Dementia Admissions Research Articles

Associated adverse health outcomes of polypharmacy and potentially inappropriate medications in community-dwelling older adults with diabetes.

Aim: This study aimed to identify the association of chronic polypharmacy and potentially inappropriate medications (PIMs) with adverse health outcomes (AHOs) in community-dwelling older adults with diabetes in China. Methods: A 2-year retrospective cohort study was conducted using 11,829 community-followed older adults with diabetes and medical records from 83 hospitals and 702 primary care centers in Shenzhen, China. Chronic polypharmacy and PIMs were identified from prescription records using Beers' criteria, and their associated AHO was analyzed using multivariable logistic regression analysis. Results: The prevalence of chronic polypharmacy and at least one PIM exposure was 46.37% and 55.09%, respectively. The top five PIMs were diuretics, benzodiazepines, first-generation antihistamines, sulfonylureas, and insulin (sliding scale). Chronic polypharmacy was positively associated with all-cause hospital admission, admission for coronary heart disease, admission for stroke, admission for dementia, and emergency department visits. Exposure to PIMs was positively associated with all-cause hospital admission, admission for heart failure (PIMs ≥2), admission for stroke (PIMs ≥3), emergency department visits, bone fracture, constipation, and diarrhea. Conclusion: Chronic polypharmacy and PIMs were prevalent in older adults with diabetes in Chinese communities. Iatrogenic exposure to chronic polypharmacy and PIMs is associated with a higher incidence of different AHOs. This observational evidence highlights the necessity of patient-centered medication reviews for chronic polypharmacy and PIMs use in older patients with diabetes in primary care facilities in China and draws attention to the caution of polypharmacy, especially PIM use in older adults with diabetes in clinical practice.

Association between ambient temperature and dementia‐related hospital admissions in England

AbstractBackgroundThe impacts of a changing climate on dementia burdens have not been widely explored, despite the increasing pressures associated with dementia on the public health and social care systems. This study explores the association between ambient temperature and the dementia‐related emergency hospital admission, using the national hospital inpatient dataset for England. We also examine important modifiers of the heat‐risk, including separate results for each Government region of the country.MethodsDaily counts of emergency admissions with a primary diagnosis of dementia (ICD codes F00‐F03) and daily ambient temperature data from Met Office land surface stations were obtained for the period 2000‐2009 in England. Poisson regression was used to detect short‐term associations between daily mean temperature and daily counts of dementia admissions, adjusting for overdispersion and day‐of‐week effects, and including spline functions to model any underlying trends and seasonal patterns in the series. Distributed lag non‐linear models employing cross‐basis functions were used to characterise the exposure‐response relationship, at both national and regional levels at different lags of temperature; a 7‐day lag structure was used to explore potential delayed effects of temperature on the week leading up to admission. The modifying effects of age‐group, urban/rural residence, and quintiles of area‐level deprivation were also examined.ResultThere was some suggestion of seasonality in dementia admissions, with numbers peaking in the summer and winter months each year. After seasonal adjustment, there was an increase in the risk of dementia‐related hospital admission associated with high temperature, with adverse effects becoming apparent once daily mean temperatures rose above 15.0°C. At the national level, we estimated an approximately 10% increase in the risk of dementia admission for every 5°C increase in temperature above 15.0°C. When disaggregated by regions, the risk was highest in London. Separate results by age‐group, deprivation and urban/rural residence will be presented.ConclusionThe findings are likely to have important public health implications for priority settings, such as for hospital emergency department planning during hot seasons. The dangers of heat‐induced symptoms among dementia sufferers can be anticipated by caregivers whenever hot weather is forecast.

PCN123 Hospital Admissions Associated with Cancer Pain and Dementia in Older Adults

Our objective was to characterize the healthcare utilization and costs in hospitalized cancer pain patients with and without dementia in the United States. This cohort study used retrospective data from the 2012-2016 National Inpatient Sample. The sample included hospital admissions of individuals aged 60 or older with a primary diagnosis of cancer pain. Dementia was defined using ICD-9-CM and ICD-10-CM diagnosis codes. Healthcare utilization outcomes were: number of admissions, costs, and length of stay (LOS). Sample weights from NIS were applied to generate nationally representative estimates. Descriptive statistics and multivariable regression models were used to examine the relationship between dementia, costs, and LOS. We identified 60,170 admissions for cancer pain and 680 (1.1%) included a diagnosis of dementia. The mean age at admission was 70.5 for those without dementia and 78.5 for those with dementia (p = <0.0001). Constipation was present in 24.5% and 13.2% of non-dementia and dementia admissions, respectively (p = 0.0024). The total costs of all patient admissions for cancer pain was $127 million. The mean LOS was five days in persons with dementia and those without (p = 0.3499). Mean costs per admission were higher in persons without dementia ($10,736 vs. $9,022, p = 0.0304). In adjusted regression results, increased costs were associated with non-elective admissions and longer LOS, and decreased costs with age above the mean. In contrast, decreased LOS was associated with age above the mean and non-elective admissions. Dementia was associated with neither endpoint. Though dementia was not associated with increased healthcare utilization and costs, we did find substantial costs associated with cancer related pain admissions. These data provide information that may be used to provide improvements in pain management for persons with and without dementia living with cancer pain.

Patterns of hospital utilisation in the lead up to a diagnosis of dementia: A longitudinal retrospective study of hospital dementia patients in Australia.

To describe patterns of hospitalisation in the years preceding the first (index) admission coded with dementia. Retrospective longitudinal analysis of hospitalisation preceding an index admission for dementia for 7919 patients and a matched cohort in a regional local health district of New South Wales, Australia, from 1 July 2006 to 31 December 2016. The dementia cohort experienced a sharp increase in frequency of hospitalisation, particularly in the year pre-index, and primarily for falls and urinary tract infections. They also demonstrated more episodes for nervous and musculoskeletal illnesses and injuries than controls and visited emergency department more frequently with neurological illnesses and injuries. Findings highlight opportunities for earlier diagnosis of dementia in hospital, through more targeted screening and follow-up of suspected cases with comprehensive geriatric assessment prior to discharge. This may result in a definitive diagnosis on discharge, allowing for better coordination of ongoing management to prevent unnecessary readmissions.

Under-coding of dementia and other conditions indicates scope for improved patient management: A longitudinal retrospective study of dementia patients in Australia.

Under-coding of dementia during hospitalisation results in an inability to identify all patients with dementia using hospital administrative data. Clinical coding can be viewed as a proxy for management; therefore, under-coding indicates dementia was not considered in the patient's management. While under-coding of dementia is well established, there is sparse evidence on whether dementia is coded in subsequent hospitalisations among patients with a known diagnosis. (a) To describe patterns of dementia coding over 5 years after a first-coded (i.e. index) admission for dementia; (b) to identify factors associated with clinical coding of dementia; and (c) to identify patient subgroups at risk of not being coded to inform future interventions to improve hospital identification and management of dementia. Retrospective study of longitudinal hospital data from 1 July 2006 to 30 June 2015 for 7919 patients hospitalised during the 5 years' post-index admission for dementia in a regional local health district of New South Wales, Australia. Dementia was coded in 63.9% of admissions in the 12 months following index admission for dementia; this decreased to 53.7% after 5 years. Patients were 20% more likely to have dementia actively managed when it co-occurred with delirium. Under-coding varied across conditions, with dementia more likely to be coded in admissions for falls and pneumonitis, and less likely for heart failure, pneumonia and urinary tract infection (UTI). The frequency with which dementia was not coded highlights opportunities to improve identification and management of dementia through dementia-specific care, enhanced clinical protocols, and interventions focused around heart failure, pneumonia and UTI admissions.

Mining electronic health records to identify influential predictors associated with hospital admission of patients with dementia: an artificial intelligence approach

BackgroundEarly prediction of the outcomes of dementia is important and challenging. This study aimed to identify influential predictors from primary care electronic health records that can robustly predict whether patients with dementia will be admitted to hospital or remain under GP care. MethodsHealth records of patients with dementia were collected from general practice (GP) and hospital data in Wales between 1980 and 2015. These records were linked at individual patient level via the Secure Anonymised Information Linkage databank. The GP records of each patient were selected 1 year before diagnosis up to hospital admission. An artificial intelligence technique, neural network with entropy regularisation (a multilayer feedforward neural network whose weights between input layer and the first hidden layer were regularised by an entropy metric into the fitness function during training process) was used to automatically identify the most influential predictors from initial GP read codes, sex, and age. 10-fold cross validation was used to assess the predictive performance of the identified signals. Findings52·5 million individual records of 59 298 patients (20 674 men, 38 624 women) with dementia were used. 30 178 were admitted to hospital and 29 120 remained with GP care. More men were admitted to hospital than stayed with GP care (11 233 vs 9441), whereas more women stayed with GP care than were admitted (19 679 vs 18 945). From the 54 649 initial event codes, the ten most important signals identified for admission for dementia were two diagnostic events (nightmares, essential hypertension), five medication events (betahistine dihydrochloride, ibuprofen gel, simvastatin, influenza vaccine, calcium carbonate and colecalciferol chewable tablets), and three procedural events (third party encounter, social group 3—skilled, blood glucose raised). They performed significantly above chance to predict admission to hospital with sensitivity of 0·758 (95% CI 0·731–0·785), specificity 0·759 (0·71–0·808), precision 0·766 (0·735–0·797), and negative predictive value 0·751 (0·741–0·761). Linear regression with all raw features yielded values of 0·286 (0·26–0·313), 0·804 (0·792–0·816), 0·487 (0·463–0·511), and 0·633 (0·615–0·651), respectively, and with ten identified features yielded values of 0·684 (0·679–0·691), 0·712 (0·705–0·718), 0·747 (0·738–0·754), and 0·644 (0·64–0·651). InterpretationOutperforming traditional methods, the artificial intelligence technique provides an effective means of identifying influential clinical signals to predict hospital admission of patients with dementia significantly above chance. FundingHealth Data Research UK Wales and Northern Ireland Site, National Centre for Population Health and Wellbeing Research (CA02), Major Project of National Social Science Foundation of China (16ZDA0092), Guangxi University Digital ASEAN Cloud Big Data Security and Mining Technology Innovation Team.

Dementia and Alzheimer's disease risks in patients with autoimmune disorders.

To investigate an association between autoimmune disorders (AID) and hospitalization for dementia and Alzheimer's disease, and to study whether the risk is associated with follow-up time and age. We followed up all individuals in Sweden without previous hospital admission for dementia and Alzheimer's disease, and with a primary or secondary diagnosis of an AID between 1 January 1964 and 31 December 2010, in the Swedish National Patient Register for dementia and Alzheimer's disease. The Swedish National Patient Register includes both inpatients and outpatients. We calculated standardized incidence ratios (SIR) for dementia and Alzheimer's disease, adjusted for individual variables, including age, sex and comorbidities. A total of 788 103 individuals were admitted to hospital because of an autoimmune disorder without previous dementia and Alzheimer's disease. Among a total of 42 conditions of AID, 9998 dementia and Alzheimer's disease patients were identified with a SIR of 1.28 (95% CI 1.26-1.31). A total of 17 showed an increased risk, and of those the remaining, 14 conditions were still at risk, when dementia and Alzheimer's disease diagnosed in the year of AID diagnosed were excluded. The risks depended on the age at hospitalization for dementia and Alzheimer's disease. The present large study quantified the increased risks of dementia and Alzheimer's disease in patients with many types of AID. Geriatr Gerontol Int 2018; 18: 1350-1355.

A population-based study examining injury among older adults with and without dementia

ABSTRACTObjectiveTo estimate the incidence and risk factors for injuries among older adults with and without dementia.MethodsA retrospective, population-based cohort study was undertaken using the Western Australian Data Linkage System (WADLS). Cases included 29,671 (47.9%) older adults with an index hospital admission for dementia, aged 50+ years between 2001 and 2011. Comparison participants without dementia included a random sample of 32,277 (52.1%) older adults aged 50+ years from the State Electoral Roll. The outcome of interest was a hospital admission to a metropolitan tertiary hospital in Perth Western Australia for at least 24 hours with an injury as the principal diagnosis. Descriptive statistics were used to compare participants with and without dementia in terms of socio-demographic characteristics, co-morbid conditions, injury severity, cause of injury and length of stay in hospital. Population rates were calculated based on the relevant WA population data from the Australian Bureau of Statistics. Poisson regression with robust standard errors was used to examine risk factors for injuries in those with and without dementia, after adjusting for relevant confounders. ResultsThe age-standardised injury rates for older adults (60+ years) were 117 per 1,000 population with dementia and 24 per 1,000 population without dementia. The majority of injuries were caused by falls for both the dementia (94%) and non-dementia (87%) groups followed by transport-related injuries and burns. The results of the multivariable modelling found that older adults with a diagnosis of dementia had over double the risk of hospital admission for an injury compared to those without dementia (IRR=2.05; 95% CI=1.96-2.15). Other significant predictors of an admission for all-cause injury were older adults aged 85+ years (IRR=1.43; 95% CI=1.13-1.81), being unmarried (IRR=1.07; 95% CI=1.03-1.12) and a history of falls (IRR=1.03; 95% CI=1.01-1.06). Females were at reduced risk of injury (IRR=0.92; 95% CI=0.87-0.97).ConclusionsOlder adults with dementia were at increased risk of an admission for an injury compared to those without dementia. Multifactorial injury prevention programs should target older people with dementia, those over 85 years, living alone and with a history of previous falls.

A Population-Based Study Examining Injury in Older Adults with and without Dementia.

To estimate the incidence of and risk factors for injuries in older adults with and without dementia. Retrospective, population-based cohort study. Western Australian Data Linkage System (WADLS). Cases included 29,671 (47.9%) older adults aged 50 and older with an index hospital admission for dementia between 2001 and 2011. Comparison participants without dementia included a random sample of 32,277 (52.1%) older adults aged 50 and older from the state electoral roll. Hospital admission to a metropolitan tertiary hospital for at least 24 hours with an injury. Age-standardized all-cause injury rates for older adults with dementia (≥60) were 117 per 1,000 population and 24 per 1,000 population for older adults without dementia. Falls caused the majority of injuries for both groups (dementia, 94%; without dementia, 87%), followed by transport-related injuries and burns. Multivariate modeling found that older adults with a diagnosis of dementia had more than twice the risk of hospital admission for an injury than those without dementia (incidence rate ratio (IRR) = 2.05, 95% confidence interval (CI) = 1.96-2.15). Other significant risk factors for a hospital admission for injury were age 85 and older (IRR = 1.43, 95% CI = 1.13-1.81), being unmarried (IRR = 1.07, 95% CI = 1.03-1.12), and a history of falls (IRR = 1.03, 95% CI = 1.01-1.06). Women were at lower risk then men of a hospital admission due to an injury (IRR = 0.92, 95% CI = 0.87-0.97). Older adults with dementia are at greater risk of a hospital admission for an injury. Multifactorial injury prevention programs would benefit older adults with and without dementia, especially those aged 85 and older, living alone, and with a history of previous falls.

Counting the cost of dementia-related hospital admissions: A regional investigation.

At a time of increasing dementia prevalence, this research explores the cost of treatment and length of stay associated with the syndrome in a large regional hospital. Database analysis of 4332 recorded admissions to a large regional Australian hospital among adults aged 55 years and older during winter 2013 and 2014. Costs of hospital treatment and length of stay for people with a diagnosis of dementia who presented to a regional hospital were significantly greater than people with no diagnosis over two years. Costs were unrelated to age or likelihood of death in hospital. Prevalence of dementia admissions was low, but treated conditions indicate that the syndrome may be an underlying, and potentially unrecognised, factor in many admissions. Dementia imposes a large cost and resource burden on a regional hospital. Improved identification of the syndrome on admission and implementation of best-evidence management of dementia in regional hospitals may improve care efficiency.

Long-term PM2.5 Exposure and Neurological Hospital Admissions in the Northeastern United States.

BackgroundLong-term exposure to fine particles (particulate matter ≤ 2.5 μm; PM2.5) has been consistently linked to heart and lung disease. Recently, there has been increased interest in examining the effects of air pollution on the nervous system, with evidence showing potentially harmful effects on neurodegeneration.ObjectiveOur objective was to assess the potential impact of long-term PM2.5 exposure on event time, defined as time to first admission for dementia, Alzheimer’s (AD), or Parkinson’s (PD) diseases in an elderly population across the northeastern United States.MethodsWe estimated the effects of PM2.5 on first hospital admission for dementia, AD, and PD among all Medicare enrollees ≥ 65 years in 50 northeastern U.S. cities (1999–2010). For each outcome, we first ran a Cox proportional hazards model for each city, adjusting for prior cardiopulmonary-related hospitalizations and year, and stratified by follow-up time, age, sex, and race. We then pooled the city-specific estimates by employing a random effects meta-regression.ResultsWe followed approximately 9.8 million subjects and observed significant associations of long-term PM2.5 city-wide exposure with all three outcomes. Specifically, we estimated a hazard ratio (HR) of 1.08 (95% CI: 1.05, 1.11) for dementia, an HR of 1.15 (95% CI: 1.11, 1.19) for AD, and an HR of 1.08 (95% CI: 1.04, 1.12) for PD admissions per 1-μg/m3 increase in annual PM2.5 concentrations.ConclusionsTo our knowledge, this is the first study to examine the relationship between long-term exposure to PM2.5 and time to first hospitalization for common neurodegenerative diseases. We found strong evidence of association for all three outcomes. Our findings provide the basis for further studies, as the implications of such exposures could be crucial to public health.CitationKioumourtzoglou MA, Schwartz JD, Weisskopf MG, Melly SJ, Wang Y, Dominici F, Zanobetti A. 2016. Long-term PM2.5 exposure and neurological hospital admissions in the northeastern United States. Environ Health Perspect 124:23–29; http://dx.doi.org/10.1289/ehp.1408973

INCIDENCE OF DEMENTIA, ALZHEIMER'S DISEASE, PARKINSON'S DISEASE, AND EPILEPSY AMONG DANISH SEVENTH-DAY ADVENTISTS AND BAPTISTS

In search of neuroprotective life styles, to observe the incidences of the chronic disorders of dementia, Alzheimer's disease, Parkinson's disease and epilepsy among Danish Seventh Day Adventists (SDA) and Baptists compared to the Danish population. Hospital admissions for dementia, AD, PD and epilepsy were compared between members of the Danish Religious Societies Health Study (2003) comprising 6532 SDAs and 3720 Baptist with the general Danish population. Standardized incidence rates (SIR) stratified by sex, age and calendar time were calculated. The outcome was first hospital admission for dementia, AD, PD or epilepsy. Dementia and AD were combined to one outcome. From 1977 to 2009 256 cases of dementia and AD, 70 cases of PD and 96 cases of epilepsy among SDAs, 81 with dementia or AD, 33 with PD and 59 with epilepsy among BAPs. Both communities had significantly lower incidence rates than expected for dementia and AD, most pronounced for BAPs (SDA: 0,87 [0,77-0,98], BAP: 0,59[0,47-0,73]). The female SDA and the male BAP were of lowest risk. The risk of epilepsy was only marginally reduced, and the risk of PD was not different. This national cohort study shows positive association of membership of the religious cohorts of SDAs and BAPs and the risk of dementia and AD.This finding suggests that parts of the life style of the two communities, in particularly the BAPs, are delaying the onset of or protecting against dementia and AD.

Use of Statins and Risk of Hospitalization With Dementia

Several epidemiologic studies have indicated reduced risk of dementia among users of statins. We assessed the risk of hospitalization with dementia associated with use of statins in a population-based case-control study in 4 Northern Danish counties in the period 1991 to 2005. We identified 11,039 cases with dementia and 110,340 age- matched and sex-matched population controls using data from the National Patient Registry, the Danish Psychiatric Central Register, and the Civil Registration System. Prescriptions for statins filled before the admission for dementia were identified using population-based prescription databases. We used conditional logistic regression analysis to compute relative risk of hospitalization with dementia associated with use of statins using nonusers as reference group. We found an overall reduced risk of hospitalization with dementia among statin users (adjusted odds ratio: 0.67, 95% confidence intervals: 0.60-0.75). The reduced risk associated with statin use remained robust in various subanalyses, however, we found no clear dose-response pattern between the number of filled prescriptions for statin and the risk of hospitalization with dementia. In conclusion, we found a reduced risk of hospitalization with dementia among users of statins, however, whether this association is causal remains to be clarified.

Does the weather influence dementia admissions?

There is currently no literature on the relationship between weather parameters and admissions of organic brain syndromes such as dementias. In this present study we aimed to examine the effect of weather parameters such as relative humidity, sunshine hours, diurnal variations in temperature and rainfall on dementia admissions in North Cheshire. Daily number of hospital admissions of dementias and other diagnoses in North Cheshire was analysed in relation to meteorological data, which were measured at the nearest meterological office to the study population. The study found no evidence of any statistically significant association between weather parameters and dementia admissions. There was a weak, lagged inverse relationship between dementia admissions and relative humidity and a positive association with diurnal variations in temperature within a week of admission. However, neither finding achieved statistical significance. The study is the first in currently available literature on the subject and may therefore provide a base reference for future studies. The interesting observation relating to relative humidity and diurnal variations in temperature is unexpected and may suggest further research.

Effectiveness of Special Care Unit (SCU) placements in reducing physically aggressive behaviors in recently admitted dementia nursing home residents

Using a sample of new dementia admissions who entered selected nursing facilities December 1992 through June 1994, this paper compares special care dementia units (SCUs) to non-specialized (traditional) nursing home care in their effectiveness in reducing physically aggressive behaviors within six-months of placement. Findings indicate that SCUs admit younger and more highly aggressive residents. Our results indicate that when differences in age and baseline levels of disruptive behaviors are controlled, SCU placement showed no positive or negative effect on the frequency of aggressive behaviors. Rather than SCU placement, it was the increased use of psychotropic medications and the reduction in the use of physical restraints that showed a relationship with lower levels of physically aggressive behaviors. While SCUs do not appear to be the hoped for panacea with regard to reducing physically aggressive behaviors, they still appear to serve a useful function within the broader context of the provision of services for residents with dementia within the nursing home.

Characteristics of dementia admissions to standard nursing homes and to special care units

As a result of using admission criteria, the characteristics of special care unit (SCU) admissions are generally different from dementia admissions. As part of the National Evaluation of Special Care Units Project, all dementia admissions to a nationwide sample of SCUs and comparable non-SCU nursing facilities were screened during a 13-month recruitment window. Results show that SCU admissions are younger, more likely to be male, admitted from home, admitted under private-pay status, have recorded AD diagnoses, are independently mobile, and have fewer physical health problems. Program and policy implications of these findings are discussed.

Age-Specific Hospital Incidence Rates in Dementia

A random sample (n = 101,104) was taken from total general hospital admissions to Scottish hospitals (1:25 fraction) during the period 1968–1977. Record linkage was used to connect general hospital and psychiatric hospital morbidity records (SMR 1 and SMR 4). Patients with a subsequent admission with dementia (principal diagnosis ICD 9 290) were identified from the general hospital sample on follow-up. Age-specific first-admission rates for dementia were calculated for the hospital population considered. First-admission rates ranged from 41.9 (per 100,000 person-years-at-risk, PYR) for male patients aged 60–64 years to 514.2 in the age band 80 years and over. The equivalent figures for female patients were 40.8 (per 100,000 PYR) and 723.1. Epidemiological research has shown an approximate doubling of prevalence rates every 5 years after the age of 60 years, and the age-banded hospital admission rates in the present study are consistent with this underlying pattern. Expected first-admission rates in dementia were calculated from admission rates in dementia and community prevalence reported in previous studies. Expected rates were contrasted with the rates observed in the present study. An estimated 6-7% of prevalent dementia cases and between 11 and 14% of ‘expected dementia admissions’ achieved a recorded main diagnosis of dementia, and proportions were stable across age bands in the case of both measures. The wide discrepancy between expected and observed admission rates suggests relative underreporting of dementia as a principal diagnosis in hospital statistics.