies and percentages. Continuous measures are described by means and standard deviations or medians and interquartile range as appropriate depending on their distribution. In terms of group matching, Propensity Score Matching was used to correct for effects of the uneven features of the clinical outcomes between those with dementia versus without dementia. Greedy one-to-one matching was used where each patient in the dementia group was matched to a patient in the nondementia group with the closest propensity score. Standardized differences were used to assess the balance of characteristics after matching, standardized difference less than 0.1 was considered to represent covariate balance. To compare outcomes between matched groups, dependent sample statistical methods were used: McNemar test for categorical variables and a signed rank sum test or paired t-tests for continuous variables. Multivariable regression analyses were used to assess the effect of patient factors –age, sex, race/ethnicity, hospital region, and status on length of stay, type of discharge and hospital charges. All tests were 2-sided. A P < 0.05 was considered statistically significant. Analyses were performed using SAS Software (Version 9.4, Cary, NC). Results A total of 55,015 elderly patients over the age of 60 years who underwent colonoscopy in 2019 were included. From these, 4,323 had a diagnosis of dementia and 50,692 did not have a diagnosis of dementia (Table 1 ). The mean age of the dementia cohort was 80.08 years and those without dementia was 73.69 years. Females made up 59.6% of those with dementia and 53.9% of those without dementia. Whites made up 67.1% of those with dementia and 72.6% of those without dementia. Blacks with dementia were more likely to receive a colonoscopy than those without (18.3% vs. 14.3%). Obese patients with dementia (9.23%) had a lower percentage of colonoscopy versus those without dementia (16.6%). In terms of urgency of the procedure, those with dementia (95.39%) were more likely to have received a colonoscopy on an emergent basis than those without dementia (87.7%); conversely, there was a higher likelihood of receiving a colonoscopy on an elective basis in those without dementia (12.3% vs 4.61%). There was a lower likelihood for those with private insurance and with dementia (4.8%) to receive colonoscopy compared to those without dementia (13.6%) and same insurance. Correspondingly, a patient who is on Medicare and has dementia (91.2%) is more likely to get a colonoscopy than a patient without dementia on Medicare (78.9%). In our cohort of elderly patients aged over 60 years, colonoscopy-related complications – colon perforations, bleeding, and splenic injury – occurred at about the same rate in the dementia versus the non-dementia comparison (Table 2 ). Non-procedure related complications, however, were more common in patients with dementia compared to those without dementia including renal and/or acute kidney injury, pulmonary and/or pneumonia, cerebrovascular accident (CVA), and sepsis (all with significant p-values, p 60 years receiving colonoscopy in the matched comparison. Colonoscopy- related complications Without Dementia (N = 4176) With Dementia (N = 4176) P-value Colon Perforation 30 (0.72) 28 (0.67) 0.7928 Post colonoscopy bleeding 27 (0.65) 16 (0.38) 0.0934 Splenic Injury 0 0 -- Complications-other Acute kidney injury/ Renal 1139 (27.27) 1258 (30.12) 0.0042 Cardiac arrest / Cardiac 28 (0.67) 27 (0.65) 0.8927 DVT/PE 71 (1.70) 68 (1.63) 0.7975 Pulmonary / Pneumonia 175 (4.19) 247 (5.91) 0.0003 Myocardial infarction < 10 < 10 0.4142 Cerebral vascular accident 19 (0.45) 40 (0.96) 0.0063 Sepsis (with or without shock) 260 (6.23) 354 (8.48) < .0001 DVT: Deep venous thrombosis; PE: Pulmonary embolism. Statistics presented as n (%) Patients with dementia versus non-dementia groups (Table 3 ) showed a significant increase in length of stay (LOS) and hospital charges. For instance, 28.1% of those with dementia had a routine discharge while 54.7% had such a discharge in those without dementia (p < 0.001). Those with dementia had a prolonged LOS when compared to those without dementia (6 days vs. 5 days, p < 0.0001). Finally, those with dementia incurred higher hospital charges with an estimated cost of $ 55,808 vs. $ 47,912 (p < 0.0001). No significant difference in in-hospital mortality was appreciated between the groups. Table 3 Outcomes in Dementia vs without Dementia groups. Without Dementia (N = 4176) (matched) With Dementia (N = 4176) P-value Routine Discharge, n (%) 2282 (54.65) 1174 (28.11) < .0001 Length of Stay 5.0 (3.0–8.0) 6.0 (4.0–9.0) < .0001 Charges ($) 47912.5 (28784.0–85628.5) 55808.0(33273.0–100303.0) < .0001 Complications, n (%) 1410 (33.76) 1606 (38.46) < .0001 Mortality, n (%) 82 (1.96) 76 (1.82) 0.6310 Statistics presented as n (%) or median (Q1 – Q3). On multivariable regression, patients with dementia were 69% less likely to have had a routine discharge as compared to non-dementia patients (Table 4 ). Table 4 also indicates that when compared with those private insurance, Medicare and Medicaid patients were less likely to have a routine discharge (30% and 33% less likely, respectively, significant 95% CI). Medicaid patients were also 23% more likely to have a longer length of stay (1.04–1.42, 99% CI). Other pertinent findings included lower costs at rural hospitals (33% less vs. teaching hospitals, 0.73–0.81, 95% CI), lower likelihood of routine discharge at hospitals in the Northeast region (34% less likely than West coast hospital (0.65–0.89, 95% CI)), but significantly lower likelihood of lower charges, and Southern states also with significantly less hospital charges. West coast hospitals incurred significantly higher hospital charges than the Northeast, Southern, and Midwest hospitals (Table 4 ). Tables 5 and 6 summarize our literature review with regards to national studies analyzing dementia comorbidity on outcomes of various medical conditions and procedures [ 2 , 6 , 8 – 17 ] and with regards to its impacts on GI procedures specifically [ 5 , 18 – 24 ]. Table 4. Other Factors Determining Outcomes in Elderly patient with and without dementia (multivariate analysis). Length of Stay, RR (99% CI) Routine Discharge, OR (95% CI) Hospital Charges, RR (95% CI) Dementia: Yes vs No 1.09 (1.07 - 1.12) 0.31 (0.28 -0.34) 1.07 (1.04- 1.10) Age, increasing 0.99 (0.98 - 0.99) 0.97 (0.96 - 0.98) 0.98 (0.98 - 0.99) Gender: F vs M 0.96 (0.94 - 0.98) 0.99 (0.91 - 1.09) 0.94 (0.92 - 0.97) Race Black vs White 1.05 (1.00 - 1.10) 0.94 (0.83 - 1.07) 1.00 (0.94 - 1.05) Other vs White 1.01 (0.96 - 1.06) 1.29 (1.12 - 1.48) 1.10 (1.04 - 1.16) Insurance Medicare vs private 0.95 (0.87 - 1.03) 0.70 (0.56 - 0.87) 1.00 (0.92 - 1.07) Medicaid vs private Other vs Private 1.23 (1.04 - 1.42) 0.92 (0.77 - 1.10) 0.67 (0.46 - 0.97) 1.06 (0.65 -1.71) 1.29 (1.08 - 1.53) 0.83 (0.73 - 0.94) Hospital status: Rural vs teaching Urban non vs urban teaching 0.91 (0.87 - 0.95) 0.98 (0.94 - 1.02) 0.90 (0.74 -1.08) 1.01 (0.91 -1.13) 0.77 (0.73 - 0.81) 1.09 (1.04 - 1.13) Hospital Region Northeast vs West 1.09 (0.99 - 1.19) 0.76 (0.65 - 0.89) 0.77 (0.70 - 0.83) South vs West 1.01 (0.94 - 1.09) 0.92 (0.79 -1.06) 0.59 (0.55 - 0.65) Midwest vs West 1.06 (0.98 - 1.14) 0.94 (0.82 - 1.07) 0.74 (0.69- 0.81) RR = Relative Risk, OR = Odds Ratio, CI = Confidence Intervals Table 5. Previous national studies describing the effect of dementia on clinical outcomes of various medical conditions. Authors Year Published N Outcomes Reported Result (with dementia vs. without) p-value Conclusions/Notes Alshekhlee et al 2011 621 Thrombolysis: Risk of ICH 5.8% vs. 4.51% 0.45 Total study of 35,557 patients. N listed here (621) is only of matched patients. Thrombolysis: Risk of mortality 17.39% vs. 14.49% 0.31 Lagu et al 2016 497562 IMV: Discharge to SNF 51% vs. 38% <0.001 Noted heterogeneity of dementia patients selected for IMV (less likely to have predictors of mortality including cancer, liver disease, chronic renal failure, etc.). IMV: Hospital mortality 32.5% vs. 36.8% <0.001 IMV: Hospital LOS 12.5±0.2 vs. 13.1±0.2 0.01 Ijaz et al 2022 2466369 (HF) Hospital mortality 4.7% vs. 3.1%, aOR 1.33 [1.27-1.39] <0.001 Patients with dementia, admitted for HF or AMI, found to have higher inpatient mortality and longer hospital LOS. Hospital LOS (mean days) 5.5 vs. 5.3 <0.001 1094155 (AMI) Hospital mortality 9.9% vs. 5.9%, aOR 1.23 [1.17-1.30] <0.001 Hospital LOS (mean days) 5.1 vs. 4.8 <0.001 Gupta et al 2022 576381 with COPD Hospital mortality 1.6% vs. 1.1% 0.001 Odds of inpatient death higher in younger patients with dementia (41-64 years), higher inpatient mortality. Sub-hazard ratio indicates longer LOS for dementia patients. Hospital LOS (sub-hazard ratio, 95% CI) 0.93 <0.001 Shah et al 2020 210918 with vascular surgery 30-day mortality (OR) 1.21 <0.0001 Dementia patients were older, had more comorbidities, and emergent/urgent cases were more frequent. Increased odds of 30- and 90-day mortality, extended SNF stay, longer LOS, less likely to be discharged home, and spent lower fraction of time at home after discharge. ICU admission and inpatient complications similar. 90-day mortality (OR) 1.63 <0.0001 Hospital LOS 8.29 vs. 5.41 days <0.001 Discharge to home (OR) 0.31 <0.0001 Sherzai et al 2018 1170051 stroke hospitalizations AD in females aOR 1.15 [1.11-1.19] Females, African-Americans in comparison to whites, Hispanics in comparison to whites had increased odds of Alzheimer's dementia among patients hospitalized for stroke. AD in African-Americans aOR 1.25 [1.18-1.32] VD in African-Americans aOR 1.51 [1.40-1.64] AD in Hispanics aOR 1.40 [1.30-1.50] Sharma et al 2022 4495 with spine surgery (matched) Complications 38% vs. 21% <0.0001 Greater rate of complications, longer LOS, less likely discharge to home for dementia patients. Morality rates among dementia and non-dementia patients were similar. Median LOS (days) 6 vs. 4 <0.0001 Discharge to home 19% vs. 40% <0.0001 Hospital mortality 1.4% vs. 1.6% 0.4133 Sherzai et al 2014 725527 seizures hospitalizations Developing seizures or epilepsy in patients with AD (OR) OR 3.07 [2.98-3.16] Patients with AD had a higher prevalence of seizure compared to those with non-AD. This relationship was not affected by race or gender. Sherzai et al 2016 26926896 patients >65 years; DM risk Alzheimer's dementia in diabetics (OR) OR 0.57 [0.56-0.58] 60 y and with ≥ 1 procedure Trend in respiratory/GI procedures utilization Decline by 3-7% annually Utilization of respiratory/GI procedures in hospitalized patients with AD declined by 3-7% annually. Associated with increased total charges, LOS, and mortality Total increase in cost associated with respiratory/GI procedures $18,652 <0.001 Increase in LOS with respiratory/GI procedures 1.53 days <0.001 Mortality risk associated with "respiratory/GI" procedure (OR) 4.14 [3.21-5.35] <0.001 Lin et al 2015 3716216 with GI bleed Discharge to home (OR) 0.18 [0.18-0.19] Dementia with an 82% reduction in likelihood for being discharged to home Anderson et al 2020 1843632 hospitalization age > 65y Incidence of all-cause hospitalizations Decline from 1.87 to 1.85 million 0.04 Increased preventable hospitalizations of older adults with dementia. Incidence of preventable hospitalizations Increase from 0.75 to 0.87 million <0.001 Inpatient mortality Decline from 6.4 to 6.1% <0.001 Baral et al 2023 378230 with AF In-hospital mortality aOR 1.48 [95% CI 1.34-1.64] <0.001 Patients with AF and dementia had higher mortality and lower likelihood of receiving catheter ablation and electrical cardioversion. Non-trauma ICH aOR 1.60 [95% CI 1.03-2.47] 0.032 Catheter ablation aOR 0.39 [95% CI 0.35-0.43] <0.001 Electrical cardioversion aOR 0.33 [95% CI 0.31-0.35] <0.001 ICH: intracerebral hemorrhage; IMV: invasive mechanical ventilation; SNF: skilled nursing facility; aOR: adjusted odds ratio; OR: odds ration; HF: heart failure; AMI: acute myocardial infarction; COPD: Chronic obstructive pulmonary disease; LOS: length of stay; AD: Alzheimer’s Dementia; VD: vascular dementia; DM: diabetes mellitus; AF: atrial fibrillation Table 6. Studies on dementia patients undergoing gastrointestinal procedures Authors Study Goals N Outcomes Reported Results p-value Conclusions/Notes Lv et al, 2022 Impact of dementia on CRC screening utilization, knowledge, and associated health disparities 178820457 Likelihood of colorectal cancer screening AD - 39% less likely (OR 0.61; 95% CI 0.5-0.76) Overall CRC screening in older adults increased from 86.4% to 88.96% from 2015 to 2018. Dementia patients were less likely to use any CRC screening when compared to older adults without. Related dementia (RD) - 25% less likely (OR 0.75; 0.62-0.91) Knowledge of colonoscopy AD - 77% more likely (OR 1.77; 1.12-2.81) Knowledge of Medicare pay for screening AD - 19% less likely (OR 0.81; 0.70-0.94) Agrawal et al, 2022 Predictors of poor bowel preparations and colonoscopy cancellations in inpatient colonoscopies, a single center retrospective study 1029 Factors associated with colonoscopy cancellation Graduate level education (OR 1.41) 0.05 Graduate level education, Hispanic ethnicity, Hgb <10 is associated with colonoscopy cancellation. Study found dementia, gastroparesis, and inpatient opioid use to be associated with poor bowel prep. Hispanic ethnicity (OR 0.47) <0.01 Hemoglobin <10 g/dL (OR 1.41) 0.05 Factors associated with poor bowel preparation Dementia (OR 2.44) 0.02 Gastroparesis (OR 3.98) 0.01 Inpatient opioid use (OR 1.69) 0.04 Yang et al, 2021 The association between cognitive impairment and breast and colorectal cancer screening utilization 24782 Percentage of colonoscopy use in cognitively impaired vs. unimpaired 60.3% unimpaired vs. 61.8% impaired (2018) 0.436 In regression analysis, cognitively impaired men were less likely to have had a recent colonoscopy. 57.8% unimpaired vs. 58.3% impaired (2019) 0.918 Likelihood of colonoscopy screening in men Mild cognitive impairment: OR 0.79 <0.001 Severe cognitive impairment: OR 0.69 0.038 Yee et al, 2015 Predictors of an inadequate bowel preparation 2101 Factors predictive of inadequate preparation Stroke/dementia: OR 3.5; 95% CI 1.6-7.7 0.002 Opioids: OR 2.3; 1.1-4.6 0.02 Male sex: OR 2.0; 1.4-2.9 0 Calcium channel blocker: OR 1.9; 1.1-3.3 0.03 Antidepressants: OR 1.7; 1.1-2.7 0.02 Iida et al, 2018 Efficacy/safety of endoscopic procedures for CBD in > 85y 235 Incidence of complication rate in patients 85 y had significantly higher rates of dementia, but insignificant. Endoscopic procedures for CBD stones is safe and effective. Murata et al, 2015 Effect of dementia on outcomes of patients with hemorrhagic PUD 14569 In-hospital mortality within 30 days OR 1.00; 95% CI 0.68-1.46 0.986 Mortality rates were similar but increased LOS and medical costs in patients with dementia. Overall mortality 1.02; 0.74-1.41 0.877 LOS Unstandardized coefficient 3.12 days; 1.58-4.67 <0.001 Medical costs Unstandardized coefficient 1171.7 US dollars; 533.8-1809.5 <0.001 Kitagawa et al, 2021 Efficacy/safety between palliative EBS and duct clearance among elderly patients with choledocholithiasis 50 Cholangitis-free period Complete stone removal had longer duration than EBS. <0.01 Complete stone removal led to greater duration of cholangitis-free period compared to EBS. Mortality rate and procedure-related adverse events between the two groups were similar. Mortality rate 3 (12%) in EBS vs. 2 (8%) complete stone removal 1 Procedure-related adverse events 16% in EBS vs. 8% in complete stone removal 0.67 Gandhi et al, 2018 Characteristics associated with quality of bowel preparation 75818 Factors associated with inadequate bowel preparation Age: OR 1.14; 1.07-1.21 0.001 Age, male sex, low education, and comorbidities of diabetes, hypertension, stroke/dementia, and opioid use found to be significantly associated with inadequate bowel preparation. Male sex: OR 1.23; 1.12-1.28 0.001 Low education: OR 1.49; 1.27-1.45 0.001 Stroke/dementia: OR 2.09; 1.56-2.81 0.001 Opioids: OR 1.70; 1.39-2.07 0.001 CRC: colorectal cancer; AD: Alzheimer’s Dementia; CBD: common bile duct; PUD: peptic ulcer disease; LOS: length of stay; EBS: endoscopic biliary stent. Discussion Utilizing the NIS database, we found 55,015 inpatient colonoscopies were performed in elderly patients over the age of 60 years, 4,323 of which in dementia patients. Compared to those without dementia, those with dementia receiving colonoscopy were overall older by an average of 7 years, had a higher percentage of females, had proportionately less Whites, were significantly less likely to be obese, less likely to have private insurance, and more likely to receive the procedure emergently. Black patients who have dementia are more likely to receive a colonoscopy than those Black patients without dementia. We found the number of complications from colonoscopy were similar in patients with and without dementia; however, we did note that other non-procedural related complications were higher in those with dementia. Outcomes analysis also indicated that dementia patients also had worse LOS, charges, and discharge disposition. 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. Indeed, it is also possible that in such scenarios, the gastroenterologist is faced with the decision to perform the procedure on these patients versus not, and it seems that gastroenterologists in certain cases were more likely to opt for or recommend colonoscopy. For instance, we hypothesize that Black patients without dementia were more likely to decline colonoscopy (as they are likely the primary decision maker) due to certain biases or feelings about the procedure. Similarly, females with dementia probably have the same scenario when it comes to proper informed consent with their next of kin deciding on their behalf to consent for a colonoscopy procedure, as we find a smaller percentage among them without dementia undergoing colonoscopy. Again, the proceduralist/endoscopist decision-making process and/or their biases along with it, should be taken into consideration when assessing these findings. The impact of obesity on receiving a colonoscopy is also demonstrated in our study. It is indicative that it influences decision-making by the gastroenterologist whether to perform the procedure or not, with obese patients without dementia being more favored to receive the procedure than those with obesity and dementia. This suggests that increasing comorbidities is a further hinderance on gastroenterologists to perform the procedure. At the same time, it potentially indicates patient preference with more obese patients without dementia opting for colonoscopy. Findings on the effects of insurance status on colonoscopy utilization is indicative that dementia patients are more likely to get an index colonoscopy during hospitalization if they were on Medicare rather than private insurance when compared to their non-dementia counterparts. The cause for this is likely multifactorial; again, patient factors and physician factors are likely at play including decision making by both parties, personal biases, and insurance reimbursement considerations. In terms of specific complications related to colonoscopy, dementia patients did not incur an increased risk of colonic perforation, post-colonoscopy bleeding, or splenic injury, suggesting that this comorbidity doesn’t result in altered colon anatomy that may put them at risk of such complications. From an endoscopist perspective, it also suggests that performing a colonoscopy on dementia patients will not put them at a higher risk of procedure-related complications as may occur with other comorbidities. However, other more general complications such as CVA, pneumonia, sepsis, and AKI did occur at a higher rate among the dementia group indicating that proceeding with a colonoscopy in patients with this comorbidity should be done with caution. The overall picture of the patient’s pre-procedure clinical status should be considered including indication of the procedure, patient mental status, other comorbidities, laboratory and imaging findings, and social situation. We also report significant outcomes with regards to discharge disposition, LOS, and hospitalization charges. All of these latter outcomes were significantly worse (i.e. less routine discharge, higher LOS, and higher charges) among patients with dementia. This goes along with other previous studies that reported on dementia patients and its association with a poor prognosis during hospitalization, procedure utilization, and surgical operations. While we find that mortality rate is the same between our comparisons, we are unable to report on longer term mortality rate following discharge, as this data is not available. We hypothesize that since approximately there was a 2:1 ratio of dementia versus nondementia patients to have a non-routine discharge (i.e. not to home, and rather to acute rehab facility, skilled nursing facility, etc.), there is a high likelihood that more patients died at outside facilities shortly after the index hospitalization, implying a likely higher mortality among dementia patient than we find in our study. However, other previous studies have reported a similar trend in which there is greater rates of complications, longer lengths of stay, less likelihood of home discharge, and higher medical costs in dementia patients while the mortality rate is insignificant comparatively [ 14 , 22 ]. Others also corroborated our findings in terms of procedure urgency with a higher likelihood of emergent/urgent procedures performed on dementia patients [ 13 ]. Our data also suggests disparities based on insurance status, type of hospital, and geography. The finding that patients with private insurance are more likely to have a routine discharge is puzzling and is likely to be multifactorial in nature. Private insurance patients could possibly encounter more difficulties in obtaining authorization to be placed at skilled nursing facilities or acute rehab institutions and more likely settle on being taken care of at home with family members. Also possible, family members of such patients are more likely to provide support to them when compared to patients on Medicare or Medicaid. These patients may have been more likely to refuse placement at such long-terms facilities and opted to be discharged home as well. Similar explanations could also account for the higher length of stay in elderly patients on Medicaid. Likely due to less resources and manpower, rural hospitals incurred less charges when compared to teaching hospitals, which have more resources, more likely to be located in urban areas, and more likely to spend on areas such as medical care. Finally, the disparities found based on geography are quite puzzling; these findings should be further investigated in future retrospective or prospective studies. Other recent studies have also suggested that dementia patients undergoing procedures have worse outcomes when compared to non-dementia patients. One example of this is demonstrated by Shah et al. when evaluating outcomes after vascular surgery [ 13 ]. Their study found dementia patients to have higher likelihood of 30 and 90-day mortality, longer hospital LOS, and lower likelihood of discharge to home. Similar results in terms of LOS and hospital discharge have also been found in dementia patients undergoing spine fusion [ 14 ]. A study by Beydoun et al. evaluated trends in hospitalized Alzheimer’s dementia patients among a variety of commonly performed procedures. Notably, in patients undergoing respiratory or GI procedures, grouped together in their analysis, they report increased cost of hospital stay, increased length of stay, and higher mortality risk [ 11 ]. Although colonoscopy is generally considered a minor and safe procedure, patient safety and procedure benefit must still be assessed. Two major factors to consider are ability to tolerate bowel prep and risk for adverse outcomes or complications. In the dementia population, there is a paucity of evidence regarding the safety profile of these patients when undergoing colonoscopy. Inadequate bowel preparation can result in colonoscopy cancellation or lead to prolonged procedure time, increased risk for complications, and suboptimal visualization. Several studies demonstrate dementia as being one of the strongest associations of predictors of inadequate bowel preparation for colonoscopy [ 18 – 19 , 24 ]. Patients with cognitive impairment may have significant barriers to completing a bowel preparation regimen, including impaired ability to swallow and intolerance of the large volume of fluid. Given these challenges, some suggest strategies including clear liquids or low-residue diet in the days prior to procedure or even direct administration of preparation through esophagogastroduodenoscope or nasogastric tube [ 25 ]. Proper evaluation and consideration of patient fit for colonoscopy is very important, especially given recent population-level and epidemiologic data. In a recent study by Lv and colleagues, colorectal cancer screening utilization in older adults increased from 86.4–88.96% from 2015 to 2018; however, those with Alzheimer’s or other related dementias were significantly less likely to undergo screening [ 5 ]. On the other hand, a recent study evaluated utilization of colonoscopy during 2018–2019 in screening-eligible patients and found no statistically significant difference in utilization rate between those with cognitive impairment and those without [ 23 ]. As colonoscopy is performed more frequently in older patients and in patients with dementia, a comprehensive understanding of patient safety and benefit must be established. The limitations of this study include inability to assess symptoms, medications, labs, long term follow up, or readmissions. The coding used to identify patients with dementia may underestimate or overestimate the prevalence of dementia. Along the same lines, coding errors may and do occur. Importantly, the severity of dementia is unable to be defined or evaluated in this study. In addition, this study may not be generalizable to younger patients with dementia. In this national inpatient study, we found elderly dementia patients receiving colonoscopy have similar colonoscopy related complications as patients without dementia. However, patients with dementia do have higher complications in general (renal, pulmonary, etc.). Major outcomes such as discharge disposition, LOS, and hospital costs were also worse in dementia cohort. We also report on significant interesting findings and implications on demographic, socioeconomic, and hospital level characteristics among dementia patients undergoing colonoscopy. As now more than ever gastroenterologists face the challenges of performing procedures on the elderly dementia population, 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. Future investigations in this area are required given limited data available on this specific patient population, particularly with regards to long term clinical outcomes. Declarations Author Contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Faris Shweikeh and Gordon Hong. The first draft of the manuscript was written by Faris Shweikeh and Gordon Hong and all authors commented on previous versions of the manuscript. Primary conception and design: Faris Shweikeh. Acquisition of Data: Faris Shweikeh and Gordon Hong. Analysis and Interpretation of Data: All authors. Critically revising the article: Anthony Lembo, Matthew Hoscheit, Mohamad Mouchli, and Kathleen Rogers. All authors read and approved the final version of the manuscript. This manuscript has not been published elsewhere in any language, nor is it under consideration for publication by another journal. The authors declare that this research is performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its subsequent amendments. Institutional Review Board (IRB) approval was obtained through the Cleveland Clinic IRB review board, and it was approved with an exempt status. The authors declare that there are no conflicts of interest with regards to the publication of this article. The authors acknowledge that there isn’t any grants or financial support to declare with regards to publication of this manuscript. Results of this study were presented in abstract form at the 2023 Ohio Gastroenterology Society Annual Meeting in Columbus, OH, USA on September 9 th , 2023. References Gale SA, Acar D, Daffner KR. Dementia. Am J Med. 2018;131(10):1161–1169. Anderson TS, Marcantonio ER, McCarthy EP, Herzig SJ. National Trends in Potentially Preventable Hospitalizations of Older Adults with Dementia. J Am Geriatr Soc. 2020;68(10):2240–2248. Olaiya B, Adler DG. Adverse Events After Inpatient Colonoscopy in Octogenarians: Results From the National Inpatient Sample (1998–2013). J Clin Gastroenterol. 2020;54(9):813–818. Arias F, Riverso M, Levy SA, et al. Pilot Study: Neurocognitive Disorders and Colonoscopy in Older Adults. Anesth Analg. 2019;129(3):e89-e93. Lv G, Wang X, Jiang X, Li M, Lu K. Impact of Alzheimer's disease and related dementias on colorectal cancer screening utilization, knowledge, and associated health disparities. Front Pharmacol. 2022;13:872702. Ijaz SH, Minhas AMK, Ghoneem A, et al. Association of dementia with in-hospital outcomes in primary heart failure and acute myocardial infarction hospitalizations. Prog Cardiovasc Dis. 2022;73:24–31. Baral N, Mitchell JD, Aggarwal NT, et al. Sex-based disparities and in-hospital outcomes of patients hospitalized with atrial fibrillation with and without dementia. American Heart Journal Plus: Cardiology Research and Practice. 2023;26:100266. Lin RY, Scanlan BC, Liao W, Nguyen TP. Disproportionate effects of dementia on hospital discharge disposition in common hospitalization categories. J Hosp Med. 2015;10(9):586–591. Alshekhlee A, Li CC, Chuang SY, et al. Does dementia increase risk of thrombolysis?: a case-control study. Neurology. 2011;76(18):1575–80. Beydoun MA, Gamaldo AA, Beydoun HA, et al. Trends, Predictors, and Outcomes of Healthcare Resources Used in Patients Hospitalized with Alzheimer's Disease with at Least One Procedure: The Nationwide Inpatient Sample. J Alzheimers Dis. 2017;57(3):813–824. Gupta A, McKeever TM, Hutchinson JP, Bolton CE. Impact of Coexisting Dementia on Inpatient Outcomes for Patients Admitted with a COPD Exacerbation. Int J Chron Obstruct Pulmon Dis. 2022;17:535–544. Lagu T, Zilberberg MD, Tjia J, et al. Dementia and Outcomes of Mechanical Ventilation. J Am Geriatr Soc. 2016;64(10):e63-e66. Shah SK, Jin G, Reich AJ, at al. Dementia is associated with increased mortality and poor patient-centered outcomes after vascular surgery. J Vasc Surg. 2020;71(5):1685–1690.e2. Sharma M, Dietz N, Scott V, Wang D, Ugiliweneza B, Boakye M. Trends and Outcomes in Patients with Dementia Undergoing Spine Fusions: A Matched Nationwide Inpatient Sample Analysis. World Neurosurg. 2023;169:e164-e170. Sherzai A, Ovbiagele B, Sherzai D. Time Trends and Characteristics of Prevalent Dementia among Patients Hospitalized for Stroke in the United States. J Stroke Cerebrovasc Dis. 2018;27(6):1447–1457. Sherzai D, Losey T, Vega S, Sherzai A. Seizures and dementia in the elderly: Nationwide Inpatient Sample 1999–2008. Epilepsy Behav. 2014;36:53–6. Sherzai D, Sherzai A, Lui K, et al. The Association Between Diabetes and Dementia Among Elderly Individuals: A Nationwide Inpatient Sample Analysis. J Geriatr Psychiatry Neurol. 2016;29(3):120–5. Agrawal R, Majeed M, Attar BM, et al. Predictors of poor bowel preparations and colonoscopy cancellations in inpatient colonoscopies, a single center retrospective study. Transl Gastroenterol Hepatol. 2022;7:4. Gandhi K, Tofani C, Sokach C, et al. Patient Characteristics Associated With Quality of Colonoscopy Preparation: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2018;16(3):357–369.e10. Iida T, Kaneto H, Wagatsuma K, et al. Efficacy and safety of endoscopic procedures for common bile duct stones in patients aged 85 years or older: A retrospective study. PLoS One. 2018;13(1):e0190665. Kitagawa K, Mitoro A, Ozutsumi T, et al. Comparison of the efficacy and safety between palliative biliary stent placement and duct clearance among elderly patients with choledocholithiasis: a propensity score-matched analysis. BMC Gastroenterol. 2021;21(1):369. Murata A, Mayumi T, Muramatsu K, Ohtani M, Matsuda S. Effect of dementia on outcomes of elderly patients with hemorrhagic peptic ulcer disease based on a national administrative database. Aging Clin Exp Res. 2015;27(5):717–25. Yang S, Bian J, George TJ, et al. The association between cognitive impairment and breast and colorectal cancer screening utilization. BMC Cancer. 2021;21(1):539. Yee R, Manoharan S, Hall C, Hayashi A. Optimizing bowel preparation for colonoscopy: what are the predictors of an inadequate preparation? Am J Surg. 2015;209(5):787–92 Lim YJ, Hong SJ. What is the best strategy for successful bowel preparation under special conditions?. World J Gastroenterol. 2014;20(11):2741–2745. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 25 Mar, 2024 Read the published version in Digestive Diseases and Sciences → Version 1 posted Editorial decision: Revision requested 08 Feb, 2024 Reviews received at journal 08 Feb, 2024 Reviewers agreed at journal 29 Jan, 2024 Reviewers invited by journal 24 Jan, 2024 Editor assigned by journal 22 Jan, 2024 Submission checks completed at journal 18 Jan, 2024 First submitted to journal 17 Jan, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3874007","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":267862007,"identity":"7a64c522-3ab5-41a6-aa66-052d58672114","order_by":0,"name":"Faris Shweikeh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvUlEQVRIiWNgGAWjYDACCSBOOCAnx8DA+IAkLcbGDAzMBiRoYThgnNhAtBb52T2GDx6cMUjvbz/MwPBxTy1hLQZ3zhgbJNwwyJ1xJpmBccaz40RokcjdJpHw4U/uBgn+A8w8B44R4bAZudt/JHwwSDeQYGYgTgvDjdxtDECHJUC11BDhsBv5nyUSzhgYgvxycMaBA8Q4LC3x449jBvL87YcZH3w4UEeEw5AB0IrDJGoBAlJtGQWjYBSMgpEAALmYPe9yWcvdAAAAAElFTkSuQmCC","orcid":"","institution":"Cleveland Clinic Akron General","correspondingAuthor":true,"prefix":"","firstName":"Faris","middleName":"","lastName":"Shweikeh","suffix":""},{"id":267862008,"identity":"832b1d85-8eae-4cf9-b015-8c8174f732bc","order_by":1,"name":"Gordon Hong","email":"","orcid":"","institution":"University Hospitals Cleveland Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Gordon","middleName":"","lastName":"Hong","suffix":""},{"id":267862009,"identity":"fbee7913-883f-4381-9959-fdb4c9fe52c4","order_by":2,"name":"Kathleen Rogers","email":"","orcid":"","institution":"Cleveland Clinic Akron General","correspondingAuthor":false,"prefix":"","firstName":"Kathleen","middleName":"","lastName":"Rogers","suffix":""},{"id":267862010,"identity":"65ebf002-1bfe-46ee-9d80-a523f8c9926f","order_by":3,"name":"Mohamad Mouchli","email":"","orcid":"","institution":"Cleveland Clinic","correspondingAuthor":false,"prefix":"","firstName":"Mohamad","middleName":"","lastName":"Mouchli","suffix":""},{"id":267862011,"identity":"4bb6982a-f6f0-4508-bc52-6ed463a14861","order_by":4,"name":"Matthew Hoscheit","email":"","orcid":"","institution":"Cleveland Clinic","correspondingAuthor":false,"prefix":"","firstName":"Matthew","middleName":"","lastName":"Hoscheit","suffix":""},{"id":267862012,"identity":"61a2b86e-0280-4b97-b43a-4dcbed9e8a67","order_by":5,"name":"Anthony Lembo","email":"","orcid":"","institution":"Cleveland Clinic","correspondingAuthor":false,"prefix":"","firstName":"Anthony","middleName":"","lastName":"Lembo","suffix":""}],"badges":[],"createdAt":"2024-01-17 23:05:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3874007/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3874007/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10620-024-08363-3","type":"published","date":"2024-03-25T15:00:47+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":53869481,"identity":"b1d85665-e96b-49c4-9e91-cd289584abe5","added_by":"auto","created_at":"2024-04-01 15:09:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":658744,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3874007/v1/d4e42a49-e0e0-46d6-81c8-5c29345793cb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Colonoscopy Utilization in Elderly Dementia Patients: Characteristics, Complications, and Charges in a National Matched-Cohort Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eColonoscopy is a common procedure used both diagnostically for colon cancer screening as well as therapeutically for acute gastrointestinal bleeding. Though generally considered safe, as with any invasive procedure, complications of bowel preparation, the procedure itself, and the sedation do occur and are all increased in older patients. Therefore, patient selection is particularly important taking into account potential benefits, risk factors and patient preference.\u003c/p\u003e \u003cp\u003eDementia describes a clinical syndrome that includes cognitive decline with resulting reduction in functional status. Specific pathologies include Alzheimer\u0026rsquo;s disease, Lewy Body and vascular dementia. Manifestations and outcomes vary depending on the diagnosis and dementia patients can represent a challenging patient population [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Hospitalized elderly patients with dementia have higher financial burden than those without dementia [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. As hospital charges soar in this population, it becomes even more prudent to investigate the clinical tendencies, outcomes, and predictors of various procedures for inpatients. For common gastroenterology procedures, besides the direct risks of the procedure itself and the associated anesthesia, risks can go beyond that in the dementia population. With regards to colonoscopy specifically, previous research has shown that dementia is associated with less likelihood to utilize colorectal cancer screening, less likelihood to know that Medicare covers it, missed colonoscopy appointments, and suboptimal bowl preparation [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious studies in hospitalized patients with dementia have generally demonstrated worse outcomes. In a study by Ijaz et al., dementia patients admitted for heart failure or acute myocardial infarction were found to have significantly higher inpatient mortality and longer hospital lengths of stay (LOS) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Similarly, Baral et al. found that patients with atrial fibrillation and dementia had greater risk of in-hospital mortality while also lower likelihood of undergoing cardiac procedures [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In regard to discharge disposition, patients with dementia also appear to fare worse. Lin et al. utilized a national database to evaluate for several common admission diagnoses and found dementia patients with enteritis, gastrointestinal (GI) bleed, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), pneumonia, and arrhythmia were less likely to be discharged to home [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Gastrointestinal bleeding patients specifically had an 82% reduction in likelihood in home discharge (aOR 0.18, 95% CI 0.18\u0026ndash;0.19). This is compounded by the fact that the elderly and those with dementia face an increased risk of both upper and lower gastrointestinal disorders [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith increasing age of the population gastroenterologists increasingly face the challenges of performing procedures in patients with dementia [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In this study, we evaluate the outcomes of patients diagnosed with dementia undergoing colonoscopy in the inpatient setting utilizing the National Inpatient Sample (NIS), the largest all-payer database of in-patient care publicly available in the United States. We hypothesize that patients with dementia will serve as a challenge for the gastroenterologist performing this procedure because of higher likelihood of worse clinical outcomes. We will identify a potential problem in elderly patients and find ways towards better outcomes in this population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study utilized the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) during the year 2019. \u0026nbsp; This database is sponsored by the Agency for Healthcare Research and Quality (AHQR). \u0026nbsp;The NIS is the largest all-payer database of hospitalized patients in the United States with a large sample size allowing ideal analysis of association and comparisons between various conditions and procedures. \u0026nbsp;This study was approved by the Cleveland Clinic Institutional Review Board (IRB) as an exempted study.\u003c/p\u003e\n\u003cp\u003ePatients aged \u0026gt; 60 years who had received a colonoscopy identified via International Classification of Diseases, tenth edition, clinical modification (ICD-10-CM) procedure codes were included in the study. \u0026nbsp;The following ICD-10-CM codes were used for colonoscopy: 0DJD8ZZ, 0DJD3ZZ, 0DJD4ZZ, 0DJD7ZZ, 0DJD8ZZ, 0DBE8ZX, 0DBF8ZX, 0DBG8ZX, 0DBH8ZX, 0DBK8ZX, 0DBL8ZX, 0DBM8ZX, and 0DBN8ZX. Presence of dementia as a comorbidity (along with other identifiable comorbidities) were identified using Elixhauser Comorbidity Software administered by AHRQ. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatient and hospital characteristics were collected for each hospitalization. \u0026nbsp; Hospitalizations records were divided into 2 groups: elderly patients (i.e.\u0026gt; 60 years) \u003cu\u003ewithout\u003c/u\u003e dementia and elderly patients \u003cu\u003ewith\u003c/u\u003e dementia. Demographic and clinical data were compared between the 2 groups. Factors and variables analyzed included sex, race, type of insurance coverage, hospital type, discharge disposition, length of stay, mortality, and comorbidities (see Tables 1-4).\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eDemographics and matching among elderly patients receiving colonoscopy with and without dementia.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"672\" style=\"margin-right: calc(1%); width: 99%;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;60yo, received colonoscopy, \u003cu\u003eWithout\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDementia\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=50,692)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026gt;60, received colonoscopy, With Dementia (N=4323)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBefore matching\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWith\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDementia\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMatched\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=4176)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eWithout\u003c/u\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Dementia\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMatched\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=4176)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.928571428571429%\" valign=\"top\" style=\"width: 23.8886%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD after matching\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex, Females,\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e27341 (53.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e2575 (59.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e2492 (59.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e2492 (59.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.928571428571429%\" valign=\"top\" style=\"width: 23.8886%;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, years Mean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e73.69 (8.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e80.08 (7.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e0.794\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e80.13 (7.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e80.23 (7.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.928571428571429%\" valign=\"top\" style=\"width: 23.8886%;\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003cp\u003eBlack\u003c/p\u003e\n \u003cp\u003eHispanic\u003c/p\u003e\n \u003cp\u003eAsian/Pacific Islander\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e36088 (72.66)\u003c/p\u003e\n \u003cp\u003e6966 (14.03)\u003c/p\u003e\n \u003cp\u003e3901 (7.85)\u003c/p\u003e\n \u003cp\u003e1337 (2.69)\u003c/p\u003e\n \u003cp\u003e1376 (2.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2848 (67.12)\u003c/p\u003e\n \u003cp\u003e777 (18.31)\u003c/p\u003e\n \u003cp\u003e383 (9.03)\u003c/p\u003e\n \u003cp\u003e122 (2.88)\u003c/p\u003e\n \u003cp\u003e113 (2.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.115\u003c/p\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2802 (67.10)\u003c/p\u003e\n \u003cp\u003e760 (18.20)\u003c/p\u003e\n \u003cp\u003e381 (9.12)\u003c/p\u003e\n \u003cp\u003e121 (2.90)\u003c/p\u003e\n \u003cp\u003e112 (2.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2899 (69.42)\u003c/p\u003e\n \u003cp\u003e709 (16.98)\u003c/p\u003e\n \u003cp\u003e349 (8.36)\u003c/p\u003e\n \u003cp\u003e126 (3.02)\u003c/p\u003e\n \u003cp\u003e93 (2.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.928571428571429%\" valign=\"top\" style=\"width: 23.8886%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.050\u003c/p\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"75%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e17731 (34.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e1580 (36.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e0.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e1521 (36.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e1463 (35.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.928571428571429%\" valign=\"top\" style=\"width: 23.8886%;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e38857 (76.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e3564 (82.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e3448 (82.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e3489 (83.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.928571428571429%\" valign=\"top\" style=\"width: 23.8886%;\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003ePulmonary disease\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e12805 (25.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e1047 (24.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e1020 (24.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e995 (23.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.928571428571429%\" valign=\"top\" style=\"width: 23.8886%;\"\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eObesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e8414 (16.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e399 (9.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e0.221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e383 (9.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e370 (8.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.928571428571429%\" valign=\"top\" style=\"width: 23.8886%;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e6236 (12.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e815 (18.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e0.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e784 (18.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e717 (17.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.928571428571429%\" valign=\"top\" style=\"width: 23.8886%;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003eAlcohol abuse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e1940 (3.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e110 (2.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e107 (2.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e99 (2.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.928571428571429%\" valign=\"top\" style=\"width: 23.8886%;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUrgency\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eElective\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNon-elective/Emergent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6233 (12.31)\u003c/p\u003e\n \u003cp\u003e44413 (87.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e199 (4.61)\u003c/p\u003e\n \u003cp\u003e4121 (95.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.279\u003c/p\u003e\n \u003cp\u003e0.279\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e186 (4.45)\u003c/p\u003e\n \u003cp\u003e3990 (95.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e160 (3.83)\u003c/p\u003e\n \u003cp\u003e4016 (96.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.928571428571429%\" valign=\"top\" style=\"width: 23.8886%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome quartiles\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e1 \u0026ndash; 47,999\u003c/p\u003e\n \u003cp\u003e48,000 \u0026ndash; 60,999\u003c/p\u003e\n \u003cp\u003e61,000 \u0026ndash; 81,999\u003c/p\u003e\n \u003cp\u003e82,000+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14217 (28.47)\u003c/p\u003e\n \u003cp\u003e12701 (25.43)\u003c/p\u003e\n \u003cp\u003e12511 (25.05)\u003c/p\u003e\n \u003cp\u003e10507 (21.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1317 (30.91)\u003c/p\u003e\n \u003cp\u003e1062 (24.92)\u003c/p\u003e\n \u003cp\u003e1032 (24.22)\u003c/p\u003e\n \u003cp\u003e850 (19.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1287 (30.82)\u003c/p\u003e\n \u003cp\u003e1039 (24.88)\u003c/p\u003e\n \u003cp\u003e1010 (24.19)\u003c/p\u003e\n \u003cp\u003e840 (20.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1288 (30.84)\u003c/p\u003e\n \u003cp\u003e1067 (25.55)\u003c/p\u003e\n \u003cp\u003e1027 (24.59)\u003c/p\u003e\n \u003cp\u003e794 (19.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.928571428571429%\" valign=\"top\" style=\"width: 23.8886%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion of Hospital\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNortheast\u003c/p\u003e\n \u003cp\u003eMidwest\u003c/p\u003e\n \u003cp\u003eSouth\u003c/p\u003e\n \u003cp\u003eWest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9871 (19.47)\u003c/p\u003e\n \u003cp\u003e12120 (23.91)\u003c/p\u003e\n \u003cp\u003e19339 (38.15)\u003c/p\u003e\n \u003cp\u003e9362 (18.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e745 (17.23)\u003c/p\u003e\n \u003cp\u003e1031 (23.85)\u003c/p\u003e\n \u003cp\u003e1781 (41.20)\u003c/p\u003e\n \u003cp\u003e766 (17.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e732 (17.53)\u003c/p\u003e\n \u003cp\u003e992 (23.75)\u003c/p\u003e\n \u003cp\u003e1712 (41.00)\u003c/p\u003e\n \u003cp\u003e740 (17.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e690 (16.52)\u003c/p\u003e\n \u003cp\u003e1002 (23.99)\u003c/p\u003e\n \u003cp\u003e1733 (41.50)\u003c/p\u003e\n \u003cp\u003e751 (17.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.928571428571429%\" valign=\"top\" style=\"width: 23.8886%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital Location and Teaching Status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003cp\u003eUrban non-teaching\u003c/p\u003e\n \u003cp\u003eUrban teaching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e3826 (7.55)\u003c/p\u003e\n \u003cp\u003e9584 (18.91)\u003c/p\u003e\n \u003cp\u003e37282 (73.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e301 (6.96)\u003c/p\u003e\n \u003cp\u003e989 (22.88)\u003c/p\u003e\n \u003cp\u003e3033 (70.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e294 (7.04)\u003c/p\u003e\n \u003cp\u003e958 (22.94)\u003c/p\u003e\n \u003cp\u003e2924 (70.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e283 (6.78)\u003c/p\u003e\n \u003cp\u003e948 (22.70)\u003c/p\u003e\n \u003cp\u003e2945 (70.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.928571428571429%\" valign=\"top\" style=\"width: 23.8886%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBed size\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003cp\u003eLarge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10490 (20.69)\u003c/p\u003e\n \u003cp\u003e15209 (30.00)\u003c/p\u003e\n \u003cp\u003e24993 (49.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e917 (21.21)\u003c/p\u003e\n \u003cp\u003e1388 (32.11)\u003c/p\u003e\n \u003cp\u003e2018 (46.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e868 (20.79)\u003c/p\u003e\n \u003cp\u003e1355 (32.45)\u003c/p\u003e\n \u003cp\u003e1953 (46.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e879 (21.05)\u003c/p\u003e\n \u003cp\u003e1335 (31.97)\u003c/p\u003e\n \u003cp\u003e1962 (46.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.928571428571429%\" valign=\"top\" style=\"width: 23.8886%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePayer/Insurance Status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMedicare\u003c/p\u003e\n \u003cp\u003eMedicaid\u003c/p\u003e\n \u003cp\u003ePrivate insurance\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e39977 (78.92)\u003c/p\u003e\n \u003cp\u003e2186 (4.32)\u003c/p\u003e\n \u003cp\u003e6911 (13.64)\u003c/p\u003e\n \u003cp\u003e1582 (3.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.178571428571429%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e3940 (91.20)\u003c/p\u003e\n \u003cp\u003e116 (2.69)\u003c/p\u003e\n \u003cp\u003e207 (4.79)\u003c/p\u003e\n \u003cp\u003e57 (1.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.142857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.349\u003c/p\u003e\n \u003cp\u003e0.089\u003c/p\u003e\n \u003cp\u003e0.310\u003c/p\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e3812 (91.28)\u003c/p\u003e\n \u003cp\u003e110 (2.63)\u003c/p\u003e\n \u003cp\u003e202 (4.84)\u003c/p\u003e\n \u003cp\u003e52 (1.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.285714285714286%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e3887 (93.08)\u003c/p\u003e\n \u003cp\u003e94 (2.25)\u003c/p\u003e\n \u003cp\u003e153 (3.66)\u003c/p\u003e\n \u003cp\u003e42 (1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.928571428571429%\" valign=\"top\" style=\"width: 23.8886%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: Percentages do not reflect missing values. Statistics presented as n (%) unless otherwise indicated in the table. SD = Standardized differences. Standardized difference \u0026lt;0.1 represents covariate balance.\u003c/p\u003e\n\u003cp\u003eNote: Percentages do not reflect missing values. Statistics presented as n (%) unless otherwise indicated in the table. SD = Standardized differences. Standardized difference \u0026lt;0.1 represents covariate balance.\u003c/p\u003e\n\u003cp\u003eCategorical variables are described by frequencies and percentages. Continuous measures are described by means and standard deviations or medians and interquartile range as appropriate depending on their distribution. \u0026nbsp;In terms of group matching, Propensity Score Matching was used to correct for effects of the uneven features of the clinical outcomes between those with dementia versus without dementia. Greedy one-to-one matching was used where each patient in the dementia group was matched to a patient in the nondementia group with the closest propensity score. Standardized differences were used to assess the balance of characteristics after matching, standardized difference less than 0.1 was considered to represent covariate balance. To compare outcomes between matched groups, dependent sample statistical methods were used: McNemar test for categorical variables and a signed rank sum test or paired t-tests for continuous variables. \u0026nbsp;Multivariable regression analyses were used to assess the effect of patient factors \u0026ndash;age, sex, race/ethnicity, hospital region, and status on length of stay, type of discharge and hospital charges. All tests were 2-sided. A P \u0026lt; 0.05 was considered statistically significant. Analyses were performed using SAS Software (Version 9.4, Cary, NC).\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 55,015 elderly patients over the age of 60 years who underwent colonoscopy in 2019 were included. From these, 4,323 had a diagnosis of dementia and 50,692 did not have a diagnosis of dementia (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean age of the dementia cohort was 80.08 years and those without dementia was 73.69 years.\u003c/p\u003e \u003cp\u003eFemales made up 59.6% of those \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ewith\u003c/span\u003e dementia and 53.9% of those \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ewithout\u003c/span\u003e dementia. Whites made up 67.1% of those with dementia and 72.6% of those without dementia. Blacks with dementia were more likely to receive a colonoscopy than those without (18.3% vs. 14.3%). Obese patients with dementia (9.23%) had a lower percentage of colonoscopy versus those without dementia (16.6%). In terms of urgency of the procedure, those with dementia (95.39%) were more likely to have received a colonoscopy on an emergent basis than those without dementia (87.7%); conversely, there was a higher likelihood of receiving a colonoscopy on an elective basis in those without dementia (12.3% vs 4.61%). There was a lower likelihood for those with private insurance and with dementia (4.8%) to receive colonoscopy compared to those without dementia (13.6%) and same insurance. Correspondingly, a patient who is on Medicare and has dementia (91.2%) is more likely to get a colonoscopy than a patient without dementia on Medicare (78.9%).\u003c/p\u003e \u003cp\u003eIn our cohort of elderly patients aged over 60 years, colonoscopy-related complications \u0026ndash; colon perforations, bleeding, and splenic injury \u0026ndash; occurred at about the same rate in the dementia versus the non-dementia comparison (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Non-procedure related complications, however, were more common in patients with dementia compared to those without dementia including renal and/or acute kidney injury, pulmonary and/or pneumonia, cerebrovascular accident (CVA), and sepsis (all with significant p-values, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComplications in patients age\u0026thinsp;\u0026gt;\u0026thinsp;60 years receiving colonoscopy in the matched comparison.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColonoscopy- related complications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWithout Dementia (N\u0026thinsp;=\u0026thinsp;4176)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWith Dementia (N\u0026thinsp;=\u0026thinsp;4176)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColon Perforation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (0.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (0.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7928\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost colonoscopy bleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (0.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (0.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0934\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSplenic Injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e--\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplications-other\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcute kidney injury/ Renal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1139 (27.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1258 (30.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiac arrest / Cardiac\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (0.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (0.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8927\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDVT/PE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (1.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (1.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7975\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonary / Pneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e175 (4.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e247 (5.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMyocardial infarction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.4142\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebral vascular accident\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (0.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (0.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.0063\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSepsis (with or without shock)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e260 (6.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e354 (8.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eDVT: Deep venous thrombosis; PE: Pulmonary embolism. Statistics\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003epresented as n (%)\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePatients with dementia versus non-dementia groups (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e) showed a significant increase in length of stay (LOS) and hospital charges. For instance, 28.1% of those with dementia had a routine discharge while 54.7% had such a discharge in those without dementia (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Those with dementia had a prolonged LOS when compared to those without dementia (6 days vs. 5 days, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Finally, those with dementia incurred higher hospital charges with an estimated cost of \u003cspan\u003e$\u003c/span\u003e55,808 vs. \u003cspan\u003e$\u003c/span\u003e47,912 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). No significant difference in in-hospital mortality was appreciated between the groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOutcomes in Dementia vs without Dementia groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWithout Dementia (N\u0026thinsp;=\u0026thinsp;4176) (matched)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWith Dementia (N\u0026thinsp;=\u0026thinsp;4176)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRoutine Discharge, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2282 (54.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1174 (28.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLength of Stay\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.0 (3.0\u0026ndash;8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.0 (4.0\u0026ndash;9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCharges ($)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47912.5 (28784.0\u0026ndash;85628.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55808.0(33273.0\u0026ndash;100303.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplications, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1410 (33.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1606 (38.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMortality, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82 (1.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76 (1.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6310\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eStatistics presented as n (%) or median (Q1 \u0026ndash; Q3).\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOn multivariable regression, patients with dementia were 69% less likely to have had a routine discharge as compared to non-dementia patients (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e4\u003c/span\u003e also indicates that when compared with those private insurance, Medicare and Medicaid patients were less likely to have a routine discharge (30% and 33% less likely, respectively, significant 95% CI). Medicaid patients were also 23% more likely to have a longer length of stay (1.04\u0026ndash;1.42, 99% CI). Other pertinent findings included lower costs at rural hospitals (33% less vs. teaching hospitals, 0.73\u0026ndash;0.81, 95% CI), lower likelihood of routine discharge at hospitals in the Northeast region (34% less likely than West coast hospital (0.65\u0026ndash;0.89, 95% CI)), but significantly lower likelihood of lower charges, and Southern states also with significantly less hospital charges. West coast hospitals incurred significantly higher hospital charges than the Northeast, Southern, and Midwest hospitals (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTables\u0026nbsp;5 and \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e6\u003c/span\u003e summarize our literature review with regards to national studies analyzing dementia comorbidity on outcomes of various medical conditions and procedures [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] and with regards to its impacts on GI procedures specifically [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR19 CR20 CR21 CR22 CR23\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eOther Factors Determining Outcomes in Elderly patient with and without dementia (multivariate analysis).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of Stay, RR (99% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRoutine Discharge, OR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital Charges, RR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDementia: Yes vs No\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e1.09 (1.07 - 1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e0.31 (0.28 -0.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e1.07 (1.04- 1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, increasing\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e0.99 (0.98 - 0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e0.97 (0.96 - 0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e0.98 (0.98 - 0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender: F vs M\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e0.96 (0.94 - 0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e0.99 (0.91 - 1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e0.94 (0.92 - 0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRace\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Black vs White\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e1.05 (1.00 - 1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e0.94 (0.83 - 1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e1.00 (0.94 - 1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Other vs White\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e1.01 (0.96 - 1.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e1.29 (1.12 - 1.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e1.10 (1.04 - 1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInsurance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Medicare vs private\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e0.95 (0.87 - 1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e0.70 (0.56 - 0.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e1.00 (0.92 - 1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Medicaid vs private\u003c/p\u003e\n \u003cp\u003eOther vs Private\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e1.23 (1.04 - 1.42)\u003c/p\u003e\n \u003cp\u003e0.92 (0.77 - 1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e0.67 (0.46 - 0.97)\u003c/p\u003e\n \u003cp\u003e1.06 (0.65 -1.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e1.29 (1.08 - 1.53)\u003c/p\u003e\n \u003cp\u003e0.83 (0.73 - 0.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital status:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRural vs teaching\u003c/p\u003e\n \u003cp\u003eUrban non vs urban teaching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.91 (0.87 - 0.95)\u003c/p\u003e\n \u003cp\u003e0.98 (0.94 - 1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.90 (0.74 -1.08)\u003c/p\u003e\n \u003cp\u003e1.01 (0.91 -1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.77 (0.73 - 0.81)\u003c/p\u003e\n \u003cp\u003e1.09 (1.04 - 1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital Region\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Northeast vs West\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e1.09 (0.99 - 1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e0.76 (0.65 - 0.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e0.77 (0.70 - 0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;South vs West\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e1.01 (0.94 - 1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e0.92 (0.79 -1.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e0.59 (0.55 - 0.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.73076923076923%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;Midwest vs West\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e1.06 (0.98 - 1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.03846153846154%\" valign=\"top\"\u003e\n \u003cp\u003e0.94 (0.82 - 1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.115384615384617%\" valign=\"top\"\u003e\n \u003cp\u003e0.74 (0.69- 0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eRR = Relative Risk, OR = Odds Ratio, CI = Confidence Intervals\u003c/em\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"958\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 5. \u0026nbsp;Previous national studies describing the effect of dementia on clinical outcomes of various medical conditions. \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.304483837330553%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.40354535974974%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear Published\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.218978102189782%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.020855057351408%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcomes Reported\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51824817518248%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eResult (with dementia vs. without)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.152241918665276%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.38164754953076%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eConclusions/Notes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.304483837330553%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eAlshekhlee et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.40354535974974%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e2011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.218978102189782%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e621\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.020855057351408%\" valign=\"bottom\"\u003e\n \u003cp\u003eThrombolysis: Risk of ICH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51824817518248%\" valign=\"bottom\"\u003e\n \u003cp\u003e5.8% vs. 4.51%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.152241918665276%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.38164754953076%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eTotal study of 35,557 patients. N listed here (621) is only of matched patients.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eThrombolysis: Risk of mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003e17.39% vs. 14.49%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.304483837330553%\" rowspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003eLagu et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.40354535974974%\" rowspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.218978102189782%\" rowspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e497562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.020855057351408%\" valign=\"bottom\"\u003e\n \u003cp\u003eIMV: Discharge to SNF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51824817518248%\" valign=\"bottom\"\u003e\n \u003cp\u003e51% vs. 38%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.152241918665276%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.38164754953076%\" rowspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003eNoted heterogeneity of dementia patients selected for IMV (less likely to have predictors of mortality including cancer, liver disease, chronic renal failure, etc.).\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eIMV: Hospital mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003e32.5% vs. 36.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eIMV: Hospital LOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003e12.5\u0026plusmn;0.2 vs. 13.1\u0026plusmn;0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.304483837330553%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003eIjaz et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.40354535974974%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.218978102189782%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e2466369 (HF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.020855057351408%\" valign=\"bottom\"\u003e\n \u003cp\u003eHospital mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51824817518248%\" valign=\"bottom\"\u003e\n \u003cp\u003e4.7% vs. 3.1%, aOR 1.33 [1.27-1.39]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.152241918665276%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.38164754953076%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003ePatients with dementia, admitted for HF or AMI, found to have higher inpatient mortality and longer hospital LOS.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eHospital LOS (mean days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003e5.5 vs. 5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"18.95551257253385%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e1094155 (AMI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.13733075435203%\" valign=\"bottom\"\u003e\n \u003cp\u003eHospital mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.495164410058024%\" valign=\"bottom\"\u003e\n \u003cp\u003e9.9% vs. 5.9%, aOR 1.23 [1.17-1.30]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.411992263056092%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eHospital LOS (mean days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003e5.1 vs. 4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.304483837330553%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eGupta et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.40354535974974%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.218978102189782%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e576381 with COPD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.020855057351408%\" valign=\"bottom\"\u003e\n \u003cp\u003eHospital mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51824817518248%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.6% vs. 1.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.152241918665276%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.38164754953076%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eOdds of inpatient death higher in younger patients with dementia (41-64 years), higher inpatient mortality. Sub-hazard ratio indicates longer LOS for dementia patients.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eHospital LOS (sub-hazard ratio, 95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.304483837330553%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003eShah et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.40354535974974%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.218978102189782%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003e210918\u003c/p\u003e\n \u003cp\u003ewith vascular surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.020855057351408%\" valign=\"bottom\"\u003e\n \u003cp\u003e30-day mortality (OR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51824817518248%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.152241918665276%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.38164754953076%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003eDementia patients were older, had more comorbidities, and emergent/urgent cases were more frequent. Increased odds of 30- and 90-day mortality, extended SNF stay, longer LOS, less likely to be discharged home, and spent lower fraction of time at home after discharge. ICU admission and inpatient complications similar.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003e90-day mortality (OR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eHospital LOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003e8.29 vs. 5.41 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eDischarge to home (OR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.304483837330553%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003eSherzai et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.40354535974974%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.218978102189782%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003e1170051 stroke hospitalizations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.020855057351408%\" valign=\"bottom\"\u003e\n \u003cp\u003eAD in females\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51824817518248%\" valign=\"bottom\"\u003e\n \u003cp\u003eaOR 1.15 [1.11-1.19]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.152241918665276%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.38164754953076%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003eFemales, African-Americans in comparison to whites, Hispanics in comparison to whites had increased odds of Alzheimer\u0026apos;s dementia among patients hospitalized for stroke.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eAD in African-Americans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003eaOR 1.25 [1.18-1.32]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eVD in African-Americans\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003eaOR 1.51 [1.40-1.64]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eAD in Hispanics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003eaOR 1.40 [1.30-1.50]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.304483837330553%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003eSharma et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.40354535974974%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.218978102189782%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003e4495 with spine surgery (matched)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.020855057351408%\" valign=\"bottom\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51824817518248%\" valign=\"bottom\"\u003e\n \u003cp\u003e38% vs. 21%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.152241918665276%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.38164754953076%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003eGreater rate of complications, longer LOS, less likely discharge to home for dementia patients. Morality rates among dementia and non-dementia patients were similar.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eMedian LOS (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003e6 vs. 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eDischarge to home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003e19% vs. 40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eHospital mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.4% vs. 1.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.4133\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.304483837330553%\" valign=\"bottom\"\u003e\n \u003cp\u003eSherzai et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.40354535974974%\" valign=\"bottom\"\u003e\n \u003cp\u003e2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.218978102189782%\" valign=\"bottom\"\u003e\n \u003cp\u003e725527 seizures hospitalizations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.020855057351408%\" valign=\"bottom\"\u003e\n \u003cp\u003eDeveloping seizures or epilepsy in patients with AD (OR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51824817518248%\" valign=\"bottom\"\u003e\n \u003cp\u003eOR 3.07 [2.98-3.16]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.152241918665276%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.38164754953076%\" valign=\"bottom\"\u003e\n \u003cp\u003ePatients with AD had a higher prevalence of seizure compared to those with non-AD. This relationship was not affected by race or gender.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.304483837330553%\" valign=\"bottom\"\u003e\n \u003cp\u003eSherzai et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.40354535974974%\" valign=\"bottom\"\u003e\n \u003cp\u003e2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.218978102189782%\" valign=\"bottom\"\u003e\n \u003cp\u003e26926896 patients \u0026gt;65 years; DM risk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.020855057351408%\" valign=\"bottom\"\u003e\n \u003cp\u003eAlzheimer\u0026apos;s dementia in diabetics (OR)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51824817518248%\" valign=\"bottom\"\u003e\n \u003cp\u003eOR 0.57 [0.56-0.58]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.152241918665276%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.38164754953076%\" valign=\"bottom\"\u003e\n \u003cp\u003ePatients with diagnosis of DM had lower odds of having Alzheimer\u0026apos;s dementia.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.304483837330553%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003eBeydoun et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.40354535974974%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.218978102189782%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003e92300 patients \u0026gt; 60 y and with \u0026ge; 1 procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.020855057351408%\" valign=\"bottom\"\u003e\n \u003cp\u003eTrend in respiratory/GI procedures utilization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51824817518248%\" valign=\"bottom\"\u003e\n \u003cp\u003eDecline by 3-7% annually\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.152241918665276%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.38164754953076%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003eUtilization of respiratory/GI procedures in hospitalized patients with AD declined by 3-7% annually. Associated with increased total charges, LOS, and mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eTotal increase in cost associated with respiratory/GI procedures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003e$18,652\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eIncrease in LOS with respiratory/GI procedures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003e1.53 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eMortality risk associated with \u0026quot;respiratory/GI\u0026quot; procedure (OR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003e4.14 [3.21-5.35]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.304483837330553%\" valign=\"bottom\"\u003e\n \u003cp\u003eLin et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.40354535974974%\" valign=\"bottom\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.218978102189782%\" valign=\"bottom\"\u003e\n \u003cp\u003e3716216 with GI bleed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.020855057351408%\" valign=\"bottom\"\u003e\n \u003cp\u003eDischarge to home (OR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51824817518248%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.18 [0.18-0.19]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.152241918665276%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.38164754953076%\" valign=\"bottom\"\u003e\n \u003cp\u003eDementia with an 82% reduction in likelihood for being discharged to home\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.304483837330553%\" rowspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003eAnderson et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.40354535974974%\" rowspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.218978102189782%\" rowspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003e1843632 hospitalization age \u0026gt; 65y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.020855057351408%\" valign=\"bottom\"\u003e\n \u003cp\u003eIncidence of all-cause hospitalizations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51824817518248%\" valign=\"bottom\"\u003e\n \u003cp\u003eDecline from 1.87 to 1.85 million\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.152241918665276%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.38164754953076%\" rowspan=\"3\" valign=\"bottom\"\u003e\n \u003cp\u003eIncreased preventable hospitalizations of older adults with dementia.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eIncidence of preventable hospitalizations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003eIncrease from 0.75 to 0.87 million\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eInpatient mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003eDecline from 6.4 to 6.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.304483837330553%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003eBaral et al\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.40354535974974%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.218978102189782%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003e378230 with AF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.020855057351408%\" valign=\"bottom\"\u003e\n \u003cp\u003eIn-hospital mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.51824817518248%\" valign=\"bottom\"\u003e\n \u003cp\u003eaOR 1.48 [95% CI 1.34-1.64]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.152241918665276%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.38164754953076%\" rowspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003ePatients with AF and dementia had higher mortality and lower likelihood of receiving catheter ablation and electrical cardioversion.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eNon-trauma ICH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003eaOR 1.60 [95% CI 1.03-2.47]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eCatheter ablation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003eaOR 0.39 [95% CI 0.35-0.43]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"45.82338902147971%\" valign=\"bottom\"\u003e\n \u003cp\u003eElectrical cardioversion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.09546539379475%\" valign=\"bottom\"\u003e\n \u003cp\u003eaOR 0.33 [95% CI 0.31-0.35]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.081145584725537%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eICH: intracerebral hemorrhage; IMV: invasive mechanical ventilation; SNF: skilled nursing facility; aOR: adjusted odds ratio; OR: odds ration; HF: heart failure; AMI: acute myocardial infarction; COPD: Chronic obstructive pulmonary disease; LOS: length of stay; AD: Alzheimer\u0026rsquo;s Dementia; VD: vascular dementia; DM: diabetes mellitus; AF: atrial fibrillation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"738\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 6. Studies on dementia patients undergoing gastrointestinal procedures\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.94308943089431%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy Goals\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.401084010840108%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.615176151761517%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOutcomes Reported\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.88617886178862%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.13821138211382%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eConclusions/Notes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.94308943089431%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eLv et al, 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eImpact of dementia on CRC screening utilization, knowledge, and associated health disparities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.401084010840108%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e178820457\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.615176151761517%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eLikelihood of colorectal cancer screening\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.642276422764226%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAD - 39% less likely (OR 0.61; 95% CI 0.5-0.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.13821138211382%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eOverall CRC screening in older adults increased from 86.4% to 88.96% from 2015 to 2018. Dementia patients were less likely to use any CRC screening when compared to older adults without.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eRelated dementia (RD) - 25% less likely (OR 0.75; 0.62-0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.92215568862275%\" valign=\"top\"\u003e\n \u003cp\u003eKnowledge of colonoscopy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61.07784431137725%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAD - 77% more likely (OR 1.77; 1.12-2.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.92215568862275%\" valign=\"top\"\u003e\n \u003cp\u003eKnowledge of Medicare pay for screening\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"61.07784431137725%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAD - 19% less likely (OR 0.81; 0.70-0.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.94308943089431%\" rowspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003eAgrawal et al, 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\" rowspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003ePredictors of poor bowel preparations and colonoscopy cancellations in inpatient colonoscopies, a single center retrospective study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.401084010840108%\" rowspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e1029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.615176151761517%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eFactors associated with colonoscopy cancellation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.88617886178862%\" valign=\"top\"\u003e\n \u003cp\u003eGraduate level education (OR 1.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\" valign=\"top\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.13821138211382%\" rowspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003eGraduate level education, Hispanic ethnicity, Hgb \u0026lt;10 is associated with colonoscopy cancellation. Study found dementia, gastroparesis, and inpatient opioid use to be associated with poor bowel prep.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.70588235294117%\" valign=\"top\"\u003e\n \u003cp\u003eHispanic ethnicity (OR 0.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.294117647058826%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.70588235294117%\" valign=\"top\"\u003e\n \u003cp\u003eHemoglobin \u0026lt;10 g/dL (OR 1.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.294117647058826%\" valign=\"top\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.92215568862275%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eFactors associated with poor bowel preparation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.52095808383233%\" valign=\"top\"\u003e\n \u003cp\u003eDementia (OR 2.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.55688622754491%\" valign=\"top\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.70588235294117%\" valign=\"top\"\u003e\n \u003cp\u003eGastroparesis (OR 3.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.294117647058826%\" valign=\"top\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.70588235294117%\" valign=\"top\"\u003e\n \u003cp\u003eInpatient opioid use (OR 1.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.294117647058826%\" valign=\"top\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.94308943089431%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eYang et al, 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eThe association between cognitive impairment and breast and colorectal cancer screening utilization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.401084010840108%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e24782\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.615176151761517%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePercentage of colonoscopy use in cognitively impaired vs. unimpaired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.88617886178862%\" valign=\"top\"\u003e\n \u003cp\u003e60.3% unimpaired vs. 61.8% impaired (2018)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\" valign=\"top\"\u003e\n \u003cp\u003e0.436\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.13821138211382%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eIn regression analysis, cognitively impaired men were less likely to have had a recent colonoscopy.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.70588235294117%\" valign=\"top\"\u003e\n \u003cp\u003e57.8% unimpaired vs. 58.3% impaired (2019)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.294117647058826%\" valign=\"top\"\u003e\n \u003cp\u003e0.918\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.92215568862275%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eLikelihood of colonoscopy screening in men\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.52095808383233%\" valign=\"top\"\u003e\n \u003cp\u003eMild cognitive impairment: OR 0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.55688622754491%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.70588235294117%\" valign=\"top\"\u003e\n \u003cp\u003eSevere cognitive impairment: OR 0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.294117647058826%\" valign=\"top\"\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.94308943089431%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eYee et al, 2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003ePredictors of an inadequate bowel preparation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.401084010840108%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e2101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.615176151761517%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eFactors predictive of inadequate preparation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.88617886178862%\" valign=\"top\"\u003e\n \u003cp\u003eStroke/dementia: OR 3.5; 95% CI 1.6-7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\" valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.13821138211382%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003eOpioids: OR 2.3; 1.1-4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.333333333333336%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003eMale sex: OR 2.0; 1.4-2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.333333333333336%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003eCalcium channel blocker: OR 1.9; 1.1-3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.333333333333336%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"36.666666666666664%\" valign=\"top\"\u003e\n \u003cp\u003eAntidepressants: OR 1.7; 1.1-2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.333333333333336%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.94308943089431%\" valign=\"top\"\u003e\n \u003cp\u003eIida et al, 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\" valign=\"top\"\u003e\n \u003cp\u003eEfficacy/safety of endoscopic procedures for CBD in \u0026gt; 85y\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.401084010840108%\" valign=\"top\"\u003e\n \u003cp\u003e235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.615176151761517%\" valign=\"top\"\u003e\n \u003cp\u003eIncidence of complication rate in patients \u0026lt; 85 vs. \u0026ge;85 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.88617886178862%\" valign=\"top\"\u003e\n \u003cp\u003e8.6% vs. 14.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\" valign=\"top\"\u003e\n \u003cp\u003eNot significant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.13821138211382%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt; 85 y had significantly higher rates of dementia, but insignificant. Endoscopic procedures for CBD stones is safe and effective.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.94308943089431%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eMurata et al, 2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eEffect of dementia on outcomes of patients with hemorrhagic PUD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.401084010840108%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e14569\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.615176151761517%\" valign=\"top\"\u003e\n \u003cp\u003eIn-hospital mortality within 30 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.88617886178862%\" valign=\"top\"\u003e\n \u003cp\u003eOR 1.00; 95% CI 0.68-1.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\" valign=\"top\"\u003e\n \u003cp\u003e0.986\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.13821138211382%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eMortality rates were similar but increased LOS and medical costs in patients with dementia.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.92215568862275%\" valign=\"top\"\u003e\n \u003cp\u003eOverall mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.52095808383233%\" valign=\"top\"\u003e\n \u003cp\u003e1.02; 0.74-1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.55688622754491%\" valign=\"top\"\u003e\n \u003cp\u003e0.877\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.92215568862275%\" valign=\"top\"\u003e\n \u003cp\u003eLOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.52095808383233%\" valign=\"top\"\u003e\n \u003cp\u003eUnstandardized coefficient 3.12 days; 1.58-4.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.55688622754491%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.92215568862275%\" valign=\"top\"\u003e\n \u003cp\u003eMedical costs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.52095808383233%\" valign=\"top\"\u003e\n \u003cp\u003eUnstandardized coefficient 1171.7 US dollars; 533.8-1809.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.55688622754491%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.94308943089431%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eKitagawa et al, 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eEfficacy/safety between palliative EBS and duct clearance among elderly patients with choledocholithiasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.401084010840108%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.615176151761517%\" valign=\"top\"\u003e\n \u003cp\u003eCholangitis-free period\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.88617886178862%\" valign=\"top\"\u003e\n \u003cp\u003eComplete stone removal had longer duration than EBS.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.13821138211382%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eComplete stone removal led to greater duration of cholangitis-free period compared to EBS. Mortality rate and procedure-related adverse events between the two groups were similar.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.92215568862275%\" valign=\"top\"\u003e\n \u003cp\u003eMortality rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.52095808383233%\" valign=\"top\"\u003e\n \u003cp\u003e3 (12%) in EBS vs. 2 (8%) complete stone removal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.55688622754491%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.92215568862275%\" valign=\"top\"\u003e\n \u003cp\u003eProcedure-related adverse events\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.52095808383233%\" valign=\"top\"\u003e\n \u003cp\u003e16% in EBS vs. 8% in complete stone removal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.55688622754491%\" valign=\"top\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.94308943089431%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eGandhi et al, 2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.260162601626018%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eCharacteristics associated with quality of bowel preparation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.401084010840108%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e75818\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.615176151761517%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eFactors associated with inadequate bowel preparation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.88617886178862%\" valign=\"top\"\u003e\n \u003cp\u003eAge: OR 1.14; 1.07-1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.75609756097561%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.13821138211382%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eAge, male sex, low education, and comorbidities of diabetes, hypertension, stroke/dementia, and opioid use found to be significantly associated with inadequate bowel preparation.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.70588235294117%\" valign=\"top\"\u003e\n \u003cp\u003eMale sex: OR 1.23; 1.12-1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.294117647058826%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.70588235294117%\" valign=\"top\"\u003e\n \u003cp\u003eLow education: OR 1.49; 1.27-1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.294117647058826%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.70588235294117%\" valign=\"top\"\u003e\n \u003cp\u003eStroke/dementia: OR 2.09; 1.56-2.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.294117647058826%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"64.70588235294117%\" valign=\"top\"\u003e\n \u003cp\u003eOpioids: OR 1.70; 1.39-2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"35.294117647058826%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCRC: colorectal cancer; AD: Alzheimer\u0026rsquo;s Dementia; CBD: common bile duct; PUD: peptic ulcer disease; LOS: length of stay; EBS: endoscopic biliary stent.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUtilizing the NIS database, we found 55,015 inpatient colonoscopies were performed in elderly patients over the age of 60 years, 4,323 of which in dementia patients. Compared to those without dementia, those with dementia receiving colonoscopy were overall older by an average of 7 years, had a higher percentage of females, had proportionately less Whites, were significantly less likely to be obese, less likely to have private insurance, and more likely to receive the procedure emergently. Black patients who have dementia are more likely to receive a colonoscopy than those Black patients without dementia. We found the number of complications from colonoscopy were similar in patients with and without dementia; however, we did note that other non-procedural related complications were higher in those with dementia. Outcomes analysis also indicated that dementia patients also had worse LOS, charges, and discharge disposition.\u003c/p\u003e \u003cp\u003eThis 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. Indeed, it is also possible that in such scenarios, the gastroenterologist is faced with the decision to perform the procedure on these patients versus not, and it seems that gastroenterologists in certain cases were more likely to opt for or recommend colonoscopy. For instance, we hypothesize that Black patients without dementia were more likely to decline colonoscopy (as they are likely the primary decision maker) due to certain biases or feelings about the procedure. Similarly, females with dementia probably have the same scenario when it comes to proper informed consent with their next of kin deciding on their behalf to consent for a colonoscopy procedure, as we find a smaller percentage among them without dementia undergoing colonoscopy. Again, the proceduralist/endoscopist decision-making process and/or their biases along with it, should be taken into consideration when assessing these findings.\u003c/p\u003e \u003cp\u003eThe impact of obesity on receiving a colonoscopy is also demonstrated in our study. It is indicative that it influences decision-making by the gastroenterologist whether to perform the procedure or not, with obese patients without dementia being more favored to receive the procedure than those with obesity and dementia. This suggests that increasing comorbidities is a further hinderance on gastroenterologists to perform the procedure. At the same time, it potentially indicates patient preference with more obese patients without dementia opting for colonoscopy. Findings on the effects of insurance status on colonoscopy utilization is indicative that dementia patients are more likely to get an index colonoscopy during hospitalization if they were on Medicare rather than private insurance when compared to their non-dementia counterparts. The cause for this is likely multifactorial; again, patient factors and physician factors are likely at play including decision making by both parties, personal biases, and insurance reimbursement considerations.\u003c/p\u003e \u003cp\u003eIn terms of specific complications related to colonoscopy, dementia patients did not incur an increased risk of colonic perforation, post-colonoscopy bleeding, or splenic injury, suggesting that this comorbidity doesn\u0026rsquo;t result in altered colon anatomy that may put them at risk of such complications. From an endoscopist perspective, it also suggests that performing a colonoscopy on dementia patients will not put them at a higher risk of procedure-related complications as may occur with other comorbidities. However, other more general complications such as CVA, pneumonia, sepsis, and AKI did occur at a higher rate among the dementia group indicating that proceeding with a colonoscopy in patients with this comorbidity should be done with caution. The overall picture of the patient\u0026rsquo;s pre-procedure clinical status should be considered including indication of the procedure, patient mental status, other comorbidities, laboratory and imaging findings, and social situation.\u003c/p\u003e \u003cp\u003eWe also report significant outcomes with regards to discharge disposition, LOS, and hospitalization charges. All of these latter outcomes were significantly worse (i.e. less routine discharge, higher LOS, and higher charges) among patients with dementia. This goes along with other previous studies that reported on dementia patients and its association with a poor prognosis during hospitalization, procedure utilization, and surgical operations. While we find that mortality rate is the same between our comparisons, we are unable to report on longer term mortality rate following discharge, as this data is not available. We hypothesize that since approximately there was a 2:1 ratio of dementia versus nondementia patients to have a non-routine discharge (i.e. not to home, and rather to acute rehab facility, skilled nursing facility, etc.), there is a high likelihood that more patients died at outside facilities shortly after the index hospitalization, implying a likely higher mortality among dementia patient than we find in our study. However, other previous studies have reported a similar trend in which there is greater rates of complications, longer lengths of stay, less likelihood of home discharge, and higher medical costs in dementia patients while the mortality rate is insignificant comparatively [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Others also corroborated our findings in terms of procedure urgency with a higher likelihood of emergent/urgent procedures performed on dementia patients [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur data also suggests disparities based on insurance status, type of hospital, and geography. The finding that patients with private insurance are more likely to have a routine discharge is puzzling and is likely to be multifactorial in nature. Private insurance patients could possibly encounter more difficulties in obtaining authorization to be placed at skilled nursing facilities or acute rehab institutions and more likely settle on being taken care of at home with family members. Also possible, family members of such patients are more likely to provide support to them when compared to patients on Medicare or Medicaid. These patients may have been more likely to refuse placement at such long-terms facilities and opted to be discharged home as well. Similar explanations could also account for the higher length of stay in elderly patients on Medicaid. Likely due to less resources and manpower, rural hospitals incurred less charges when compared to teaching hospitals, which have more resources, more likely to be located in urban areas, and more likely to spend on areas such as medical care. Finally, the disparities found based on geography are quite puzzling; these findings should be further investigated in future retrospective or prospective studies.\u003c/p\u003e \u003cp\u003eOther recent studies have also suggested that dementia patients undergoing procedures have worse outcomes when compared to non-dementia patients. One example of this is demonstrated by Shah et al. when evaluating outcomes after vascular surgery [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Their study found dementia patients to have higher likelihood of 30 and 90-day mortality, longer hospital LOS, and lower likelihood of discharge to home. Similar results in terms of LOS and hospital discharge have also been found in dementia patients undergoing spine fusion [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. A study by Beydoun et al. evaluated trends in hospitalized Alzheimer\u0026rsquo;s dementia patients among a variety of commonly performed procedures. Notably, in patients undergoing respiratory or GI procedures, grouped together in their analysis, they report increased cost of hospital stay, increased length of stay, and higher mortality risk [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough colonoscopy is generally considered a minor and safe procedure, patient safety and procedure benefit must still be assessed. Two major factors to consider are ability to tolerate bowel prep and risk for adverse outcomes or complications. In the dementia population, there is a paucity of evidence regarding the safety profile of these patients when undergoing colonoscopy. Inadequate bowel preparation can result in colonoscopy cancellation or lead to prolonged procedure time, increased risk for complications, and suboptimal visualization. Several studies demonstrate dementia as being one of the strongest associations of predictors of inadequate bowel preparation for colonoscopy [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Patients with cognitive impairment may have significant barriers to completing a bowel preparation regimen, including impaired ability to swallow and intolerance of the large volume of fluid. Given these challenges, some suggest strategies including clear liquids or low-residue diet in the days prior to procedure or even direct administration of preparation through esophagogastroduodenoscope or nasogastric tube [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eProper evaluation and consideration of patient fit for colonoscopy is very important, especially given recent population-level and epidemiologic data. In a recent study by Lv and colleagues, colorectal cancer screening utilization in older adults increased from 86.4\u0026ndash;88.96% from 2015 to 2018; however, those with Alzheimer\u0026rsquo;s or other related dementias were significantly less likely to undergo screening [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. On the other hand, a recent study evaluated utilization of colonoscopy during 2018\u0026ndash;2019 in screening-eligible patients and found no statistically significant difference in utilization rate between those with cognitive impairment and those without [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. As colonoscopy is performed more frequently in older patients and in patients with dementia, a comprehensive understanding of patient safety and benefit must be established.\u003c/p\u003e \u003cp\u003eThe limitations of this study include inability to assess symptoms, medications, labs, long term follow up, or readmissions. The coding used to identify patients with dementia may underestimate or overestimate the prevalence of dementia. Along the same lines, coding errors may and do occur. Importantly, the severity of dementia is unable to be defined or evaluated in this study. In addition, this study may not be generalizable to younger patients with dementia.\u003c/p\u003e \u003cp\u003eIn this national inpatient study, we found elderly dementia patients receiving colonoscopy have similar colonoscopy related complications as patients without dementia. However, patients with dementia do have higher complications in general (renal, pulmonary, etc.). Major outcomes such as discharge disposition, LOS, and hospital costs were also worse in dementia cohort. We also report on significant interesting findings and implications on demographic, socioeconomic, and hospital level characteristics among dementia patients undergoing colonoscopy. As now more than ever gastroenterologists face the challenges of performing procedures on the elderly dementia population, the decision whether to perform colonoscopy in this patient population is multifactorial. A careful assessment of a dementia patient\u0026rsquo;s history can help with this decision. Future investigations in this area are required given limited data available on this specific patient population, particularly with regards to long term clinical outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Faris Shweikeh and Gordon Hong. The first draft of the manuscript was written by Faris Shweikeh and Gordon Hong and all authors commented on previous versions of the manuscript. Primary conception and design: Faris Shweikeh. Acquisition of Data:\u0026nbsp;Faris Shweikeh and Gordon Hong. Analysis and Interpretation of Data: All authors. \u0026nbsp;Critically revising the article: Anthony Lembo,\u0026nbsp;Matthew Hoscheit,\u0026nbsp;Mohamad Mouchli, and Kathleen Rogers. All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThis manuscript has not been published elsewhere in any language, nor is it under consideration for publication by another journal.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe authors declare that this research is performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its subsequent amendments. Institutional Review Board (IRB) approval was obtained through the Cleveland Clinic IRB review board, and it was approved with an exempt status.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe authors declare that there are no conflicts of interest with regards to the publication of this article.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe authors acknowledge that there isn’t any grants or financial support to declare with regards to publication of this manuscript.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults of this study were presented in abstract form at the 2023 Ohio Gastroenterology Society Annual Meeting in Columbus, OH, USA on September 9\u003csup\u003eth\u003c/sup\u003e, 2023. \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGale SA, Acar D, Daffner KR. Dementia. Am J Med. 2018;131(10):1161\u0026ndash;1169.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnderson TS, Marcantonio ER, McCarthy EP, Herzig SJ. National Trends in Potentially Preventable Hospitalizations of Older Adults with Dementia. J Am Geriatr Soc. 2020;68(10):2240\u0026ndash;2248.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlaiya B, Adler DG. Adverse Events After Inpatient Colonoscopy in Octogenarians: Results From the National Inpatient Sample (1998\u0026ndash;2013). J Clin Gastroenterol. 2020;54(9):813\u0026ndash;818.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArias F, Riverso M, Levy SA, et al. Pilot Study: Neurocognitive Disorders and Colonoscopy in Older Adults. Anesth Analg. 2019;129(3):e89-e93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLv G, Wang X, Jiang X, Li M, Lu K. Impact of Alzheimer's disease and related dementias on colorectal cancer screening utilization, knowledge, and associated health disparities. Front Pharmacol. 2022;13:872702.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIjaz SH, Minhas AMK, Ghoneem A, et al. Association of dementia with in-hospital outcomes in primary heart failure and acute myocardial infarction hospitalizations. Prog Cardiovasc Dis. 2022;73:24\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaral N, Mitchell JD, Aggarwal NT, et al. Sex-based disparities and in-hospital outcomes of patients hospitalized with atrial fibrillation with and without dementia. American Heart Journal Plus: Cardiology Research and Practice. 2023;26:100266.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin RY, Scanlan BC, Liao W, Nguyen TP. Disproportionate effects of dementia on hospital discharge disposition in common hospitalization categories. J Hosp Med. 2015;10(9):586\u0026ndash;591.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlshekhlee A, Li CC, Chuang SY, et al. Does dementia increase risk of thrombolysis?: a case-control study. Neurology. 2011;76(18):1575\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBeydoun MA, Gamaldo AA, Beydoun HA, et al. Trends, Predictors, and Outcomes of Healthcare Resources Used in Patients Hospitalized with Alzheimer's Disease with at Least One Procedure: The Nationwide Inpatient Sample. J Alzheimers Dis. 2017;57(3):813\u0026ndash;824.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupta A, McKeever TM, Hutchinson JP, Bolton CE. Impact of Coexisting Dementia on Inpatient Outcomes for Patients Admitted with a COPD Exacerbation. Int J Chron Obstruct Pulmon Dis. 2022;17:535\u0026ndash;544.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLagu T, Zilberberg MD, Tjia J, et al. Dementia and Outcomes of Mechanical Ventilation. J Am Geriatr Soc. 2016;64(10):e63-e66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShah SK, Jin G, Reich AJ, at al. Dementia is associated with increased mortality and poor patient-centered outcomes after vascular surgery. J Vasc Surg. 2020;71(5):1685\u0026ndash;1690.e2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma M, Dietz N, Scott V, Wang D, Ugiliweneza B, Boakye M. Trends and Outcomes in Patients with Dementia Undergoing Spine Fusions: A Matched Nationwide Inpatient Sample Analysis. World Neurosurg. 2023;169:e164-e170.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSherzai A, Ovbiagele B, Sherzai D. Time Trends and Characteristics of Prevalent Dementia among Patients Hospitalized for Stroke in the United States. J Stroke Cerebrovasc Dis. 2018;27(6):1447\u0026ndash;1457.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSherzai D, Losey T, Vega S, Sherzai A. Seizures and dementia in the elderly: Nationwide Inpatient Sample 1999\u0026ndash;2008. Epilepsy Behav. 2014;36:53\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSherzai D, Sherzai A, Lui K, et al. The Association Between Diabetes and Dementia Among Elderly Individuals: A Nationwide Inpatient Sample Analysis. J Geriatr Psychiatry Neurol. 2016;29(3):120\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgrawal R, Majeed M, Attar BM, et al. Predictors of poor bowel preparations and colonoscopy cancellations in inpatient colonoscopies, a single center retrospective study. Transl Gastroenterol Hepatol. 2022;7:4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGandhi K, Tofani C, Sokach C, et al. Patient Characteristics Associated With Quality of Colonoscopy Preparation: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2018;16(3):357\u0026ndash;369.e10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIida T, Kaneto H, Wagatsuma K, et al. Efficacy and safety of endoscopic procedures for common bile duct stones in patients aged 85 years or older: A retrospective study. PLoS One. 2018;13(1):e0190665.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKitagawa K, Mitoro A, Ozutsumi T, et al. Comparison of the efficacy and safety between palliative biliary stent placement and duct clearance among elderly patients with choledocholithiasis: a propensity score-matched analysis. BMC Gastroenterol. 2021;21(1):369.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurata A, Mayumi T, Muramatsu K, Ohtani M, Matsuda S. Effect of dementia on outcomes of elderly patients with hemorrhagic peptic ulcer disease based on a national administrative database. Aging Clin Exp Res. 2015;27(5):717\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang S, Bian J, George TJ, et al. The association between cognitive impairment and breast and colorectal cancer screening utilization. BMC Cancer. 2021;21(1):539.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYee R, Manoharan S, Hall C, Hayashi A. Optimizing bowel preparation for colonoscopy: what are the predictors of an inadequate preparation? Am J Surg. 2015;209(5):787\u0026ndash;92\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLim YJ, Hong SJ. What is the best strategy for successful bowel preparation under special conditions?. World J Gastroenterol. 2014;20(11):2741\u0026ndash;2745.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"digestive-diseases-and-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ddsj","sideBox":"Learn more about [Digestive Diseases and Sciences](http://link.springer.com/journal/10620)","snPcode":"10620","submissionUrl":"https://submission.nature.com/new-submission/10620/3","title":"Digestive Diseases and Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Colonoscopy, Elderly, Dementia, Outcomes, National","lastPublishedDoi":"10.21203/rs.3.rs-3874007/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3874007/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIt is projected that the elderly population will continue to increase. Many will develop chronic conditions such as dementia.\u003c/p\u003e\u003ch2\u003eAims\u003c/h2\u003e \u003cp\u003eOur aims are to describe the utilization of colonoscopy among dementia patients and compare outcomes in those with and without dementia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eInitially, 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\u0026thinsp;=\u0026thinsp;0.0042), pulmonary/pneumonia (p\u0026thinsp;=\u0026thinsp;0.003), cerebrovascular accidents (p\u0026thinsp;=\u0026thinsp;0.0063), and sepsis (\u0026lt;\u0026thinsp;0.0001). Dementia patients were also less likely to have routine discharges (\u0026lt;\u0026thinsp;0.0001), had longer hospital stays (\u0026lt;\u0026thinsp;0.0001), and higher hospital costs (\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eElderly 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\u0026rsquo;s history can help with this decision.\u003c/p\u003e","manuscriptTitle":"Colonoscopy Utilization in Elderly Dementia Patients: Characteristics, Complications, and Charges in a National Matched-Cohort Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-22 10:17:18","doi":"10.21203/rs.3.rs-3874007/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-02-09T01:21:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-02-08T23:43:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3679bde9-25c6-48f3-9287-24284089fcd4","date":"2024-01-29T12:40:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-01-24T11:53:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-01-22T19:19:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-01-18T15:01:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"Digestive Diseases and Sciences","date":"2024-01-17T23:00:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"digestive-diseases-and-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ddsj","sideBox":"Learn more about [Digestive Diseases and Sciences](http://link.springer.com/journal/10620)","snPcode":"10620","submissionUrl":"https://submission.nature.com/new-submission/10620/3","title":"Digestive Diseases and Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"4ab7be55-7de6-4e19-9eb5-9c596c430967","owner":[],"postedDate":"January 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-04-01T15:03:09+00:00","versionOfRecord":{"articleIdentity":"rs-3874007","link":"https://doi.org/10.1007/s10620-024-08363-3","journal":{"identity":"digestive-diseases-and-sciences","isVorOnly":false,"title":"Digestive Diseases and Sciences"},"publishedOn":"2024-03-25 15:00:47","publishedOnDateReadable":"March 25th, 2024"},"versionCreatedAt":"2024-01-22 10:17:18","video":"","vorDoi":"10.1007/s10620-024-08363-3","vorDoiUrl":"https://doi.org/10.1007/s10620-024-08363-3","workflowStages":[]},"version":"v1","identity":"rs-3874007","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3874007","identity":"rs-3874007","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}