Risk of death or hospital admission among community-dwelling older adults living with dementia in Australia

BMC Geriatrics

Colleen Doyle⁴  Stephen Vander Hoorn³  Vanessa White⁵  David Robert Dunt¹  Emily (Chuanmei) You² 

[1] Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Victoria 3010, Australia;Centre for Advanced Imaging, The University of Queensland, Brisbane Queensland 4072, Australia;Department of Mathematics and Statistics, Statistical Consulting Centre, The University of Melbourne, Victoria 3010, Australia;Australian Catholic University & Catholic Homes, Victoria 3065, Australia;Australian Institute for Primary Care & Ageing, Faculty of Health Sciences, La Trobe University, Victoria 3086, Australia

关键词: Dementia;    Risk factors;    Community-dwelling;    Death or hospital admission;   

Others  :  854655
DOI  :  10.1186/1471-2318-14-71

 received in 2014-01-28, accepted in 2014-06-03,  发布年份 2014

【 摘 要 】

Background

Older people living with dementia prefer to stay at home to receive support. But they are at high risk of death and/or hospital admissions. This study primarily aimed to determine risk factors for time to death or hospital admission (combined) in a sample of community-dwelling older people living with dementia in Australia. As a secondary study purpose, risk factors for time to death were also examined.

Methods

This study used the data of a previous project which had been implemented during September 2007 and February 2009. The original project had recruited 354 eligible clients (aged 70 and over, and living with dementia) for Extended Aged Care At home Dementia program services during September 2007 and 2008. Client information and carer stress had been collected from their case managers through a baseline survey and three-monthly follow-up surveys (up to four in total). The principal data collection tools included Global Deterioration Scale, Modified Barthel Index, Instrumental-Dependency OARS, Adapted Cohen-Mansfield Agitation Inventory, as well as measures of clients’ socio-demographic characteristics, service use and diseases diagnoses. The sample of our study included 284 clients with at least one follow-up survey. The outcome variable was death or hospital admission, and death during six, nine and 16-month study periods. Stepwise backwards multivariate Cox proportional hazards analysis was employed, and Kaplan-Meier survival analysis using censored data was displayed.

Results

Having previous hospital admissions was a consistent risk factor for time to death or hospital admission (six-month: HR = 3.12; nine-month: HR = 2.80; 16-month: HR = 2.93) and for time to death (six-month: HR = 2.27; 16-month: HR = 2.12) over time. Previously worse cognitive status was a consistent risk factor over time (six- and nine-month: HR = 0.58; 16-month: HR = 0.65), but no previous use of community care was only a short-term risk factor (six-month: HR = 0.42) for time to death or hospital admission.

Conclusions

Previous hospital admissions and previously worse cognitive status are target intervention areas for reducing dementia clients’ risk of time to death or hospital admission, and/or death. Having previous use of community care as a short-term protective factor for dementia clients’ time to death or hospital admission is noteworthy.

【 授权许可】

   
2014 You et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Gaugler J, Duval S, Anderson K, Kane R: Predicting nursing home admission in the U.S.: a meta-analysis. BMC Geriatr 2007, 7(13):13-13.
• [2]Badrakalimuthu V: Do people with dementia die at their preferred location of death? a systematic literature review and narrative synthesis. Age Ageing 2014, 43(1):13.
• [3]Eaker ED, Vierkant RA, Mickel SF: Predictors of nursing home admission and/or death in incident Alzheimer's disease and other dementia cases compared to controls: a population-based study. J Clin Epidemiol 2002, 55(5):462-468.
• [4]Chan D, Livingston G, Jones L, Sampson EL: Grief reactions in dementia carers: a systematic review. Int J Geriatric Psychiatry 2013, 28(1):1-17.
• [5]Gaugler J, Kane R, Kane R, Newcomer R: Unmet care needs and key outcomes in dementia. J Am Geriatr Soc 2005, 53(12):2098-2105.
• [6]Cohen-Mansfield J, Wirtz P: Predictors of entry to the nursing home: does length of follow-up matter? Arch Gerontol Geriatr 2011, 53(3):309-315.
• [7]Huang ME, Wartella JE, Kreutzer JS: Functional outcomes and quality of life in patients with brain tumors: a preliminary report. Archi Physical Med Rehabil 2001, 82(11):1540-1546.
• [8]Gaugler JE, Yu F, Krichbaum KF, Wyman J: Predictors of nursing home admission for persons with dementia. Med Care 2009, 47(2):191-198.
• [9]Luppa M, Luck T, Braehler E, Koenig H, Riedel-Heller S: Prediction of institutionalisation in dementia-a systematic review. Dement Geriatr Cogn Disord 2008, 26(1):65-78.
• [10]Luppa M, Luck T, Weyerer S, Knig H, Brhler E, Riedel-Heller S: Prediction of institutionalization in the elderly. Syst Rev Age Ageing 2010, 39(1):31-38.
• [11]Becker M, Boaz T, Andel R, Gum A, Papadopoulos A: Predictors of preventable nursing home hospitalizations: the role of mental disorders and dementia. Am J Geriatr Psychiatry 2010, 18(6):475-482.
• [12]Miller EA, Weissert WG: Predicting elderly people's risk for nursing home placement, hospitalization, functional impairment, and mortality: a synthesis. Med Care Res Rev 2000, 57(3):259-297.
• [13]Aneshensel CS, Pearlin LI, Levy Storms L, Schuler RH: The transition from home to nursing home mortality among people with dementia. J Gerontol Ser B Psychol Sci Soc Sci 2000, 55(3):S152-S162.
• [14]McClendon M, Smyth K, Neundorfer M: Long-term-care placement and survival of persons with Alzheimer's disease. J Gerontol Ser B Psychol Sci Soc Sci 2006, 61(4):P220-P227.
• [15]Wolinsky FD, Callahan CM, Fitzgerald JF, Johnson RJ: Changes in functional status and the risks of subsequent nursing home placement and death. J Gerontol 1993, 48(3):94-101.
• [16]Meinow B, Kreholt I, Parker M, Thorslund M: The effect of the duration of follow-up in mortality analysis: the temporal pattern of different predictors. J Gerontol Ser B Psychol Sci Soc Sci 2004, 59(3):S181-S189.
• [17]Takahashi PY, Tung EE, Crane SJ, Chaudhry R, Cha S, Hanson GJ: Use of the elderly risk assessment (ERA) index to predict 2-year mortality and nursing home placement among community dwelling older adults. Arch Gerontol Geriatr 2012, 54(1):34-38.
• [18]Kuzuya M, Masuda Y, Hirakawa Y, Iwata M, Enoki H, Hasegawa J: Day care service use is associated with lower mortality in community-dwelling frail older people. J Am Geriatr Soc 2006, 54(9):1364-1371.
• [19]Todd S, Barr S, Roberts M, Passmore AP: Survival in dementia and predictors of mortality: a review. Int J Geriatr Psychiatry 2013, 28(11):1109-1124.
• [20]Bharucha A, Pandav R, Shen C, Dodge H, Ganguli M: Predictors of nursing facility admission: a 12-year epidemiological study in the United States. J Am Geriatr Soc 2004, 52(3):434-439.
• [21]Brown MA, Sampson EL, Jones L, Barron AM: Prognostic indicators of 6-month mortality in elderly people with advanced dementia: a systematic review. Palliat Med 2013, 27(5):389-400.
• [22]Schonwetter R, Han B, Small B, Martin B, Tope K, Haley W: Predictors of six-month survival among patients with dementia: an evaluation of hospice Medicare guidelines. Am J Hospice Palliat Med 2003, 20(2):105-113.
• [23]Boersma F, Van Den Brink W, Deeg DJ, Eefsting JA, Van Tilburg W: Survival in a population-based cohort of dementia patients: predictors and causes of mortality. Int J Geriatr Psychiatry 1999, 14(9):748-753.
• [24]Hsiu-Li H: Factors associated with dementia care practices among community health nurses: results of a postal survey. Int J Nurs Stud 2013, 50(9):1219.
• [25]Karmel R, Anderson P: Pathways in Aged Care: Program Use After Assessment. Australian Institute of Health and Welfare: Canberra ACT; 2011.
• [26]Doyle C, Day S, Dunt D, McKenzie R, Dort PV, Yates K, White V: Dementia Initiative National Evaluation: National Evaluation of EACHD Program. Melbourne Victoria: LAMA Consortium, The University of Melbourne; 2009.
• [27]Department of Health and Ageing: Community Packaged Care Guidelines: Incorporating Community Aged Care Packages. Canberra ACT: Department of Health and Ageing; 2011.
• [28]Australian Institute of Health and Welfare: Movement Between Hospital and Residential Aged Care 2008–09. Canberra ACT: Australian Institute of Health and Welfare; 2013.
• [29]Limited AEP: National Dementia Initiative Economic Evaluation. New South Wales: Sydney; 2009.
• [30]Department of Health and Ageing: Aged Care Assessment and Approval Guidelines. Canberra ACT: Department of Health and Ageing; 2006.
• [31]Muramatsu N, Yin H, Campbell R, Hoyem R, Jacob M, Ross C: Risk of nursing home admission among older americans: does states' spending on home- and community-based services matter? J Gerontol Ser B Psychol Sci Soc Sci 2007, 62(3):S169-S178.
• [32]Parsons M, Senior H, Kerse N, Chen MH, Jacobs S, Vanderhoorn S, Anderson C: Should care managers for older adults be located in primary care? A randomized controlled trial. J Am Geriatr Soc 2012, 60(1):86-92.
• [33]Muzzarelli S, Leibundgut G, Maeder MT, Rickli H, Handschin R, Gutmann M, Investigators TC: Predictors of early readmission or death in elderly patients with heart failure. Am Heart J 2010, 160(2):308-314.
• [34]Gustafsson F, Schou M, Videbæk L, Dridi N, Ryde H, Handberg J, Hildebrandt PR: Incidence and predictors of hospitalization or death in patients managed in multidisciplinary heart failure clinics. Eur J Heart Fail 2009, 11(4):413-419.
• [35]Charlson ME, Pompei P, Ales KL, MacKenzie CR: A New method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987, 40(5):373-383.
• [36]Kerr GD, Dunt DR: Early prediction of risk in patients with suspected unstable angina using serum troponin T. Aust New Zealand J Med 1997, 27(5):554-560.
• [37]Hosmer DW, Lemeshow S: Applied Survival Analysis. New York: John Wiley and Sons; 1999.
• [38]Christensen MD, White HK: Dementia assessment and management. J Am Med Dir Assoc 2006, 7(2):109-118.
• [39]Grand JH, Caspar S, Macdonald SW: Clinical features and multidisciplinary approaches to dementia care. J Multidiscip Healthc 2011, 4:125-147.
• [40]Australian Institute of Health and Welfare: Dementia in Australia: National Data Analysis and Development. Canberra ACT: Australian Institute of Health and Welfare; 2007.
• [41]Kountouras J, Gavalas E, Boziki M, Zavos C, Deretzi G, Grigoriadis N, Tsiaousi E, Katsinelos P, Chatzopoulos D, Tzilves D, Kouklakis G: High prevalence of dementia and cognitive impairment in indigenous Australians. Neurology 2009, 73(6):487-488.
• [42]Department of Health and Ageing: Living Longer. Living Better. Aged Care Reform Package. Canberra ACT: Department of Health and Ageing; 2012.
• [43]Lindeman MA, Smith K: Remote primary health care practitioners' views about priorities in Indigenous dementia research. Rural Remote Health 2010, 10(3):1538.
• [44]Smith K, Flicker L, Dwyer A, Atkinson D, Almeida O, Lautenschlager N, LoGiudice D: Factors associated with dementia in Aboriginal Australians. Aust N Z J Psychiatry 2010, 44(10):888-893.
• [45]Banaszak-Holl J, Fendrick A, Foster N, Herzog A, Kabeto M, Kent D: Predicting nursing home admission - estimates from a 7-year follow-up of a notionally representative sample of older Americans. Alzheimer Dis Assoc Disord 2004, 18(2):83-89.
• [46]Kim E, Cho E, June K: Factors influencing use of home care and nursing homes. J Adv Nurs 2006, 54(4):511-517.
• [47]Wells Y, Swerissen H, Kendig H: Client outcomes in case managed care: who benefits most? Aust J Ageing 1999, 18(2):79-85.