S961 Inpatient Outcomes of Alzheimer’s Dementia Patients With Dysphagia: A Nationwide Study

Introduction: Dysphagia is a common complication of Alzheimer’s disease dementia, contributing to malnutrition and frequent aspiration events. Patients with Alzheimer’s who develop swallowing difficulties are presumed to have higher morbidity and healthcare utilization, but large-scale data on their inpatient outcomes are limited. We aimed to evaluate the impact of dysphagia on clinical outcomes and resource use in hospitalized Alzheimer’s patients using a national inpatient database. Methods: We analyzed the National Inpatient Sample (NIS) between 2016 and 2020, identifying all hospitalizations for patients aged ≥70 with a diagnosis of Alzheimer’s disease dementia. Cases with co-diagnosed dysphagia were identified via ICD-10 codes. We compared patient characteristics and outcomes between Alzheimer’s patients with dysphagia and those without. Primary outcomes included mortality, length of stay (LOS), and total hospital cost (THC). Secondary outcomes include endoscopic evaluation, PEG tube placement, and prevalence of aspiration pneumonia. Student t test and chi-square were utilized for analysis in SAS 9.4. Results: Among 1,965,035 patients with Alzheimer’s dementia, dysphagia was present in 205,565 cases (10.5%). Patients with dysphagia had a mean age of 83.98 years, were predominantly women (56.4%), and primarily White (65.9%). Alzheimer’s patients with dysphagia showed significantly worse outcomes than those without. Compared to patients without dysphagia, those with dysphagia had significantly higher inpatient mortality rates (7.0% vs 4.9%; P < 0.05), longer hospital stays (mean length of stay: 7.92 vs 5.96 days; P < 0.05), and greater total hospital costs ($15,636 vs $11,551). Aspiration pneumonia was notably more common among patients with dysphagia (27% vs 5.4%; P < 0.05). Additionally, the dysphagia group had higher rates of upper endoscopy utilization (2.3% vs 1.1%; P < 0.05) and percutaneous endoscopic gastrostomy tube placements (675 vs 435 cases). Conclusion: Hospitalized Alzheimer’s disease patients with coexisting dysphagia have substantially worse inpatient outcomes and higher resource utilization than those without dysphagia. Given limited effectiveness of current interventions (e.g., thickened liquids have shown no clear mortality benefit in this population), a multidisciplinary approach and early swallowing assessments with personalized feeding strategies are essential to mitigate aspiration risks and improve outcomes.