Alzheimer’s Disease And Nursing Homes

Gaugler, Joseph E.; Yu, Fang; Davila, Heather; Shippee, Tetyana

doi:10.1377/hlthaff.2013.1268

Cited by 84 publications

(81 citation statements)

References 34 publications

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“…While most people with dementia live in the community, about one-third live in some type of residential care setting, either a nursing home (assuming two-thirds of nursing home residents have dementia)[9,25] or another type of residential care (Exhibit 2). As nursing home residence among people ages sixty-five and older who need long-term services and supports continues to decline,[30] residential care alternatives for providing these services have grown.…”

Section: Discussionmentioning

confidence: 99%

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The Disproportionate Impact Of Dementia On Family And Unpaid Caregiving To Older Adults

et al. 2015

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The number of US adults ages sixty-five and older who are living with dementia is substantial and expected to grow, raising concerns about the demands that will be placed on family members and other unpaid caregivers. We used data from the 2011 National Health and Aging Trends Study and its companion study, the National Study of Caregiving, to investigate the role of dementia in caregiving. We found that among family and unpaid caregivers to older noninstitutionalized adults, one-third of caregivers, and 41 percent of the hours of help they provide, help people with dementia, who account for about 10 percent of older noninstitutionalized adults. Among older adults who receive help, the vast majority in both community and residential care settings other than nursing homes rely on family or unpaid caregivers (more than 90 percent and more than 80 percent, respectively), regardless of their dementia status. Caregiving is most intense, however, to older adults with dementia in community settings and from caregivers who are spouses or daughters or who live with the care recipient.

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Section: Discussionmentioning

confidence: 99%

“…Half to two-thirds of nursing home residents have dementia. [9,10] The condition is thought to be equally prevalent in assisted living facilities. [11]…”

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confidence: 99%

The Disproportionate Impact Of Dementia On Family And Unpaid Caregiving To Older Adults

et al. 2015

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“…For example, at baseline 4.6% of persons reported a dementia diagnosis, compared to estimates that suggest 14% of community-dwelling adults over 71 have dementia (Plassman et al, 2007). Further, nursing home residents, who have an even higher prevalence of dementia (Gaugler, Yu, Davila, & Shippee, 2014), were excluded from this analysis. Therefore, it is likely the observed relationship would remain if the sample included institutionalized adults.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal association between diabetes and cognitive decline: The National Health and Aging Trends Study

Wennberg

Hagen

Gottesman³

et al. 2017

Archives of Gerontology and Geriatrics

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Type II diabetes mellitus (DM) is associated with increased risk of dementia; however, few studies have examined the longitudinal association between DM and cognitive outcomes in large nationally representative cohorts. We investigated these associations in 7605 participants enrolled in the National Health and Aging Trends Study, a nationally representative prospective study of Medicare beneficiaries ≥65, from 2011 to 2015. Participants or proxy respondents reported DM and dementia diagnosis, and participants completed immediate and delayed recall word list learning tests and the Clock Drawing Test. In multivariable-adjusted generalized linear mixed models, baseline DM diagnosis was associated with decline on immediate and delayed word recall and the Clock Drawing Test. In Cox proportional hazards models, DM also predicted incident dementia in older age groups at baseline. These findings further support the notion that DM is associated with cognitive outcomes, suggesting that treatment and prevention of DM may reduce the risk of these outcomes. However, more studies are needed to better understand whether DM treatments affect this relationship.

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“…LOS, successful discharge, and becoming a long‐stay resident did not seem to vary according to obesity level until we accounted for dementia and cognitive impairment. Dementia confounds the association between obesity and these outcomes because it is a risk factor for being frail or underweight and for outcomes related to nursing home LOS . After controlling for dementia and other covariates, we found that obesity conferred a strong risk for all outcomes.…”

Section: Discussionmentioning

confidence: 68%

Effect of Obesity on Postacute Outcomes of Skilled Nursing Facility Residents with Hip Fracture

Kosar

Thomas

Gozalo

et al. 2018

J American Geriatrics Society

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OBJECTIVES To examine the effect of obesity (body mass index (BMI)≥ 30.0 kg/m2) on outcomes of older adults admitted to skilled nursing facilities (SNFs) for hip fracture postacute care (PAC). DESIGN Retrospective cohort study. SETTING U.S. Medicare- and Medicaid-certified SNFs from 2008 to 2015. PARTICIPANTS Medicare fee-for-service beneficiaries discharged to a SNF after hospitalization for hip fracture (N=586,683; n=82,768 (14.1%) meeting obesity criteria). Exclusion criteria were aged younger than 65, being underweight (BMI<18.5 kg/m2), and SNF use in the year prior to index hospitalization. MEASUREMENTS Residents were divided into 4 BMI categories according to cutoffs that the World Health Organization has established: not obese (BMI 18.5–29.9 kg/m2), mild obesity (BMI 30.0–34.9 kg/m2), moderate obesity (BMI 35.0–39.9 kg/m2), and severe obesity (BMI≥40.0 kg/m2). Robust Poisson regression was used to compare differences in average nursing facility length of stay (LOS) and rates of 30-day hospital readmission, successful discharge to community, and becoming a long-stay resident (LOS>100) according to obesity level. Models were adjusted for individual-level covariates and facility fixed effects. RESULTS Residents with mild (adjusted relative risk (aRR)=1.16, 95% CI=1.12–1.19), moderate (aRR=1.27, 95% CI=1.20–1.35), and severe (aRR=1.67, 95% CI=1.54–1.82) obesity were more likely to be readmitted within 30 days than those who were not obese. The average difference in LOS between residents without obesity and those with mild obesity was 2.6 days (95% CI=2.2–2.9 days); moderate obesity, 4.2 days (95% CI=3.7–5.1 days); and severe obesity, 7.0 days (95% CI=5.9–8.2 days). Residents with obesity were less likely to be successfully discharged and more likely to become long-stay nursing home residents. CONCLUSION Obesity was associated with worse outcomes in postacute SNF residents with hip fracture. Efforts to provide targeted care to residents with obesity may be essential to improve outcomes. Obesity may be an overlooked risk adjuster in quality-of-care measures and in payment reforms related to PAC for individuals with hip fracture.

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Alzheimer’s Disease And Nursing Homes

Cited by 84 publications

References 34 publications

The Disproportionate Impact Of Dementia On Family And Unpaid Caregiving To Older Adults

The Disproportionate Impact Of Dementia On Family And Unpaid Caregiving To Older Adults

Longitudinal association between diabetes and cognitive decline: The National Health and Aging Trends Study

Effect of Obesity on Postacute Outcomes of Skilled Nursing Facility Residents with Hip Fracture

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