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Bonares M, Fisher S, Quinn K, Wentlandt K, Tanuseputro P. Study protocol for the development and validation of a clinical prediction tool to estimate the risk of 1-year mortality among hospitalized patients with dementia. Diagn Progn Res 2024; 8:5. [PMID: 38500236 PMCID: PMC10949607 DOI: 10.1186/s41512-024-00168-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/05/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Patients with dementia and their caregivers could benefit from advance care planning though may not be having these discussions in a timely manner or at all. A prognostic tool could serve as a prompt to healthcare providers to initiate advance care planning among patients and their caregivers, which could increase the receipt of care that is concordant with their goals. Existing prognostic tools have limitations. We seek to develop and validate a clinical prediction tool to estimate the risk of 1-year mortality among hospitalized patients with dementia. METHODS The derivation cohort will include approximately 235,000 patients with dementia, who were admitted to hospital in Ontario from April 1st, 2009, to December 31st, 2017. Predictor variables will be fully prespecified based on a literature review of etiological studies and existing prognostic tools, and on subject-matter expertise; they will be categorized as follows: sociodemographic factors, comorbidities, previous interventions, functional status, nutritional status, admission information, previous health care utilization. Data-driven selection of predictors will be avoided. Continuous predictors will be modelled as restricted cubic splines. The outcome variable will be mortality within 1 year of admission, which will be modelled as a binary variable, such that a logistic regression model will be estimated. Predictor and outcome variables will be derived from linked population-level healthcare administrative databases. The validation cohort will comprise about 63,000 dementia patients, who were admitted to hospital in Ontario from January 1st, 2018, to March 31st, 2019. Model performance, measured by predictive accuracy, discrimination, and calibration, will be assessed using internal (temporal) validation. Calibration will be evaluated in the total validation cohort and in subgroups of importance to clinicians and policymakers. The final model will be based on the full cohort. DISCUSSION We seek to develop and validate a clinical prediction tool to estimate the risk of 1-year mortality among hospitalized patients with dementia. The model would be integrated into the electronic medical records of hospitals to automatically output 1-year mortality risk upon hospitalization. The tool could serve as a trigger for advance care planning and inform access to specialist palliative care services with prognosis-based eligibility criteria. Before implementation, the tool will require external validation and study of its potential impact on clinical decision-making and patient outcomes. TRIAL REGISTRATION NCT05371782.
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Affiliation(s)
- Michael Bonares
- Department of Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Stacey Fisher
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- ICES Ottawa, Ottawa, ON, Canada
| | - Kieran Quinn
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sinai Health System, Toronto, ON, Canada
- ICES Toronto, Toronto, ON, Canada
| | - Kirsten Wentlandt
- Department of Supportive Care, University Health Network, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- ICES Ottawa, Ottawa, ON, Canada
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Tseng PY, Wu CL, Chen JD, Ma KJ, Yao CY, Wang JY. Association between use of different long-term care services and risks of mental disorder and mortality as well as medical utilization. Front Psychiatry 2023; 14:1073030. [PMID: 37850103 PMCID: PMC10577215 DOI: 10.3389/fpsyt.2023.1073030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 09/04/2023] [Indexed: 10/19/2023] Open
Abstract
Objective This study sought to investigate mental disorder and mortality risks and medical utilization among various long-term care (LTC) services and examine the associated factors. Methods This retrospective cohort study used data from the National Health Insurance Research Database of the entire population of Taiwan recorded between 2006 and 2017. A total of 41,407 patients using LTC (study group) were identified and propensity score-matched with 41,407 LTC nonusers (control group) at a ratio of 1:1 according to sex, age, salary-based premium, comorbidity index score, and urbanization level. Patients were divided into four groups according to LTC service type. The age distribution was as follows: 50-60 years (10.47%), 61-70 years (14.48%), 71-80 years (35.59%), and 81 years and older (39.45%). The mean age was 70.18 years and 53.57% of female participants were included. The major statistical methods were the Cox proportional hazards model and the general linear model (GLM). Results Users of both institutional and inhome LTC services had the highest risk of mental disorder [adjusted hazard ratio (aHR) = 3.2]. The mean mortality rate in LTC nonusers was 46.2%, whereas that in LTC users was 90.4%, with the highest found among the users of both institutional and inhome LTC (90.6%). The institutional LTC users had the shortest survival time (4.1 years). According to the adjusted Cox model analysis, the odds of mortality was significantly higher among institutional LTC users than among inhome LTC users (aHR = 1.02). After the adjustment of covariates, adjusted GLM model results revealed that the annual medical expenditure per capita of LTC nonusers was NT$46,551, which was 1.6 times higher that of LTC users. Conclusion Users of both institutional and inhome LTC services have higher risk of mental disorder, shorter survival time, and lower medical utilization.
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Affiliation(s)
- Pei-Ying Tseng
- Department of Public Health, China Medical University, Taichung, Taiwan
- Department of Medical, Lee’s General Hospital, Miaoli, Taiwan
| | - Chia-Ling Wu
- Hospital Accreditation Department, Joint Commission of Taiwan, Taipei, Taiwan
| | - Jen-De Chen
- Department of Sports, National Changhua University of Education, Changhua, Taiwan
| | - Kai-Jie Ma
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chi-Yu Yao
- Department of Psychiatry, An-Nan Hospital, Tainan, Taiwan
| | - Jong-Yi Wang
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
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Lai YC, Tsai KT, Ho CH, Liao JY, Tseng WZ, Petersen I, Wang YC, Chen YH, Chiou HY, Hsiung CA, Yu SJ, Sampson EL, Chen PJ. Mortality rate and its determinants among people with dementia receiving home healthcare: a nationwide cohort study. Intern Emerg Med 2023; 18:2121-2130. [PMID: 37253992 DOI: 10.1007/s11739-023-03319-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/17/2023] [Indexed: 06/01/2023]
Abstract
People with dementia (PwD) who receive home healthcare (HHC) may have distressing symptoms, complex care needs and high mortality rates. However, there are few studies investigating the determinants of mortality in HHC recipients. To identify end-of-life care needs and tailor individualized care goals, we aim to explore the mortality rate and its determinants among PwD receiving HHC. We conducted a retrospective cohort study using a Taiwanese national population database. People with new dementia diagnosis in 2007-2016 who received HHC were included. We calculated the accumulative mortality rate and applied Poisson regression model to estimate the risk of mortality for each variable (adjusted risk ratios, aRR) with a 95% confidence interval (CI). We included 95,831 PwD and 57,036 (59.5%) of them died during the follow-up period (30.5% died in the first-year). Among comorbidities, cirrhosis was associated with the highest mortality risks (aRR 1.65, 95% CI 1.49-1.83). Among HHC-related factors, higher visit frequency of HHC (> 2 versus ≦1 times/month, aRR 3.52, 95% CI 3.39-3.66) and higher level of resource utilization group (RUG, RUG 4 versus 1, aRR = 1.38, 95% CI 1.25-1.51) were risk factor of mortality risk. Meanwhile, HHC provided by physician and nurse was related to reduced mortality risk (aRR 0.79, 95% CI 0.77-0.81) compared to those provided by nurse only. Anticipatory care planning and timely end-of life care should be integrated in light of the high mortality rate among PwD receiving HHC. Determinants associated with increased mortality risk facilitate the identification of high risk group and tailoring the appropriate care goals. Trial registration number: ClinicalTrials.gov Identifier is NCT04250103 which has been registered on 31st January 2020.
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Affiliation(s)
- Yi-Chen Lai
- Department of Emergency Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Kang-Ting Tsai
- Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jung-Yu Liao
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Wei-Zhe Tseng
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Irene Petersen
- Department of Primary Care and Population Sciences, UCL, University College London, London, UK
| | - Yi-Chi Wang
- Department of Family Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Yu-Han Chen
- Department of Family Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Hung-Yi Chiou
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Chao Agnes Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Sang-Ju Yu
- Taiwan Society of Home Health Care, Taipei, Taiwan
- Home Clinic Dulan, Taitung, Taiwan
| | - Elizabeth Lesley Sampson
- Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust, London, UK
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Ping-Jen Chen
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK.
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Mitchell L, Poss J, MacDonald M, Burke R, Keefe JM. Inter-provincial variation in older home care clients and their pathways: a population-based retrospective cohort study in Canada. BMC Geriatr 2023; 23:389. [PMID: 37365495 DOI: 10.1186/s12877-023-04097-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND In Canada, publicly-funded home care programs enable older adults to remain and be cared for in their home for as long as possible but they often differ in types of services offered, and the way services are delivered. This paper examines whether these differing approaches to care shape the pathway that home care clients will take. Older adult client pathways refer to trajectories within, and out of, the home care system (e.g., improvement, long term care (LTC) placement, death). METHODS A retrospective analysis of home care assessment data (RAI-HC was linked with health administrative data, long-term care admissions and vital statistics in Nova Scotia Health (NSH) and Winnipeg Regional Health Authority (WRHA). The study cohort consists of clients age 60 + years, admitted to home care between January 1, 2011 to December 31, 2013 and up to four years from baseline. Differences in home care service use, client characteristics and their pathways were tested across the two jurisdictions overall, and among the four discharge streams within jurisdictions using t-tests and chi-square tests of significance. RESULTS NS and WHRA clients were similar in age, sex, and marital status. NS clients had higher levels of need (ADL, cognitive impairment, CHESS) at base line and were more likely discharged to LTC (43% compared to 38% in WRHA). Caregiver distress was a factor correlated with being discharged to LTC. While a third remained as home care clients after 4 years; more than half were no longer in the community - either discharged to LTC placement or death. Such discharges occurred on average at around two years, a relatively short time period. CONCLUSIONS By following older clients over 4 years, we provide enhanced evidence of client pathways, the characteristics that influence these paths, as well as the length of time to the outcomes. This evidence is central to identification of clients at risk in the community and aids in planning for future home care servicing needs that will allow more older adults to remain living in the community.
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Affiliation(s)
| | - Jeffrey Poss
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | | | - Rosanne Burke
- Nova Scotia Centre On Aging, Mount Saint Vincent University, Halifax, NS, Canada
| | - Janice M Keefe
- Department of Family Studies and Gerontology and Director, Nova Scotia Centre On Aging, Mount Saint Vincent University, Halifax, NS, Canada
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Zarshenas S, Paulino C, Sénéchal I, Décary J, Dufresne A, Bourbonnais A, Aquin C, Bruneau MA, Champoux N, Belchior P, Couture M, Bier N. Application of the Person-Centered Care to Manage Responsive Behaviors in Clients with Major Neurocognitive Disorders: A Qualitative Single Case Study. Clin Gerontol 2023:1-13. [PMID: 36591952 DOI: 10.1080/07317115.2022.2162468] [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] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Our study aimed to describe "how" and "why" the person-centered care (PCC) approach was applied within a long-term care (LTC) community to manage responsive behaviors (RBs) in individuals with major neurocognitive disorders. METHODS A descriptive holistic single case study design was employed in the context of an LTC community in Quebec, using semi-structured interviews and non-participatory observations of experienced care providers working with clients with RBs, photographing the physical environment, and accessing documents available on the LTC community's public website. A thematic content analysis was used for data analysis. RESULTS The findings generated insight into the importance of considering multiple components of the LTC community to apply the PCC approach for managing RBs, including a) creating a homelike environment, b) developing a therapeutic relationship with clients, c) engaging clients in meaningful activities, and d) empowering care providers by offering essential resources. CONCLUSIONS Applying and implementing the PCC approach within an LTC community to manage clients' RBs is a long-term multi-dimensional process that requires a solid foundation. CLINICAL IMPLICATIONS These findings highlight the importance of considering multiple factors relevant to persons, environments, and meaningful activities to apply the PCC approach within LTC communities to manage RBs.
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Affiliation(s)
- Sareh Zarshenas
- Occupational Science and Occupational Therapy Department, University of Toronto, Toronto, Canada
| | - Carmela Paulino
- School of rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Isabelle Sénéchal
- School of rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Josianne Décary
- School of rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Audrey Dufresne
- School of rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Anne Bourbonnais
- Faculty of Nursing, Université de Montréal, Montréal, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-sud-de-l'île-de-Montréal, Montréal, Canada
| | - Chloé Aquin
- Institut universitaire de gériatrie de Montréal, CIUSSS Centre-sud-de-l'île-de-Montréal, Montréal, Canada
| | - Marie-Andrée Bruneau
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-sud-de-l'île-de-Montréal, Montréal, Canada
- Department of Psychiatry and Addictology, Université de Montréal, Montréal, Canada
| | - Nathalie Champoux
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-sud-de-l'île-de-Montréal, Montréal, Canada
- Department of Family Medicine, Université de Montréal, Montréal, Canada
| | - Patricia Belchior
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-sud-de-l'île-de-Montréal, Montréal, Canada
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
| | - Melanie Couture
- Centre for Research and Expertise in Social Gerontology, CIUSSS West-Central Montreal, Cote Saint-Luc, Canada
| | - Nathalie Bier
- School of rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-sud-de-l'île-de-Montréal, Montréal, Canada
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Berete F, Demarest S, Charafeddine R, De Ridder K, Vanoverloop J, Van Oyen H, Bruyère O, Van der Heyden J. Predictors of nursing home admission in the older population in Belgium: a longitudinal follow-up of health interview survey participants. BMC Geriatr 2022; 22:807. [PMID: 36266620 PMCID: PMC9585772 DOI: 10.1186/s12877-022-03496-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 09/27/2022] [Indexed: 11/14/2022] Open
Abstract
Background This study examines predictors of nursing home admission (NHA) in Belgium in order to contribute to a better planning of the future demand for nursing home (NH) services and health care resources. Methods Data derived from the Belgian 2013 health interview survey were linked at individual level with health insurance data (2012 tot 2018). Only community dwelling participants, aged ≥65 years at the time of the survey were included in this study (n = 1930). Participants were followed until NHA, death or end of study period, i.e., December 31, 2018. The risk of NHA was calculated using a competing risk analysis. Results Over the follow-up period (median 5.29 years), 226 individuals were admitted to a NH and 268 died without admission to a NH. The overall cumulative risk of NHA was 1.4, 5.7 and 13.1% at respectively 1 year, 3 years and end of follow-up period. After multivariable adjustment, higher age, low educational attainment, living alone and use of home care services were significantly associated with a higher risk of NHA. A number of need factors (e.g., history of falls, suffering from urinary incontinence, depression or Alzheimer’s disease) were also significantly associated with a higher risk of NHA. On the contrary, being female, having multimorbidity and increased contacts with health care providers were significantly associated with a decreased risk of NHA. Perceived health and limitations were both significant determinants of NHA, but perceived health was an effect modifier on limitations and vice versa. Conclusions Our findings pinpoint important predictors of NHA in older adults, and offer possibilities of prevention to avoid or delay NHA for this population. Practical implications include prevention of falls, management of urinary incontinence at home and appropriate and timely management of limitations, depression and Alzheimer’s disease. Focus should also be on people living alone to provide more timely contacts with health care providers. Further investigation of predictors of NHA should include contextual factors such as the availability of nursing-home beds, hospital beds, physicians and waiting lists for NHA. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03496-4.
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Affiliation(s)
- Finaba Berete
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium. .,Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
| | - Stefaan Demarest
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Rana Charafeddine
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Karin De Ridder
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | | | - Herman Van Oyen
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Olivier Bruyère
- WHO Collaborating Centre for Public Health aspects of musculoskeletal health and ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Johan Van der Heyden
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
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McKay MH, Pickens ND, Medley A, Evetts CL. Outcomes of Team-Centered, Occupational Adaptation-Based Versus Traditional Dementia Workforce Training : Résultats comparés d'une formation axée sur l'équipe et l'adaptation occupationnelle et de l'approche de formation traditionnelle pour le personnel travaillant auprès des personnes atteintes de démence. The Canadian Journal of Occupational Therapy 2021; 88:384-394. [PMID: 34668409 DOI: 10.1177/00084174211048017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Dementia workforce training aligned with Occupational Adaptation (OA) theory may facilitate teams resolving challenges in the care environment more than traditional skills-based (SB) training, although comparisons are needed. Purpose. This pilot study compared effectiveness of an OA and SB program on relative mastery and team development for dementia care teams at a continuing care retirement community. Method. In a quasi-experimental study, employees underwent nine sessions in an OA or SB program. Relative Mastery Measurement Scale and Team Development Measure results were collected pre-, mid-, post-intervention. A 3 × 2 ANOVA determined differences in group score changes across time. Findings. Data from 28 employees (14/group) showed group-by-time interaction reached statistical significance for both relative mastery (F = 3.17, df = 2, p = .05) and team development (F = 8.38, df = 2, p = .001). Implications. OA-based training may improve dementia care teams' collaborative mastery over real-world challenges. While preliminary findings inform program developers, further research must explore clinical effectiveness.
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Marrie RA, Maxwell C, Mahar A, Ekuma O, McClintock C, Seitz D, Groome P. Colorectal Cancer Survival in Multiple Sclerosis: A Matched Cohort Study. Neurology 2021; 97:e1447-e1456. [PMID: 34526374 PMCID: PMC8520388 DOI: 10.1212/wnl.0000000000012634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/16/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES We tested the hypothesis that overall and cancer-specific survival after a colorectal cancer diagnosis is lower in persons with multiple sclerosis (MS) than in those without MS using a retrospective matched cohort design. METHODS Using population-based administrative data in Manitoba and Ontario, we identified persons with MS from a validated case definition and linked these cohorts to cancer registries to identify those with colorectal cancer. We selected persons with colorectal cancer and without MS, matching 4:1 on birth year, sex, cancer diagnosis year, and region. We used Cox proportional hazards regression to compare all-cause survival between cohorts, adjusting for age at cancer diagnosis, cancer diagnosis year, income, region, and Elixhauser comorbidity score. We compared cancer-specific survival between cohorts using a cause-specific hazards model. We pooled findings across provinces using random-effects meta-analysis. Complementary analyses using a subcohort from Ontario, adjusted for cancer stage and disability status, as measured from the use of home care or long-term care services. RESULTS We included 338 MS cases and 1,352 controls with colorectal cancer. The mean (SD) age at cancer diagnosis was 64.7 (11.1) years. After adjustment, MS was associated with an increased hazard for all-cause death that was highest 6 months after diagnosis (hazard ratio [HR] 1.45, 95% confidence interval [CI] 1.19-1.76) and then declined over time (HR [95% CI] at 1 year 1.34 [1.09-1.63], 2 years 1.24 [0.99-1.56], 5 years 1.10 [0.80-1.50]). MS was associated with increased cancer-specific death at 6 months after diagnosis only (HR 1.29, 95% CI 1.04-1.61). After adjustment for cancer stage, MS was associated with an increased hazard of death due to any cause (1.60, 95% CI 1.16-2.21) and with cancer-specific death (HR 1.47, 95% CI 1.02-2.12). The association of MS and all-cause death was partially attenuated after adjustment for disability status (HR 1.37, 95% CI 0.97-1.92), as was the association with cancer-specific death (HR 1.34, 95% CI 0.91-1.97). DISCUSSION Overall and cancer-specific survival was lower in persons with than without MS in the early period after colorectal cancer diagnosis. Further study is warranted to determine what factors underlie these worse outcomes.
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Affiliation(s)
- Ruth Ann Marrie
- From the Department of Internal Medicine (R.A.M.), Department of Community Health Sciences (R.A.M., A.M.), and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; ICES (C. Maxwell), Toronto; Schools of Pharmacy and Public Health and Health Systems (C. Maxwell), University of Waterloo; ICES Queen's (A.M., C. McClintock, D.S., P.G.) and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Ontario; and Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary, Alberta, Canada.
| | - Colleen Maxwell
- From the Department of Internal Medicine (R.A.M.), Department of Community Health Sciences (R.A.M., A.M.), and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; ICES (C. Maxwell), Toronto; Schools of Pharmacy and Public Health and Health Systems (C. Maxwell), University of Waterloo; ICES Queen's (A.M., C. McClintock, D.S., P.G.) and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Ontario; and Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Alyson Mahar
- From the Department of Internal Medicine (R.A.M.), Department of Community Health Sciences (R.A.M., A.M.), and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; ICES (C. Maxwell), Toronto; Schools of Pharmacy and Public Health and Health Systems (C. Maxwell), University of Waterloo; ICES Queen's (A.M., C. McClintock, D.S., P.G.) and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Ontario; and Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Okechukwu Ekuma
- From the Department of Internal Medicine (R.A.M.), Department of Community Health Sciences (R.A.M., A.M.), and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; ICES (C. Maxwell), Toronto; Schools of Pharmacy and Public Health and Health Systems (C. Maxwell), University of Waterloo; ICES Queen's (A.M., C. McClintock, D.S., P.G.) and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Ontario; and Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Chad McClintock
- From the Department of Internal Medicine (R.A.M.), Department of Community Health Sciences (R.A.M., A.M.), and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; ICES (C. Maxwell), Toronto; Schools of Pharmacy and Public Health and Health Systems (C. Maxwell), University of Waterloo; ICES Queen's (A.M., C. McClintock, D.S., P.G.) and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Ontario; and Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Dallasl Seitz
- From the Department of Internal Medicine (R.A.M.), Department of Community Health Sciences (R.A.M., A.M.), and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; ICES (C. Maxwell), Toronto; Schools of Pharmacy and Public Health and Health Systems (C. Maxwell), University of Waterloo; ICES Queen's (A.M., C. McClintock, D.S., P.G.) and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Ontario; and Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Patti Groome
- From the Department of Internal Medicine (R.A.M.), Department of Community Health Sciences (R.A.M., A.M.), and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg; ICES (C. Maxwell), Toronto; Schools of Pharmacy and Public Health and Health Systems (C. Maxwell), University of Waterloo; ICES Queen's (A.M., C. McClintock, D.S., P.G.) and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Ontario; and Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary, Alberta, Canada
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9
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Abstract
BACKGROUND Persons with dementia have higher mortality than the general population. Objective, standardized predictions of mortality risk in persons with dementia could help with planning resources for care close to the end of life. OBJECTIVE To systematically review prediction models for risk of death in persons with dementia. METHODS The Medline and PsycInfo databases were searched on November 29, 2020, for prediction models estimating the risk of death in persons with dementia. Study quality was assessed using the Prediction model Risk Of Bias ASsessment Tool. RESULTS The literature search identified 2,828 studies, of which 18 were included. These studies described 16 different prediction models with c statistics mostly ranging from 0.67 to 0.79. Five models were externally validated, of which four were applicable. There were two models that were both applicable and had reasonably low risk of bias. One model predicted risk of death at six months in persons with advanced dementia residing in a nursing home. The other predicted risk of death at three years in persons seen in primary care practice or a dementia specialty clinic, derived from a nationwide registry in Sweden but not externally validated. CONCLUSION Valid, applicable models with low risk of bias were found in two settings: advanced dementia in a nursing home and outpatient practices. The outpatient model requires external validation. Better models are needed for persons with mild to moderate dementia in nursing homes, a common demographic. These models may be useful for educating persons living with dementia and care partners and directing resources for end of life care.Registration:The study protocol is registered on PROSPERO as RD4202018076.
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Affiliation(s)
- Eric E Smith
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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10
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Wareing S, Sethares KA, Chin E, Ayotte B. Entry and Passage Variables Associated with Nursing Home Adjustment in Older Adults with Dementia. Geriatr Nurs 2021; 42:1084-1092. [PMID: 34418841 DOI: 10.1016/j.gerinurse.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
Abstract
A theory-guided non-experimental, descriptive, correlational design was used to evaluate how entry and passage variables were related to nursing home adjustment for individuals with dementia. Older adults with dementia may be unable to speak for themselves, therefore proxy responses of Certified Nursing Assistants (CNAs) provided the data for completion of the Nursing Home Adjustment Scale.1 Guided by the Meleis' Theory of Transitions, entry level factors (i.e. age, previous residence, gender, and choice), and passage variables (i.e. length of stay, extent of dementia, functional abilities, and depression) were entered into a regression equation as predictors of nursing home adjustment. Information about extent of dementia, functional abilities and depression was derived from the Minimum Data Set (MDS) maintained for all residents per Medicare and Medicaid guidelines. Descriptive and inferential statistics were calculated using IBM Statistical Package for the Social Sciences (SPSS) 26.0 software. Results indicated an inverse relationship between nursing home adjustment and depression as measured by the PHQ-9. There was no support for relationships among other variables. CNA proxy responses were found to be reliable in that they were significantly correlated with nursing responses on the same measure. This study supports the use of CNA proxy responses as a method to evaluate the experience of individuals with dementia.
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Affiliation(s)
- Susan Wareing
- Tristan Medical LLC, University of Massachusetts Dartmouth, United States.
| | | | | | - Brian Ayotte
- University of Massachusetts Dartmouth, United States
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11
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Manis DR, Rahim A, Poss JW, Bielska IA, Bronskill SE, Tarride JÉ, Abelson J, Costa AP. Do assisted living facilities that offer a dementia care program differ from those that do not? A population-level cross-sectional study in Ontario, Canada. BMC Geriatr 2021; 21:463. [PMID: 34399694 PMCID: PMC8365888 DOI: 10.1186/s12877-021-02400-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/24/2021] [Indexed: 02/23/2023] Open
Abstract
Background Many residents of assisted living facilities live with dementia, but little is known about the characteristics of assisted living facilities that provide specialized care for older adults who live with dementia. In this study, we identify the characteristics of assisted living facilities that offer a dementia care program, compared to those that do not offer such a program. Methods We conducted a population-level cross-sectional study on all licensed assisted living facilities in Ontario, Canada in 2018 (n = 738). Facility-level characteristics (e.g., resident and suite capacities, etc.) and the provision of the other 12 provincially regulated care services (e.g., pharmacist and medical services, skin and wound care, etc.) attributed to assisted living facilities were examined. Multivariable Poisson regression with robust standard errors was used to model the characteristics of assisted living facilities associated with the provision of a dementia care program. Results There were 123 assisted living facilities that offered a dementia care program (16.7% versus 83.3% no dementia care). Nearly half of these facilities had a resident capacity exceeding 140 older adults (44.7% versus 21.6% no dementia care) and more than 115 suites (46.3% versus 20.8% no dementia care). All assisted living facilities that offered a dementia care program also offered nursing services, meals, assistance with bathing and hygiene, and administered medications. After adjustment for facility characteristics and other provincially regulated care services, the prevalence of a dementia care program was nearly three times greater in assisted living facilities that offered assistance with feeding (Prevalence Ratio [PR] 2.91, 95% Confidence Interval [CI] 1.98 to 4.29), and almost twice as great among assisted living facilities that offered medical services (PR 1.78, 95% CI 1.00 to 3.17), compared to those that did not. Conclusions A dementia care program was more prevalent in assisted living facilities that housed many older adults, had many suites, and offered at least five of the other 12 regulated care services. Our findings deepen the understanding of specialized care for dementia in assisted living facilities. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02400-w.
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Affiliation(s)
- Derek R Manis
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada. .,ICES, Toronto, Ontario, Canada.
| | | | - Jeffrey W Poss
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Iwona A Bielska
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Jean-Éric Tarride
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada
| | - Julia Abelson
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada
| | - Andrew P Costa
- Centre for Health Economics and Policy Analysis, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, CRL-201, Hamilton, ON, L8S 4K1, Canada.,ICES, Toronto, Ontario, Canada.,Centre for Integrated Care, St. Joseph's Health System, Hamilton, Ontario, Canada.,Schlegel Research Institute for Aging, Waterloo, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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12
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Association Between Dementia Care Programs in Assisted Living Facilities and Transitions to Nursing Homes in Ontario, Canada: A Population-Based Cohort Study. J Am Med Dir Assoc 2021; 22:2115-2120.e6. [PMID: 34352202 DOI: 10.1016/j.jamda.2021.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/25/2021] [Accepted: 07/08/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We investigate whether older adults who were newly diagnosed with dementia (severity unspecified) and resided in an assisted living facility that offered a dementia care program had a lower rate of transition to a nursing home, compared to those who resided in an assisted living facility without such a program. DESIGN Population-based retrospective cohort study. SETTING AND PARTICIPANTS Linked, person-level health system administrative data on older adults who were newly diagnosed with dementia and resided in an assisted living facility in Ontario, Canada, from 2014 to 2019 (n = 977). METHODS Access to a dementia care program in an assisted living facility (n = 57) was examined. Multivariable Cox proportional hazards regression with robust standard errors clustered on the assisted living facility was used to model the time to transition to a nursing home from the new dementia diagnosis. RESULTS There were 11.8 transitions to a nursing home per 100 person-years among older adults who resided in an assisted living facility with a dementia care program, compared with 20.5 transitions to a nursing home per 100 person-years among older adults who resided in an assisted living facility without a dementia care program. After adjustment for relevant characteristics at baseline, older adults who resided in an assisted living facility with a dementia care program had a 40% lower rate of transition to a nursing home (hazard ratio 0.60, 95% confidence interval 0.44, 0.81), compared with those in an assisted living facility without such a program at any point during the follow-up period. CONCLUSIONS AND IMPLICATIONS The rate of transition to a nursing home was significantly lower among older adults who resided in an assisted living facility that offered a dementia care program. These findings support the expansion of dementia care programs in assisted living facilities.
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13
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Vanderkruk KR, Eberg M, Mahootchi T, Esensoy AV, Seitz DP. Trends of Dementia among Community-Dwelling Adults in Ontario, Canada, 2010-2015. Dement Geriatr Cogn Disord 2021; 49:286-294. [PMID: 32702695 DOI: 10.1159/000508687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/14/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND There are increasing numbers of people living with dementia (PLWD) and most reside in community settings. Characterizing the number of individuals affected with dementia and their transitions are important to understand in order to plan for their healthcare needs. Using administrative health data in Ontario, Canada, we examined recent trends in the prevalence and incidence of dementia among the community-dwelling population, described their characteristics, and investigated admissions to long-term care (LTC) and overall survival. METHODS Using a validated case ascertainment algorithm, we performed a population-based retrospective cohort study of community-dwelling PLWD aged 40-105 years old between 2010 and 2015. We assessed crude and age- and sex-adjusted prevalence and incidence, cohort characteristics, and time to LTC admission and survival. RESULTS Between 2010 and 2015, the adjusted community prevalence increased by 9.5% (p < 0.001), while the incidence decreased by 15.8% (p < 0.001). Demographic and socioeconomic characteristics remained similar over time, while the prevalence of comorbidities increased significantly from 2010 to 2015. There was no difference in the time to LTC admission for individuals diagnosed in 2014 when compared to 2010 (p = 0.06). A lower risk of 2-year mortality was observed for individuals diagnosed in 2015 compared to 2010 (HR 0.93, 95% CI 0.90-0.97, p < 0.001). CONCLUSION There was an increase in the prevalence of dementia despite decreasing incidence among community-dwelling PLWD. Lower rates of mortality indicate that PLWD are surviving longer following diagnosis. Adequate resources and planning are required to support this growing population, considering the changing population size and characteristics.
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Affiliation(s)
| | - Maria Eberg
- Data and Decision Sciences, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada,
| | - Tannaz Mahootchi
- Resource Optimization and Insights, Sun Life, Toronto, Ontario, Canada
| | - Ali Vahit Esensoy
- Klick Health, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Dallas Peter Seitz
- Institute for Clinical Evaluative Science (ICES) - Queen's, Kingston, Ontario, Canada.,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
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14
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Marrie RA, Maxwell C, Mahar A, Ekuma O, McClintock C, Seitz D, Groome P. Breast Cancer Survival in Multiple Sclerosis: A Matched Cohort Study. Neurology 2021; 97:e13-e22. [PMID: 34011575 DOI: 10.1212/wnl.0000000000012127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/19/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To test the hypotheses that overall survival and cancer-specific survival after breast cancer diagnosis would be lower in persons with multiple sclerosis (MS) as compared to persons without MS using a retrospective matched cohort design. METHODS We applied a validated case definition to population-based administrative data in Manitoba and Ontario, Canada, to identify women with MS. We linked the MS cohorts to cancer registries to identify women with breast cancer. Then we selected 4 breast cancer controls without MS matched on birth year, cancer diagnosis year, and region. We compared all-cause survival between cohorts using Cox proportional hazards regression adjusting for age at cancer diagnosis, cancer diagnosis period, income quintile, region, and Elixhauser comorbidity score. We compared cancer-specific survival between cohorts using a multivariable cause-specific hazards model. We pooled findings between provinces using meta-analysis. RESULTS We included 779 patients with MS and 3,116 controls with breast cancer. Most patients with stage data (1,976/2,822 [70.0%]) were diagnosed with stage I or II breast cancer and the mean (SD) age at diagnosis was 57.8 (10.7) years. After adjustment for covariates, MS was associated with a 28% increased hazard for all-cause mortality (hazard ratio [HR] 1.28; 95% confidence interval [CI] 1.08-1.53), but was not associated with altered cancer-specific survival (HR 0.98; 95% CI 0.65-1.46). CONCLUSION Women with MS have lower all-cause survival after breast cancer diagnosis than women without MS. Future studies should confirm these findings in other populations and identify MS-specific factors associated with worse prognosis.
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Affiliation(s)
- Ruth Ann Marrie
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada.
| | - Colleen Maxwell
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada
| | - Alyson Mahar
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada
| | - Okechukwu Ekuma
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada
| | - Chad McClintock
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada
| | - Dallas Seitz
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada
| | - Patti Groome
- From the Departments of Internal Medicine (R.A.M.) and Community Health Sciences (R.A.M., A.M.) and Manitoba Centre for Health Policy (A.M., O.E.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba; Schools of Pharmacy and Public Health & Health Systems (C.M.), University of Waterloo; ICES (C.M.), Toronto; ICES Queens (A.M., C.M., D.S., P.G.), Queens University, Kingston; Departments of Psychiatry and Community Health Sciences (D.S.), Cumming School of Medicine, University of Calgary; and Division of Cancer Care and Epidemiology (P.G.), Cancer Research Institute, Queen's University, Kingston, Canada
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15
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Rajamaki B, Hartikainen S, Tolppanen AM. The effect of comorbidities on survival in persons with Alzheimer's disease: a matched cohort study. BMC Geriatr 2021; 21:173. [PMID: 33750334 PMCID: PMC7941944 DOI: 10.1186/s12877-021-02130-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/02/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Alzheimer's disease (AD) is one of the leading causes of death world-wide, but little is known on the role of comorbidities on mortality among people with AD. We studied how comorbidities and age at AD diagnosis impact the survival of people with AD. METHODS The Medication Use and Alzheimer's disease (MEDALZ) cohort study included 70,718 community-dwelling persons in Finland with AD diagnosis from 2005 to 2011 and were matched 1:1 (age, gender, and hospital district) to people without AD (mean age 80 years, 65% women, and the mean follow-up 4.9 and 5.6 years, respectively). Covariates (age, gender, and socioeconomic position), comorbidities (cardiovascular disease, stroke, diabetes, asthma/ chronic obstructive pulmonary disease (COPD), hip fracture, cancer treatment, and mental or behavioral disorders excluding dementia) and survival data were obtained from nationwide registers. Cox proportional hazard models were used to compare risk of death between people with and without AD. RESULTS During the follow-up period a greater proportion of the AD cohort died compared to the non-AD cohort (63% versus 37%). In both cohorts, older age, male gender, lower socioeconomic position, and history of comorbidities were associated with shorter survival and higher risk of death. The associations of comorbidities with survival is weaker in the older age groups and people with AD. Hip fracture (adjusted HR 1.35, 95% CI 1.30-1.41), stroke (1.30, 1.27-1.34), and recent cancer treatment (1.29, 1.26-1.32) had the strongest associations in the AD cohort. Age modified the associations in both cohorts (weaker associations among older people). CONCLUSION Alzheimer's disease is the major factor affecting survival, but comorbidities further decrease survival also in individuals with Alzheimer's disease. Therefore, appropriate management of care of these comorbidities might affect not only survival but also the wellbeing of this vulnerable population.
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Affiliation(s)
- Blair Rajamaki
- School of Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.
| | - Sirpa Hartikainen
- School of Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
| | - Anna-Maija Tolppanen
- School of Pharmacy, Faculty of Health Sciences, Kuopio Campus, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
- Kuopio Research Centre of Geriatric Care, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
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