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Lutski M, Shahar R, Vered S, Novick D, Zucker I, Weinstein G. Hospitalizations in older-adults newly diagnosed with dementia: A population-based longitudinal study in Israel. Int J Geriatr Psychiatry 2023; 38:e5871. [PMID: 36683135 PMCID: PMC10108175 DOI: 10.1002/gps.5871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To compare inpatient burden (i.e. likelihood of hospitalization, number of admissions and length of stay) in persons with newly diagnosed dementia to the general population without dementia. Additionally, to evaluate whether inpatient burden is increased during the years prior to and post dementia diagnosis, and to identify factors associated with increased inpatient burden. METHOD The Israeli National Dementia Dataset (2016) was cross-linked with the National Hospital Discharge Database of the Israeli Ministry of Health (2014-2018). Dementia definition was based on documented dementia diagnoses and/or the purchase of medications during 2016. Mixed-effects models were applied to identify demographic and health characteristics associated with inpatient burden in the one and 2 years prior to and after dementia diagnosis. RESULTS The dataset included 11,625 individuals aged ≥65 years, identified as incident dementia cases. Compared to the general population of older-adults without dementia, those with newly diagnosed dementia had a higher age-standardized proportion of hospitalizations (26.4% vs. 40%). The odds for hospitalization were highest during the year preceding dementia diagnosis (OR = 3.19, 95% CI 2.51-4.06) compared to 2 years prior to diagnosis, and remained high (although slightly decreased) after dementia diagnosis. Older age was associated with inpatient burden after, but not prior to dementia diagnosis. CONCLUSIONS Older persons with dementia are a vulnerable population group with increased utilization of inpatient burden compared to those without dementia, particularly in the years surrounding dementia diagnosis. Sociodemographic risk factors may differ with respect to the time surrounding dementia diagnosis.
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Affiliation(s)
- Miri Lutski
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel.,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Rotem Shahar
- School of Public Health, University of Haifa, Haifa, Israel
| | - Shiraz Vered
- School of Public Health, University of Haifa, Haifa, Israel
| | - Deborah Novick
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Inbar Zucker
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel.,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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Helvik AS, Barca ML, Bergh S, Šaltytė-Benth J, Kirkevold Ø, Borza T. The course of depressive symptoms with decline in cognitive function - a longitudinal study of older adults receiving in-home care at baseline. BMC Geriatr 2019; 19:231. [PMID: 31443638 PMCID: PMC6708209 DOI: 10.1186/s12877-019-1226-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/25/2019] [Indexed: 11/26/2022] Open
Abstract
Background Depressive symptoms in old age are common, but the prevalence, persistence, and incidence of depressive symptoms in older adults with and without dementia receiving in-home care is less well studied, and descriptions of the relationship between severity of cognitive decline and depressive symptoms over time is, to our knowledge, lacking. The aim of the present study was to describe the prevalence, incidence and persistence of depressive symptoms over a 36-month follow-up period among older adults receiving in-home care at baseline, and to explore the association between cognitive function and the course of depressive symptoms over time. Methods In all, 1001 older people (≥ 70 years) receiving in-home care were included in a longitudinal study with three assessments over 36 months. Depressive symptoms were assessed using the Cornell Scale for Depression in Dementia. Clinical Dementia Rating Scale, diagnosis of dementia and mild cognitive impairment, general medical health, personal and instrumental activities of daily living, neuropsychiatric symptoms and the use of psychotropic medication were evaluated during the three assessments. Baseline demographic characteristics and information on nursing home residency at follow-up were recorded. Linear mixed models were estimated. Results The baseline prevalence and cumulative incidence of single depressive symptoms were higher in those with dementia at baseline than in those without dementia. The persistence of depressive symptoms did not differ between those with or without dementia at baseline. The severity of cognitive impairment and mean depressive symptom score assessed simultaneously were positively associated, but the strength of the association changed over time and was not significant at the last assessment. Furthermore, being younger, female, in very poor physical health, with neuropsychiatric symptoms and not becoming a nursing home resident were associated with more depressive symptoms when assessed simultaneously. Conclusion The baseline prevalence and cumulative incidence of depressive symptoms in those with and without dementia at baseline, as well as the relationship we found between the degree of cognitive decline and depressive symptoms over time show that depression and dementia are interconnected. Nurses and clinicians should pay attention to cognitive status when observing or evaluating depression among older adults receiving in-home care.
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Affiliation(s)
- Anne-Sofie Helvik
- General Practice Research Unit, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Postboks 8905, NO-7491, Trondheim, Norway. .,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. .,St Olavs University Hospital, Trondheim, Norway.
| | - Maria Lage Barca
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Sverre Bergh
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Jūratė Šaltytė-Benth
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Clinical Medicine, University of Oslo, Campus Ahus, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Øyvind Kirkevold
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.,Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Tom Borza
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
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7
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James BD, Wilson RS, Capuano AW, Boyle PA, Shah RC, Lamar M, Ely EW, Bennett DA, Schneider JA. Cognitive decline after elective and nonelective hospitalizations in older adults. Neurology 2019; 92:e690-e699. [PMID: 30635482 DOI: 10.1212/wnl.0000000000006918] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/14/2018] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To determine whether emergent and urgent (nonelective) hospitalizations are associated with faster acceleration of cognitive decline compared to elective hospitalizations, accounting for prehospital decline. METHODS Data came from the Rush Memory and Aging Project, a prospective cohort study of community-dwelling older persons without baseline dementia. Annual measures of cognition via a battery of 19 tests were linked to 1999 to 2010 Medicare claims records. RESULTS Of 777 participants, 460 (59.2%) were hospitalized over a mean of 5.0 (SD = 2.6) years; 222 (28.6%) had at least one elective and 418 (53.8%) at least one nonelective hospitalization. Mixed-effects regression models estimated change in global cognition before and after each type of hospitalization compared to no hospitalization, adjusted for age, sex, education, medical conditions, length of stay, surgery, intensive care unit, and comorbidities. Persons who were not hospitalized had a mean loss of 0.051 unit global cognition per year. In comparison, there was no significant difference in rate of decline before (0.044 unit per year) or after (0.048 unit per year) elective hospitalizations. In contrast, decline before nonelective hospitalization was faster (0.076 unit per year; estimate = -0.024, SE = 0.011, p = 0.032), and accelerated by 0.036 unit (SE = 0.005, p < 0.001) to mean loss of 0.112 unit per year after nonelective hospitalizations, more than doubling the rate in those not hospitalized. CONCLUSIONS Nonelective hospitalizations are related to more dramatic acceleration in cognitive decline compared to elective hospitalizations, even after accounting for prehospital decline. These findings may inform which hospital admissions pose the greatest risk to the cognitive health of older adults.
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Affiliation(s)
- Bryan D James
- From the Rush Alzheimer's Disease Center (B.D.J., R.S.W., A.W.C., P.A.B., R.C.S., M.L., D.A.B., J.A.S.), Departments of Internal Medicine (B.D.J.), Neurological Sciences (R.S.W., A.W.C., M.L., D.A.B., J.A.S.), Behavioral Sciences (R.S.W., P.A.B.), Family Medicine (R.C.S.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL; Center for Quality of Aging (E.W.E.), Vanderbilt Medical School, Nashville; Division of Allergy, Pulmonary, and Critical Care Medicine (E.W.E.), Vanderbilt University, Nashville; and Veterans Affairs Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC) (E.W.E.), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN.
| | - Robert S Wilson
- From the Rush Alzheimer's Disease Center (B.D.J., R.S.W., A.W.C., P.A.B., R.C.S., M.L., D.A.B., J.A.S.), Departments of Internal Medicine (B.D.J.), Neurological Sciences (R.S.W., A.W.C., M.L., D.A.B., J.A.S.), Behavioral Sciences (R.S.W., P.A.B.), Family Medicine (R.C.S.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL; Center for Quality of Aging (E.W.E.), Vanderbilt Medical School, Nashville; Division of Allergy, Pulmonary, and Critical Care Medicine (E.W.E.), Vanderbilt University, Nashville; and Veterans Affairs Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC) (E.W.E.), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN
| | - Ana W Capuano
- From the Rush Alzheimer's Disease Center (B.D.J., R.S.W., A.W.C., P.A.B., R.C.S., M.L., D.A.B., J.A.S.), Departments of Internal Medicine (B.D.J.), Neurological Sciences (R.S.W., A.W.C., M.L., D.A.B., J.A.S.), Behavioral Sciences (R.S.W., P.A.B.), Family Medicine (R.C.S.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL; Center for Quality of Aging (E.W.E.), Vanderbilt Medical School, Nashville; Division of Allergy, Pulmonary, and Critical Care Medicine (E.W.E.), Vanderbilt University, Nashville; and Veterans Affairs Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC) (E.W.E.), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN
| | - Patricia A Boyle
- From the Rush Alzheimer's Disease Center (B.D.J., R.S.W., A.W.C., P.A.B., R.C.S., M.L., D.A.B., J.A.S.), Departments of Internal Medicine (B.D.J.), Neurological Sciences (R.S.W., A.W.C., M.L., D.A.B., J.A.S.), Behavioral Sciences (R.S.W., P.A.B.), Family Medicine (R.C.S.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL; Center for Quality of Aging (E.W.E.), Vanderbilt Medical School, Nashville; Division of Allergy, Pulmonary, and Critical Care Medicine (E.W.E.), Vanderbilt University, Nashville; and Veterans Affairs Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC) (E.W.E.), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN
| | - Raj C Shah
- From the Rush Alzheimer's Disease Center (B.D.J., R.S.W., A.W.C., P.A.B., R.C.S., M.L., D.A.B., J.A.S.), Departments of Internal Medicine (B.D.J.), Neurological Sciences (R.S.W., A.W.C., M.L., D.A.B., J.A.S.), Behavioral Sciences (R.S.W., P.A.B.), Family Medicine (R.C.S.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL; Center for Quality of Aging (E.W.E.), Vanderbilt Medical School, Nashville; Division of Allergy, Pulmonary, and Critical Care Medicine (E.W.E.), Vanderbilt University, Nashville; and Veterans Affairs Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC) (E.W.E.), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN
| | - Melissa Lamar
- From the Rush Alzheimer's Disease Center (B.D.J., R.S.W., A.W.C., P.A.B., R.C.S., M.L., D.A.B., J.A.S.), Departments of Internal Medicine (B.D.J.), Neurological Sciences (R.S.W., A.W.C., M.L., D.A.B., J.A.S.), Behavioral Sciences (R.S.W., P.A.B.), Family Medicine (R.C.S.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL; Center for Quality of Aging (E.W.E.), Vanderbilt Medical School, Nashville; Division of Allergy, Pulmonary, and Critical Care Medicine (E.W.E.), Vanderbilt University, Nashville; and Veterans Affairs Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC) (E.W.E.), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN
| | - E Wesley Ely
- From the Rush Alzheimer's Disease Center (B.D.J., R.S.W., A.W.C., P.A.B., R.C.S., M.L., D.A.B., J.A.S.), Departments of Internal Medicine (B.D.J.), Neurological Sciences (R.S.W., A.W.C., M.L., D.A.B., J.A.S.), Behavioral Sciences (R.S.W., P.A.B.), Family Medicine (R.C.S.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL; Center for Quality of Aging (E.W.E.), Vanderbilt Medical School, Nashville; Division of Allergy, Pulmonary, and Critical Care Medicine (E.W.E.), Vanderbilt University, Nashville; and Veterans Affairs Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC) (E.W.E.), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN
| | - David A Bennett
- From the Rush Alzheimer's Disease Center (B.D.J., R.S.W., A.W.C., P.A.B., R.C.S., M.L., D.A.B., J.A.S.), Departments of Internal Medicine (B.D.J.), Neurological Sciences (R.S.W., A.W.C., M.L., D.A.B., J.A.S.), Behavioral Sciences (R.S.W., P.A.B.), Family Medicine (R.C.S.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL; Center for Quality of Aging (E.W.E.), Vanderbilt Medical School, Nashville; Division of Allergy, Pulmonary, and Critical Care Medicine (E.W.E.), Vanderbilt University, Nashville; and Veterans Affairs Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC) (E.W.E.), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN
| | - Julie A Schneider
- From the Rush Alzheimer's Disease Center (B.D.J., R.S.W., A.W.C., P.A.B., R.C.S., M.L., D.A.B., J.A.S.), Departments of Internal Medicine (B.D.J.), Neurological Sciences (R.S.W., A.W.C., M.L., D.A.B., J.A.S.), Behavioral Sciences (R.S.W., P.A.B.), Family Medicine (R.C.S.), and Pathology (J.A.S.), Rush University Medical Center, Chicago, IL; Center for Quality of Aging (E.W.E.), Vanderbilt Medical School, Nashville; Division of Allergy, Pulmonary, and Critical Care Medicine (E.W.E.), Vanderbilt University, Nashville; and Veterans Affairs Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC) (E.W.E.), Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN
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Helvik AS, Høgseth LD, Bergh S, Šaltytė-Benth J, Kirkevold Ø, Selbæk G. A 36-month follow-up of decline in activities of daily living in individuals receiving domiciliary care. BMC Geriatr 2015; 15:47. [PMID: 25888187 PMCID: PMC4406178 DOI: 10.1186/s12877-015-0047-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/31/2015] [Indexed: 12/01/2022] Open
Abstract
Background There have been few studies of how personal and instrumental activities of daily living (P-ADL and I-ADL) develop over time in older people receiving domiciliary care. This study aimed at assessing variables associated with the development of P-ADL and I-ADL functioning over a 36-month follow-up period, with a particular focus on cognitive functioning. Method In all, 1001 older people (≥70 years) receiving domiciliary care were included in a longitudinal study with three assessments of P-ADL and I-ADL functioning during 36 months. P-ADL and I-ADL were assessed using the Lawton and Brody’s Physical Self-Maintenance Scale and Instrumental Activities of Daily Living Scale, respectively. Mini Mental State Examination (MMSE), diagnosis of dementia and MCI, neuropsychiatric symptoms and use of psychotropic medication were also evaluated during the three assessments. Baseline demographic and general medical health information and information of being a nursing home resident at follow-up were recorded. Linear mixed models were estimated. Results There was a significant decline in P-ADL and I-ADL functioning throughout the follow-up. A lower MMSE sum-score, diagnosed MCI and dementia, a higher level of neuropsychiatric symptoms and the use of antipsychotics and antidepressants recorded at each assessment were associated with a decline in both P-ADL and I-ADL functioning. Furthermore, a decline in P-ADL and I-ADL functioning at follow-ups was associated with being male, a higher baseline age and in poorer medical health as well as residing in a nursing home at follow-up. Conclusion P-ADL and I-ADL functioning in older people worsened over time. The worsening was associated with lower MMSE sum-score, diagnosed MCI and dementia, poorer medical health, neuropsychiatric symptoms, use of psychotropic medication and being transferred to nursing home care. Clinicians should pay close attention to the assessment and treatment of these factors to help older people maintain their level of functioning for as long as possible.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Postbox 8905, NO7491, Trondheim, Norway. .,Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. .,St Olavs University Hospital, Trondheim, Norway.
| | - Lisbeth D Høgseth
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.
| | - Sverre Bergh
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.
| | - Jūratė Šaltytė-Benth
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway. .,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway. .,HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.
| | - Øyvind Kirkevold
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. .,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway. .,Faculty of Health, Care and Nursing, Gjøvik University College, Gjøvik, Norway.
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway. .,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway. .,Akershus University Hospital, Lørenskog, Norway.
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