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      Cognitive Aging Trajectories and Burdens of Disability, Hospitalization and Nursing Home Admission Among Community-living Older Persons

      Author(s): , , ,
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      Journal: The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
      Publisher: Oxford University Press (OUP)

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          Abstract

          <div class="section"> <a class="named-anchor" id="d711643e197"> <!-- named anchor --> </a> <h5 class="section-title" id="d711643e198">Background.</h5> <p id="d711643e200">The course of cognitive aging has demonstrated substantial heterogeneity. This study attempted to identify distinctive cognitive trajectories and examine their relationship with burdens of disability, hospitalization, and nursing home admission. </p> </div><div class="section"> <a class="named-anchor" id="d711643e202"> <!-- named anchor --> </a> <h5 class="section-title" id="d711643e203">Methods.</h5> <p id="d711643e205">Seven hundred and fifty-four community-living persons aged 70 years or older in the Yale Precipitating Events Project were assessed with the Mini-Mental State Examination every 18 months for up to 108 months. A group-based trajectory model was used to determine cognitive aging trajectories while adjusting for age, sex, and education. Cumulative burden of disabilities, hospitalizations, and nursing home admissions over 141 months associated with the cognitive trajectories were evaluated using a generalized estimating equation Poisson model. </p> </div><div class="section"> <a class="named-anchor" id="d711643e207"> <!-- named anchor --> </a> <h5 class="section-title" id="d711643e208">Results.</h5> <p id="d711643e210">Five distinct cognitive trajectories were identified, with about a third of participants starting with high baseline cognitive function and demonstrating <i>No decline</i> during the follow-up period. The remaining participants diverged with <i>Minimal</i> (prevalence 41%), <i>Moderate</i> (16%), <i>Progressive</i> (8%), and <i>Rapid</i> (3%) cognitive decline. Participants with <i>No decline</i> incurred the lowest incidence rates (per 1,000 person-months) of disability in activities of daily living (ADL; 75, 95% confidence intervals: 60–95) and instrumental ADL (492, 453–535), hospitalization (29, 26–33) and nursing home admission (18, 12–27), whereas participants on the <i>Rapid</i> trajectory experienced the greatest burden of ADL disability (612, 595–758) and those on the <i>Progressive</i> trajectory had the highest nursing home admission (363, 292–451). </p> </div><div class="section"> <a class="named-anchor" id="d711643e237"> <!-- named anchor --> </a> <h5 class="section-title" id="d711643e238">Conclusions.</h5> <p id="d711643e240">Community-living older persons follow distinct cognitive aging trajectories and experience increasing burdens of disability, hospitalization, and nursing home placement as they age, with greater burdens for those on a declining cognitive trajectory. </p> </div>

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          Prevalence of Dementia in the United States: The Aging, Demographics, and Memory Study

          B.L. Plassman, K.M. Langa, G.G. Fisher … (2007)
          Aim: To estimate the prevalence of Alzheimer’s disease (AD) and other dementias in the USA using a nationally representative sample. Methods: The Aging, Demographics, and Memory Study sample was composed of 856 individuals aged 71 years and older from the nationally representative Health and Retirement Study (HRS) who were evaluated for dementia using a comprehensive in-home assessment. An expert consensus panel used this information to assign a diagnosis of normal cognition, cognitive impairment but not demented, or dementia (and dementia subtype). Using sampling weights derived from the HRS, we estimated the national prevalence of dementia, AD and vascular dementia by age and gender. Results: The prevalence of dementia among individuals aged 71 and older was 13.9%, comprising about 3.4 million individuals in the USA in 2002. The corresponding values for AD were 9.7% and 2.4 million individuals. Dementia prevalence increased with age, from 5.0% of those aged 71–79 years to 37.4% of those aged 90 and older. Conclusions: Dementia prevalence estimates from this first nationally representative population-based study of dementia in the USA to include subjects from all regions of the country can provide essential information for effective planning for the impending healthcare needs of the large and increasing number of individuals at risk for dementia as our population ages.
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            Prevalence of cognitive impairment without dementia in the United States.

            Brenda Plassman (2008)
            Cognitive impairment without dementia is associated with increased risk for disability, increased health care costs, and progression to dementia. There are no population-based prevalence estimates of this condition in the United States. To estimate the prevalence of cognitive impairment without dementia in the United States and determine longitudinal cognitive and mortality outcomes. Longitudinal study from July 2001 to March 2005. In-home assessment for cognitive impairment. Participants in ADAMS (Aging, Demographics, and Memory Study) who were age 71 years or older drawn from the nationally representative HRS (Health and Retirement Study). Of 1770 selected individuals, 856 completed initial assessment, and of 241 selected individuals, 180 completed 16- to 18-month follow-up assessment. Assessments, including neuropsychological testing, neurologic examination, and clinical and medical history, were used to assign a diagnosis of normal cognition, cognitive impairment without dementia, or dementia. National prevalence rates were estimated by using a population-weighted sample. In 2002, an estimated 5.4 million people (22.2%) in the United States age 71 years or older had cognitive impairment without dementia. Prominent subtypes included prodromal Alzheimer disease (8.2%) and cerebrovascular disease (5.7%). Among participants who completed follow-up assessments, 11.7% with cognitive impairment without dementia progressed to dementia annually, whereas those with subtypes of prodromal Alzheimer disease and stroke progressed at annual rates of 17% to 20%. The annual death rate was 8% among those with cognitive impairment without dementia and almost 15% among those with cognitive impairment due to medical conditions. Only 56% of the nondeceased target sample completed the initial assessment. Population sampling weights were derived to adjust for at least some of the potential bias due to nonresponse and attrition. Cognitive impairment without dementia is more prevalent in the United States than dementia, and its subtypes vary in prevalence and outcomes.
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              Association of incident dementia with hospitalizations.

              Elizabeth A. Phelan, Soo Borson, Louis Grothaus … (2012)
              Dementia is associated with increased rates and often poorer outcomes of hospitalization, including worsening cognitive status. New evidence is needed to determine whether some admissions of persons with dementia might be potentially preventable. To determine whether dementia onset is associated with higher rates of or different reasons for hospitalization, particularly for ambulatory care-sensitive conditions (ACSCs), for which proactive outpatient care might prevent the need for a hospital stay. Retrospective analysis of hospitalizations among 3019 participants in Adult Changes in Thought (ACT), a longitudinal cohort study of adults aged 65 years or older enrolled in an integrated health care system. All participants had no dementia at baseline and those who had a dementia diagnosis during biennial screening contributed nondementia hospitalizations until diagnosis. Automated data were used to identify all hospitalizations of all participants from time of enrollment in ACT until death, disenrollment from the health plan, or end of follow-up, whichever came first. The study period spanned February 1, 1994, to December 31, 2007. Hospital admission rates for patients with and without dementia, for all causes, by type of admission, and for ACSCs. Four hundred ninety-four individuals eventually developed dementia and 427 (86%) of these persons were admitted at least once; 2525 remained free of dementia and 1478 (59%) of those were admitted at least once. The unadjusted all-cause admission rate in the dementia group was 419 admissions per 1000 person-years vs 200 admissions per 1000 person-years in the dementia-free group. After adjustment for age, sex, and other potential confounders, the ratio of admission rates for all-cause admissions was 1.41 (95% confidence interval [CI], 1.23-1.61; P < .001), while for ACSCs, the adjusted ratio of admission rates was 1.78 (95% CI, 1.38-2.31; P < .001). Adjusted admission rates classified by body system were significantly higher in the dementia group for most categories. Adjusted admission rates for all types of ACSCs, including bacterial pneumonia, congestive heart failure, dehydration, duodenal ulcer, and urinary tract infection, were significantly higher among those with dementia. Among our cohort aged 65 years or older, incident dementia was significantly associated with increased risk of hospitalization, including hospitalization for ACSCs.
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                Author and article information

                Journal
                Title: The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
                Abbreviated Title: GERONA
                Publisher: Oxford University Press (OUP)
                ISSN (Print): 1079-5006
                ISSN (Electronic): 1758-535X
                Publication date Created: May 12 2016
                Publication date Created: June 2016
                Publication date (Print): June 2016
                Publication date (Electronic): October 28 2015
                Volume: 71
                Issue: 6
                Pages: 766-771
                Article
                DOI: 10.1093/gerona/glv159
                PMC ID: 4888384
                PubMed ID: 26511011
                SO-VID: de44bcea-f7e4-4f1e-9fb1-5acf1816614e
                Copyright © © 2015
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