Comorbidity and Drug Use in Cognitively Impaired Elderly Living in Long-Term Care

Landi, Francesco; Gambassi, Giovanni; Lapane, Kate L.; Sgadari, Antonio; Gifford, David; Mor, Vincent; Bernabei, Roberto

doi:10.1159/000017087

Cited by 39 publications

(25 citation statements)

References 46 publications

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“…The inverse relationship between cognitive impairment and comorbidity confirms our previous results [7], and we show herein that it applies to different types of dementia. These results are in agreement with those of Hogan et al [25] who found that hypertension and body mass index decrease with increasing dementia severity in both AD and VaD.…”

Section: Discussionsupporting

confidence: 93%

“…We have documented that individuals with cognitive impairment are characterized by poor health status with a high prevalence of functional disability, and by a substantially increased mortality rate [7]. Surprisingly, we found that, compared to persons with normal cognitive Landi/Gambassi/Lapane/Sgadari/Mor/ Bernabei function, cognitively impaired patients had fewer comorbidities.…”

Section: Introductioncontrasting

confidence: 54%

See 1 more Smart Citation

Impact of the Type and Severity of Dementia on Hospitalization and Survival of the Elderly

Landi

Gambassi²,

Lapane

et al. 1999

Dement Geriatr Cogn Disord

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We conducted a retrospective cohort study to examine whether patients with Alzheimer’s disease (AD) or vascular dementia (VaD) differed in the number and type of associated comorbid conditions. In addition, we evaluated the impact of the severity of cognitive impairment on hospitalization and mortality of patients in each group. We studied 161,106 patients over age 65, with any degree of cognitive impairment, residing in any of 1,573 Medicare/Medicaid-certified nursing homes of 5 states of the USA between 1992 and 1995. Patients were assessed with the federally mandated Minimum Data Set (MDS). The MDS has been cross-linked to Medicare eligibility files and to the Medicare Provider Analysis and Review database. AD patients were younger, and more likely to be female and Caucasian than VaD patients. For comparable levels of cognitive impairment, AD patients appeared to have fewer comorbid conditions, including those that were not risk factors for VaD. In addition, patients with AD had decreased morbidity and mortality relative to patients with VaD. These findings support the hypothesis that AD patients are a healthier group of demented patients.

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Section: Discussionsupporting

confidence: 93%

Section: Introductioncontrasting

confidence: 54%

Impact of the Type and Severity of Dementia on Hospitalization and Survival of the Elderly

Landi

Gambassi²,

Lapane

et al. 1999

Dement Geriatr Cogn Disord

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“…8 14 26 Similarly, non-vascular comorbid conditions were associated with mortality in some studies,6 7 but not in others 914 21These different results may be attributable to an underrepresentation of comorbid conditions among demented patients 4857 In agreement with the results of other authors,7 9 14sensory impairment affecting vision and hearing was associated with a slightly increased risk of mortality in our study.…”

Section: Discussionsupporting

confidence: 89%

Predictors of mortality in patients with Alzheimer's disease living in nursing homes

Gambassi

Landi

Lapane

et al. 1999

Journal of Neurology, Neurosurgery & Psychiatry

114

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31; 95%CI 1.23-1.39), the presence of pressure ulcers (RR 1.24; 95% CI 1.13-1.36), a diagnosis of diabetes mellitus (RR 1.32; 95% CI 1.21-1.43), and of cardiovascular diseases (RR 1.22; 95% CI 1.14-1.30) were independent predictors of death, regardless of the severity of baseline dementia. Sensory problems (hearing and vision) and urinary incontinence were associated with increased mortality only among patients with less severe dementia. The presence of disruptive behaviour, aphasia, and a diagnosis of Parkinson's disease were not related to survival. African-Americans and other minority groups were less likely to die relative to white people. Conclusions-Age, sex, functional limitation, and malnutrition seem to be the strongest predictors of death for patients with Alzheimer's disease in nursing homes. Altogether, severity of dementia has no influence on survival, yet the predictive role of certain variables depends on the degree of impairment. Minority groups have a reduced risk of death relative to white people. (J Neurol Neurosurg Psychiatry 1999;67:59-65)

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“…This finding might be explained by the association of delirium with dementia, which Morichi et al: Delirium in Nursing Homes www.karger.com/dem © 2018S. Karger AG, Basel DOI: 10.1159 might be associated with a high risk of underrecognition and undertreatment of somatic diseases [37]. On the other hand, the negative association between polypharmacy and delirium might be explained by an appropriate deprescription in subjects with dementia and severe disability, who are more often delirious.…”

Section: Discussionmentioning

confidence: 99%

A Point Prevalence Study of Delirium in Italian Nursing Homes

Morichi

Fedecostante

Morandi

et al. 2018

Dement Geriatr Cogn Disord

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Background: Delirium is a common geriatric syndrome. Few studies have been conducted in nursing home (NH) residents. The aim of this project was to perform a point prevalence study of delirium in Italian NHs. Methods: Data collected in 71 NHs are presented. Inclusion criteria were age ≥65 years and native Italian speaker. Exclusion criteria were coma, aphasia, and end-of-life status. Sociodemographic and medical data were recorded. Delirium was assessed using the Assessment Test for Delirium and Cognitive Impairment (4-AT). Patients with a 4-AT score ≥4 were considered to have delirium. Motor subtype was evaluated using the Delirium Motor Subtype Scale (DMSS). Results: A total of 1,454 patients were evaluated (mean age 84.4 ± 7.4 years, 70.2% female), of whom 535 (36.8%) had delirium. In multivariate logistic regression analysis, variables significantly associated with delirium were education (OR 0.94, 95% CI 0.91–0.97), dementia (OR 3.12, 95% CI 2.38–4.09), functional dependence (OR 6.13, 95% CI 3.08–12.19 for ADL score 0; OR 1.99, 95% CI 1.03–3.84 for ADL score 1–5), malnutrition (OR 4.87, 95% CI 2.68–8.84), antipsychotics (OR 2.40, 95% CI 1.81–3.18), and physical restraints (OR 2.48, 95% CI 1.71–3.59). Conclusion: Delirium is common in older NH residents. Simple assessment tools might facilitate its recognition in this vulnerable population.

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Comorbidity and Drug Use in Cognitively Impaired Elderly Living in Long-Term Care

Cited by 39 publications

References 46 publications

Impact of the Type and Severity of Dementia on Hospitalization and Survival of the Elderly

Impact of the Type and Severity of Dementia on Hospitalization and Survival of the Elderly

Predictors of mortality in patients with Alzheimer's disease living in nursing homes

A Point Prevalence Study of Delirium in Italian Nursing Homes

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