Lower Postsurgical Mortality for Individuals with Dementia with Better-Educated Hospital Workforce

J Am Geriatr Soc. 2018 Jul;66(6):1137-1143. doi: 10.1111/jgs.15355. Epub 2018 Mar 20.


Objectives: To investigate whether care in a hospital with more nurses holding at least a Bachelor of Science in Nursing (BSN) degree is associated with lower mortality for individuals with Alzheimer's disease and related dementias (ADRD) undergoing surgery ADRD.

Design: Cross-sectional data from 2006-07 Medicare claims were linked with the Multi-State Nursing Care and Patient Safety Survey of nurses in 4 states.

Setting: Adult, nonfederal, acute care hospitals in California, Florida, New Jersey, and Pennsylvania (N=531).

Participants: Medicare beneficiaries aged 65 and older with and without ADRD undergoing general, orthopedic, or vascular surgery (N=353,333; ADRD, n=46,163; no ADRD, n=307,170).

Measurements: Thirty-day mortality and failure to rescue (death after a complication).

Results: Controlling for hospital, procedure, and individual characteristics, each 10% increase in the proportion of BSN nurses was associated with 4% lower odds of death (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.93-0.98) for individuals without ADRD, but 10% lower odds of death (OR=0.90, 95% CI=0.87-0.94) for those with ADRD. Each 10% increase in the proportion of nurses holding a BSN degree or higher was associated with 5% lower odds of failure to rescue (OR=0.95, 95% CI=0.92-0.98) for individuals without ADRD but 10% lower odds of failure to rescue (OR=0.90, 95% CI=0.87-0.94) for those with ADRD.

Conclusion: Individuals undergoing surgery who have coexisting ADRD are more likely to die within 30 days of admission and die after a complication than those without ADRD. Having more BSN nurses in the hospital improves the odds of good outcomes for all individuals and has a much greater effect in individuals with ADRD.

Keywords: dementia; mortality; nurse education; workforce.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Alzheimer Disease / epidemiology*
  • Dementia / epidemiology
  • Dementia / etiology
  • Female
  • Hospital Mortality
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Medicare
  • Personnel Staffing and Scheduling / organization & administration
  • Postoperative Care* / methods
  • Postoperative Care* / standards
  • Postoperative Care* / statistics & numerical data
  • Postoperative Complications / mortality*
  • Quality of Health Care / standards*
  • United States / epidemiology
  • Workforce / organization & administration
  • Workforce / standards