Unmet needs of immigrant older adults after discharge from hospital with delirium: Using administrative data to explore practice patterns and long-term adverse health outcomes

Older Canadians represent over 40% of hospital admissions and are at increased risk of experiencing hospital related harms. One of these harms is delirium, which is a syndrome of new confusion that is common and affects up to 50% of hospitalized older patients. It is important because it increases the risk of subsequently developing dementia, being admitting to a long-term care home and even dying. Immigrant older adults may do worse after discharge due to a number of risk factors such as low income, systemic racism, and language barriers. This could lead to differences in the care they receive including increased prescription of harmful medications, less access to home care, and less follow up visits with doctors. Limited visits with friends and relatives due to COVID-19 social distancing measures may have exacerbated these issues because immigrants often rely heavily on family members for support. This proposal will use linked health databases to study the care that immigrant older patients with delirium receive in Ontario. We will report the occurrence of delirium during a hospital admission for a medical or surgical reason among immigrant and non-immigrant patients over the age of 65. We will look at the differences in how delirium is managed including who is seen by a delirium specialist and who gets discharged with harmful medications. We will examine the adverse outcomes after a person is discharged including coming back to hospital, developing dementia, or moving to a long-term care home. We will study how antipsychotic prescriptions changed during the COVID-19 pandemic and compare differences in these changes by immigrant status. We anticipate that immigrant older adults will receive more antipsychotics, less home care and have more long-term unfavorable outcomes. Understanding the unmet needs of immigrant older adults after delirium will help the healthcare system implement interventions to better support patients and families.