291: COVID-19 AND ICU ADMISSION AND OUTCOMES OF PATIENTS WITH DEMENTIA AND EARLY DO-NOT-RESUSCITATE STATE

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Introduction: ICU utilization among patients with dementia has increased over time, including at end-of-life, though the benefits remain debated. The COVID-19 pandemic has strained critical care resources, affecting triage considerations. The population-level impact of COVID-19 on ICU utilization among patients with dementia and do-not-resuscitate orders present on hospital admission (DNR-POA) and outcomes of those admitted to ICU are unknown. Methods: We used a statewide dataset to identify hospitalizations ages ≥18 years with dementia and DNR-POA in Texas during April 1-December 31 for each year of 2016-2020 (to align each year with the date of introduction of COVID-19-specific ICD-10 code [U07.1] in the United States). Dementia was defined by the Clinical Classifications Software Refined category NVS011. DNR-POA was identified by ICD-10 code Z66 and presence of POA indicator. Hierarchical negative binomial regression was used on the 2016-2019 data to forecast the number of ICU admissions in 2020, with trend expressed as annual percent change (APC). Hierarchical logistic regression models were used to estimate changes in short-term mortality (defined as in-hospital death or discharge to hospice) between 2020 and 2019 among ICU admissions with DNR-POA overall and among those without COVID-19. Results: There were 80,362 hospitalizations with dementia and DNR-POA during 2016-2019, of which 49.7% were admitted to ICU. The rate of ICU admission increased between 2016 and 2019 (APC +1.1%, 95% CI 0.0 to +2.3%). In 2020 the observed and predicted ICU admissions were 10,762 (52.6% of hospitalizations) vs 10,476 (95% CI 10,262-10,790), including 2,562 (23.8%) with COVID-19. Short-term mortality among ICU admissions in 2019 and 2020 was 35.0% vs 42.5% overall. On adjusted analyses, the odds of short-term mortality among ICU admission were higher in 2020 vs 2019 overall (adjusted odds ratio [aOR] 1.27 [95% CI 1.18-1.36]) and among those without COVID-19 (aOR 1.09 [95% CI 1.03-1.18]). Conclusions: Nearly 1 in 2 hospitalizations with dementia and DNR-POA were admitted to the ICU, with ICU utilization not significantly affected by the pandemic. Short-term mortality among ICU admissions with dementia and DNR-POA was high and increased during the first year of the pandemic overall and among those without COVID-19.

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