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, a severe neuropsychiatric syndrome characterized by an acute onset of confusion. Delirium affects up to 50% of hospitalized older patients and is associated with serious consequences including dementia, admission to long-term care and death. Immigrant older adults may be at greater risk of poor outcomes after discharge as a result of insufficient health services and supports. The experience of low income, systemic racism, and language barriers may lead to inequitable care including increased prescription of harmful medications, and less access to home care or follow up. The hospital visitor restrictions employed during the COVID-19 pandemic may have further widened these gaps as immigrant older adults often have a greater reliance on family members for support. There is currently a lack of research exploring the post-discharge period after delirium and the differences in care and outcomes for immigrant populations. My thesis proposal will use large health databases to compare the practice patterns and long-term adverse outcomes after discharge from hospital with delirium between immigrant and non-immigrant older adults. We will investigate long-term adverse outcomes including a new diagnosis of dementia. We will explore changes in antipsychotic prescriptions during the COVID-19 pandemic and compare differences by immigrant status. We will examine the predictors of long-term care home admission including social risk factors such as sex, income, and immigrant status. We anticipate that immigrant older adults will receive more antipsychotics, less support after discharge and have more long-term harmful outcomes. Understanding the unmet needs of immigrant older adults after delirium will assist clinicians, researchers, and policy makers to implement interventions to better support patients and families.