Fewer dementia patients die after surgery when nurses more educated

Patients with Alzheimer’s disease and dementia may be less likely to die after surgery when they’re treated at hospitals that employ a larger proportion of nurses with at least a college degree, a U.S. study suggests.

Previous research has linked more educated nurses to better outcomes for hospital patients and lower rates of deaths and serious complications. In 2010, the U.S. Institute of Medicine called for four in five hospital nurses to have at least a bachelor’s degree by 2020.

The current study adds to the evidence linking more educated nurses to lower surgical mortality rates. It found better survival odds at hospitals where more nurses had at least four-year college degrees, even for some of the most vulnerable surgical patients: people with dementia, who already have a higher risk of complications or death.

“This suggests that comprehensive nursing care plays an important role in reducing some of the excess risk patients with dementia face when undergoing surgery, and that better education helps nurses manage the higher complexity of this patient population,” said lead study author Elizabeth White, a geriatric nurse practitioner and researcher at the University of Pennsylvania School of Nursing in Philadelphia.

“As the population ages, hospitals will be faced with the challenges of caring for an increasing number of frail, cognitively impaired older adults,” White said by email. “Our findings suggest that transitioning to a largely (college-educated) nursing workforce, as the Institute of Medicine recommends, would contribute to improved surgical outcomes for this population.”

Researchers examined data on surgical patients 65 and older covered by Medicare, the U.S. health program for the elderly, who had general surgery, orthopedic procedures or vascular operations at 531 acute care hospitals in California, Florida, New Jersey and Pennsylvania.

The study included 46,163 people with Alzheimer’s or dementia as well as a control group of 307,170 people who didn’t have these conditions.

Overall, 12,369 patients, or 3.5 percent, died within 30 days of admission to the hospital, researchers report in the Journal of the American Geriatrics Society.

Mortality rates were much higher - at 8 percent - for dementia patients, compared with less than 3 percent for the people without dementia.

On average, about 38 percent of nurses had at least a four-year bachelor’s degree, although the proportion ranged from zero to 74 percent. Larger hospitals, teaching hospitals and high-technology facilities all tended to have more college-educated nurses.

After researchers accounted for the type of surgery and individual hospital and patient characteristics, each 10 percent increase in the proportion of nurses with at least a bachelor’s degree was linked to 4 percent lower odds of death for patients without dementia and 10 percent lower odds of death for patients with dementia.

The study wasn’t a controlled experiment designed to prove whether or how nurses’ education might directly influence survival odds for surgery patients.

Still, the results add to evidence suggesting that this is one factor that can help improve patient outcomes, particularly for people with dementia who require complex care, said Dr. Rajesh Aggarwal, a professor of surgery at Thomas Jefferson University and Jefferson Health in Philadelphia who wasn’t involved in the study.

“Greater education and experience will undoubtedly make the nurse better able to manage the care cycle for these patients,” Aggarwal said by email.

The rest of the caregiving team also matters. “Nursing care is critically important, but should not overshadow the co-management of Alzheimer’s disease and dementia patients across the whole care team,” Aggarwal said.

Patients and families may want to go to hospitals where more nurses have college degrees, said Dr. Jennifer Watt, a geriatrician at St. Michael’s Hospital and the University of Toronto in Canada.

“All nurses must learn a core set of skills to provide safe and effective patient care,” Watt, who wasn’t involved in the study, said by email. “However, nurses with at least a bachelor’s degree have likely spent more time training to care for sicker patients with a greater burden of medical illnesses and who require more complicated medical care.”