Nursing Home Use Across The Spectrum of Cognitive Decline: Merging Mayo Clinic Study of Aging With CMS MDS Assessments

Abstract

BACKGROUND/OBJECTIVES Objective, complete estimates of nursing home (NH) use across the spectrum of cognitive decline are needed to help predict future care needs and inform economic models constructed to assess interventions to reduce care needs. DESIGN Retrospective longitudinal study SETTING Olmsted County, MN PARTICIPANTS Mayo Clinic Study of Aging participants assessed as Cognitively Normal (CN), Mild Cognitive Impairment (MCI), Previously-unrecognized-dementia, or Prevalent-dementia (Age=70–89 years; N=3,545) MEASUREMENTS Participants were followed in the Centers for Medicare and Medicaid Services Minimum Data Set (including Medicare/Medicaid/commercially insured/private pay) and Rochester Epidemiology Project provider-linked medical records for 1-year after assessment for days-of-observation, NH use (yes/no), NH days, NH days/days-of-observation, and mortality. RESULTS In the year after cognition was assessed, for persons categorized as CN, MCI, previously-unrecognized-dementia, and prevalent-dementia respectively, the percentages who died were 1.0%, 2.6%, 4.2%, 21%; the percentages with any NH use were 3.8%, 8.7%, 19%, 40%; for persons with any NH use, median NH days were 27, 38, 120, 305, and median percentages of NH days/days-of-observation were 7.8%, 12%, 33%, 100%. The year after assessment, among persons with prevalent-dementia and any NH use, >50% were a NH resident all days-of-observation. Pairwise comparisons revealed that each increase in cognitive-impairment-category exhibited significantly higher proportions with any NH use. One-year mortality was especially high for persons with prevalent-dementia and any NH use (30% versus 13% for those with no NH use); 58% of all deaths among persons with prevalent-dementia occurred while a NH resident. CONCLUSIONS Findings suggest reductions in NH use could result from quality alternatives to NH admission, both among persons with MCI and persons with dementia, together with suitable options for end-of-life care among persons with prevalent-dementia.

Understanding and predicting the longitudinal course of dementia

“…Yet, there is large heterogeneity with considerable proportions of the samples analyzed showing rapid declines, but often the majority shows slower decline [3,9–11]. Finally, probabilities for increasing Alzheimer's dementia severity, institutionalization and mortality were calculated and ranged much depending on age and dementia stage [12 ▪ ,13 ▪ ].…”