Aim: People with dementia in rural Australia face significant barriers to specialist care, particularly for severe behavioural and psychological symptoms of dementia (BPSD). While specialised dementia units may improve outcomes, determinants of length of stay (LOS) are poorly defined. The aim is to examine the impact of patient rurality on LOS in a specialised dementia unit and compare post-discharge readmission and mortality outcomes between rural and urban patients.
Methods: This single-centre retrospective cohort study included admissions to a Specialised Advanced Dementia Unit (SADU) in South Australia between January 2022 and December 2023. Rurality was classified using the Modified Monash. The primary outcome was LOS.
Results: Ninety-one admissions were included (29 rural, 62 urban). Rural patients were younger, more physically robust, had fewer formal supports and higher BPSD severity at admission. Median LOS was longer for rural patients (107 vs 85 days), though this was not statistically significant (p=0.19). Higher BPSD severity at admission was independently associated with longer LOS (p=0.01), whereas rurality was not. Thirty-day readmission rates were higher in rural patients (17.2% vs 8.1%), predominantly due to BPSD. 12-month readmission and mortality rates were similar between groups.
Conclusions: Patients from rural backgrounds admitted with severe BPSD experienced longer admissions and higher early readmission rates, although rurality was not an independent predictor of LOS. Severity of BPSD was the dominant determinant of prolonged admission. These findings highlight the complexity of managing severe BPSD in rural populations and underscore the need for strengthened specialist and post-discharge supports for rural patients.