Association of Positive Delirium Screening with Incident Dementia in Skilled Nursing Facilities

Briesacher, Becky A.; Koethe, Benjamin; Olivieri‐Mui, Brianne; Saczynski, Jane S.; Fick, Donna M.; Devlin, John W.; Marcantonio, Edward R.

doi:10.1111/jgs.16830

Cited by 13 publications

(12 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This has the potential to increase the number of cases of cognitive impairment following critical illness. Furthermore, many of these individuals will receive or have received mechanical ventilation, which increases one's risk of delirium, 196 an acute state of short‐term confusion that is a risk factor for dementia 197–199 …”

Section: Overview Of Alzheimer's Diseasementioning

confidence: 99%

2021 Alzheimer's disease facts and figures

2021

Alzheimer's & Dementia

1,794

849

View full text Add to dashboard Cite

This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the challenges of providing equitable health care for people with dementia in the United States. An estimated 6.2 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available, making Alzheimer's the sixth‐leading cause of death in the United States and the fifth‐leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated in 2020 by the COVID‐19 pandemic. More than 11 million family members and other unpaid caregivers provided an estimated 15.3 billion hours of care to people with Alzheimer's or other dementias in 2020. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $256.7 billion in 2020. Its costs, however, extend to family caregivers’ increased risk for emotional distress and negative mental and physical health outcomes — costs that have been aggravated by COVID‐19. Average per‐person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2021 for health care, long‐term care and hospice services for people age 65 and older with dementia are estimated to be $355 billion. Despite years of efforts to make health care more equitable in the United States, racial and ethnic disparities remain — both in terms of health disparities, which involve differences in the burden of illness, and health care disparities, which involve differences in the ability to use health care services. Blacks, Hispanics, Asian Americans and Native Americans continue to have a higher burden of illness and lower access to health care compared with Whites. Such disparities, which have become more apparent during COVID‐19, extend to dementia care. Surveys commissioned by the Alzheimer's Association recently shed new light on the role of discrimination in dementia care, the varying levels of trust between racial and ethnic groups in medical research, and the differences between groups in their levels of concern about and awareness of Alzheimer's disease. These findings emphasize the need to increase racial and ethnic diversity in both the dementia care workforce and in Alzheimer's clinical trials.

show abstract

Section: Overview Of Alzheimer's Diseasementioning

confidence: 99%

2021 Alzheimer's disease facts and figures

2021

Alzheimer's & Dementia

1,794

849

View full text Add to dashboard Cite

show abstract

“…Furthermore, a number of these individuals will receive or have received mechanical ventilation, which increases one's risk of delirium, 208 an acute state of short-term confusion that is a risk factor for dementia. [209][210][211] There is also rapidly emerging evidence on how exposure to air pollution may be related to dementia risk. A number of different air pollutants have been studied in relation to cognition, cognitive decline and dementia itself.…”

Section: Other Risk Factorsmentioning

confidence: 99%

“…This has the potential to increase the number of cases of cognitive impairment following critical illness. Furthermore, a number of these individuals will receive or have received mechanical ventilation, which increases one's risk of delirium, 208 an acute state of short‐term confusion that is a risk factor for dementia 209–211 …”

Section: Overviewmentioning

confidence: 99%

2022 Alzheimer's disease facts and figures

2022

Alzheimer's & Dementia

1,446

664

View full text Add to dashboard Cite

This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report discusses consumers' and primary care physicians' perspectives on awareness, diagnosis and treatment of mild cognitive impairment (MCI), including MCI due to Alzheimer's disease. An estimated 6.5 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available. Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States in 2019 and the seventh-leading cause of death in 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. More than 11 million family members and other unpaid caregivers provided an estimated 16 billion hours of care to people with Alzheimer's or other dementias in 2021. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $271.6 billion in 2021. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes -costs that have been aggravated by COVID-19. Members of the dementia care workforce have also been affected by COVID-19. As essential care workers, some have opted to change jobs to protect their own health and the health of their families. However, this occurs at a time when more members of the dementia care workforce are needed. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2022 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $321 billion. A recent survey commissioned by the Alzheimer's Association revealed several barriers to consumers' understanding of MCI. The survey showed low awareness of MCI among Americans, a reluctance among Americans to see their doctor after noticing MCI symptoms, and persistent challenges for primary care physicians in diagnosing MCI. Survey results indicate the need to improve MCI 700

show abstract

“…Delirium screening is required at SNF admission. SNF patients who screen positive for delirium at admission have a nearly three‐fold increased risk for receiving a new Alzheimer's Disease and Alzheimer's Disease‐related Dementia (AD/ADRD) diagnosis 1 . Despite the lack of high‐quality evidence supporting the use of medication‐based strategies to treat either delirium or dementia, psychoactive medication use is highly prevalent in long‐stay populations but little has been published about prescribing rates in the first days after an SNF admission 2 …”

Section: Introductionmentioning

confidence: 99%

“…SNF patients who screen positive for delirium at admission have a nearly three-fold increased risk for receiving a new Alzheimer's Disease and Alzheimer's Disease-related Dementia (AD/ADRD) diagnosis. 1 Despite the lack of high-quality evidence supporting the use of medicationbased strategies to treat either delirium or dementia, psychoactive medication use is highly prevalent in long-stay populations but little has been published about prescribing rates in the first days after an SNF admission. 2 The American Geriatrics Society Beers Criteria© does not recommend prescribing psychoactive medications to older adults with delirium or dementia due to their lack of proven benefit and concerns about medication-related cognitive decline and death.…”

Section: Introductionmentioning

confidence: 99%

Psychoactive medication therapy and delirium screening in skilled nursing facilities

Briesacher

Olivieri‐Mui

Koethe

et al. 2022

J American Geriatrics Society

Self Cite

View full text Add to dashboard Cite

Background: A positive delirium screen at skilled-nursing facility (SNF) admission can trigger a simultaneous diagnosis of Alzheimer's Disease or related dementia (AD/ADRD) and lead to psychoactive medication treatment despite a lack of evidence supporting use.Methods: This was a nationwide historical cohort study of 849,086 Medicare enrollees from 2011-2013 who were admitted to the SNF from a hospital without a history of dementia. Delirium was determined through positive Confusion Assessment Method screen and incident AD/ADRD through active diagnosis or claims. Cox proportional hazard models predicted the risk of receiving one of three psychoactive medications (i.e., antipsychotics, benzodiazepines, antiepileptics) within 7 days of SNF admission and within the entire SNF stay.Results: Of 849,086 newly-admitted SNF patients (62.6% female, mean age 78), 6.1% had delirium (of which 35.4% received an incident diagnosis of AD/ADRD); 12.6% received antipsychotics, 30.4% benzodiazepines, and 5.8% antiepileptics. Within 7 days of admission, patients with delirium and incident dementia were more likely to receive an antipsychotic (relative risk [RR] 3.09; 95% confidence interval [CI] 2.99 to 3.20), or a benzodiazepine (RR 1.23; 95% CI 1.19 to 1.27) than patients without either condition. By the end of the SNF stay, patients with both delirium and incident dementia were more likely to receive an antipsychotic (RR 3.04; 95% CI 2.95 to 3.14) and benzodiazepine (RR 1.32; 95% CI 1.29 to 1.36) than patients without either condition. Conclusion:In this historical cohort, a positive delirium screen was associated with a higher risk of receiving psychoactive medication within 7 days of SNF admission, particularly in patients with an incident AD/ADRD diagnosis. Future research should examine strategies to reduce inappropriate psychoactive medication prescribing in older adults admitted with delirium to SNFs.

show abstract

Association of Positive Delirium Screening with Incident Dementia in Skilled Nursing Facilities

Cited by 13 publications

References 27 publications

2021 Alzheimer's disease facts and figures

2021 Alzheimer's disease facts and figures

2022 Alzheimer's disease facts and figures

Psychoactive medication therapy and delirium screening in skilled nursing facilities

Contact Info

Product

Resources

About