Potentially Unsafe Activities and Living Conditions of Older Adults with Dementia

Abstract

Objectives To examine the prevalence of dementia in the absence of a reported dementia diagnosis and whether potentially unsafe activities and living conditions vary as a function of dementia diagnosis status in a nationally representative sample of older adults. Design Observational cohort study. Setting Community. Participants 7,609 Medicare beneficiaries age ≥ 65 enrolled in the National Health and Aging Trends Study. Measurements Participants were classified into four groups based on self-report of dementia diagnosis, proxy screening interview, and cognitive testing: 1) probable dementia with reported dementia diagnosis (n=457), 2) probable dementia without reported dementia diagnosis (n=581), 3) possible dementia (n=996), or 4) no dementia (n=5,575). We examined potentially unsafe activities (driving, preparing hot meals, managing finances or medications, attending doctor visits alone) and living conditions (falls, living alone, and unmet needs) by dementia status subgroups in stratified analyses and multivariate models, adjusting for sociodemographic factors, medical comorbidities, and physical capacity. Results The prevalence of driving (22.9%), preparing hot meals (31%), managing finances (21.9%), managing medications (36.6%), and attending doctor visits alone (20.6%) was lowest in persons with probable dementia. However, among persons with probable dementia, the covariate-adjusted rates of driving, preparing hot meals, managing finances, managing medications, and attending doctor visits alone were significantly higher in those without reported dementia diagnosis than for those with reported diagnosis (all odds ratios ≥ 2.00, p's < 0.01). Conclusion Older adults with probable dementia who are not aware of a dementia diagnosis are more likely to report engaging in potentially unsafe behaviors. Understanding the prevalence of potentially unsafe activities and living conditions can help clinicians focus safety screening and counseling in older adults with diagnosed or suspected dementia.

2020 Alzheimer's disease facts and figures

“…But outside of research settings, a substantial portion of those who would meet the diagnostic criteria for Alzheimer's and other dementias are not diagnosed with dementia by a physician 39‐42 . Furthermore, fewer than half of Medicare beneficiaries who have a diagnosis of Alzheimer's or another dementia in their Medicare billing records (or their caregiver, if the beneficiary's cognitive impairment prevented him or her from responding) report being told of the diagnosis 43‐46 . Because Alzheimer's dementia is often underdiagnosed — and if it is diagnosed, people are often unaware of their diagnosis — a large portion of Americans with Alzheimer's may not know they have it.…”

The Effects and Meanings of Receiving a Diagnosis of Mild Cognitive Impairment or Alzheimer’s Disease When One Lives Alone

“…An estimated one third of older adults with cognitive impairment live alone in the United States [1] and Canada [2]. Older adults living alone with cognitive impairment are at high risk for poor health outcomes [3].…”

Risk of injury higher in older adults with dementia than in those without

“…People with Alzheimer’s disease often develop impairments in executive function, resulting in poor judgement and unsafe behaviours 1. These problems put them at risk of accidents and injuries, particularly in the home environment.…”

“…There is growing evidence of the benefits of interventions for falls in older adults with dementia, such as exercise 6. Additional caregiver factors and living situations warrant further exploration, as well as the development and testing of additional interventions to reduce injuries,1 including in diverse populations. The findings of this study should serve as a call to action for researchers and healthcare providers.…”