Predictors of care home and hospital admissions and their costs for older people with Alzheimer's disease: findings from a large London case register

Alzheimer’s disease (AD), non-AD dementia, and Parkinson’s disease (PD) are increasingly common in older adults, yet all risk factors for their onset are not fully understood. Consequently, environmental exposures, including air pollution, have been hypothesized to contribute to the etiology of neurodegeneration. Because persistently elevated rates of AD mortality in the southern Piedmont area of North Carolina (NC) have been documented, we studied mortality and hospital admissions for AD, non-AD dementia, and PD in residential populations aged 65+ with long-term exposures to elevated levels of ambient air particulate matter 2.5 (PM2.5) exceeding the World Health Organization (WHO) air quality standards (≥10μg/m3). Health data were obtained from the State Center for Health Statistics and the Healthcare Cost and Utilization Project. PM2.5 levels were obtained from the MODIS/MISR and SeaWiFS datafiles. Residents in the Study group of elevated air particulate matter (87 zip codes with PM2.5≥10μg/m3) were compared to the residents in the Control group with low levels of air particulate matter (81 zip codes with PM2.5≤7.61μg/m3), and were found to have higher age-adjusted rates of mortality and hospital admissions for AD, non-AD dementia, and PD, including a most pronounced increase in AD mortality (323/100,000 vs. 257/100,000, respectively). After adjustment for multiple co-factors, the risk of death (odds ratio, or OR) from AD in the Study group (OR = 1.35, 95%CI[1.24–1.48]) was significantly higher than ORs of non-AD dementia or PD (OR = 0.97, 95%CI[0.90–1.04] and OR = 1.13, 95%CI[0.92–1.31]). The OR of hospital admissions was significantly increased only for AD as a primary case of hospitalization (OR = 1.54, 95%CI[1.31–1.82]). Conclusion: NC residents aged 65+ with long-term exposures to ambient PM2.5 levels exceeding the WHO standard had significantly increased risks of death and hospital admissions for AD. The effects for non-AD dementia and PD were less pronounced.

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Obstacle Crossing with Dual Tasking is a Danger for Individuals with Alzheimer's Disease and for Healthy Older People

Journal of Alzheimer s Disease ◽

10.3233/jad-140807 ◽

2014 ◽

Vol 43 (2) ◽

pp. 435-441 ◽

Cited By ~ 8

Author(s):

Lucas Simieli ◽

Fabio Augusto Barbieri ◽

Diego Orcioli-Silva ◽

Ellen Lirani-Silva ◽

Florindo Stella ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Older People ◽

Dual Tasking ◽

Obstacle Crossing

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Are noise and air pollution related to the incidence of dementia? A cohort study in London, England

BMJ Open ◽

10.1136/bmjopen-2018-022404 ◽

2018 ◽

Vol 8 (9) ◽

pp. e022404 ◽

Cited By ~ 54

Author(s):

Iain M Carey ◽

H Ross Anderson ◽

Richard W Atkinson ◽

Sean D Beevers ◽

Derek G Cook ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Air Pollution ◽

Cohort Study ◽

Vascular Dementia ◽

Care Home ◽

Secondary Outcome ◽

Area Deprivation ◽

Diagnosis Of Dementia ◽

Incidence Of Dementia

ObjectiveTo investigate whether the incidence of dementia is related to residential levels of air and noise pollution in London.DesignRetrospective cohort study using primary care data.Setting75 Greater London practices.Participants130 978 adults aged 50–79 years registered with their general practices on 1 January 2005, with no recorded history of dementia or care home residence.Primary and secondary outcome measuresA first recorded diagnosis of dementia and, where specified, subgroups of Alzheimer’s disease and vascular dementia during 2005–2013. The average annual concentrations during 2004 of nitrogen dioxide (NO2), particulate matter with a median aerodynamic diameter ≤2.5 µm (PM2.5) and ozone (O3) were estimated at 20×20 m resolution from dispersion models. Traffic intensity, distance from major road and night-time noise levels (Lnight) were estimated at the postcode level. All exposure measures were linked anonymously to clinical data via residential postcode. HRs from Cox models were adjusted for age, sex, ethnicity, smoking and body mass index, with further adjustments explored for area deprivation and comorbidity.Results2181 subjects (1.7%) received an incident diagnosis of dementia (39% mentioning Alzheimer’s disease, 29% vascular dementia). There was a positive exposure response relationship between dementia and all measures of air pollution except O3, which was not readily explained by further adjustment. Adults living in areas with the highest fifth of NO2concentration (>41.5 µg/m3) versus the lowest fifth (<31.9 µg/m3) were at a higher risk of dementia (HR=1.40, 95% CI 1.12 to 1.74). Increases in dementia risk were also observed with PM2.5, PM2.5specifically from primary traffic sources only and Lnight, but only NO2and PM2.5remained statistically significant in multipollutant models. Associations were more consistent for Alzheimer’s disease than vascular dementia.ConclusionsWe have found evidence of a positive association between residential levels of air pollution across London and being diagnosed with dementia, which is unexplained by known confounding factors.

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Dual-task as a predictor of falls in older people with mild cognitive impairment and mild Alzheimer's disease: a prospective cohort study

Brazilian Journal of Physical Therapy ◽

10.1016/j.bjpt.2018.03.011 ◽

2018 ◽

Vol 22 (5) ◽

pp. 417-423 ◽

Cited By ~ 6

Author(s):

Jessica Gonçalves ◽

Juliana Hotta Ansai ◽

Fernando Arturo Arriagada Masse ◽

Francisco Assis Carvalho Vale ◽

Anielle Cristhine de Medeiros Takahashi ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cohort Study ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Older People ◽

Prospective Cohort Study ◽

Dual Task ◽

Prospective Cohort

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Polygenic Risk for Alzheimer's Disease is not Associated with Cognitive Ability or Cognitive Aging in Non-Demented Older People

Journal of Alzheimer s Disease ◽

10.3233/jad-131058 ◽

2014 ◽

Vol 39 (3) ◽

pp. 565-574 ◽

Cited By ~ 30

Author(s):

Sarah E. Harris ◽

Gail Davies ◽

Michelle Luciano ◽

Antony Payton ◽

Helen C. Fox ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Older People ◽

Cognitive Ability ◽

Cognitive Aging ◽

Polygenic Risk

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In vivo amyloid progression in healthy middle‐aged to older people at risk of Alzheimer’s disease

Alzheimer s & Dementia ◽

10.1002/alz.040789 ◽

2020 ◽

Vol 16 (S2) ◽

Author(s):

Fedor Levin ◽

Irina Jelistratova ◽

Tobey J. Betthauser ◽

Sterling C. Johnson ◽

Stefan J. Teipel ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

At Risk ◽

Older People ◽

Middle Aged

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Predicting 10-Year Care Requirements for Older People with Suspected Alzheimer's Disease

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.2000.tb04720.x ◽

2000 ◽

Vol 48 (6) ◽

pp. 631-638 ◽

Cited By ~ 37

Author(s):

Bruce P. Kinosian ◽

Eric Stallard ◽

Jason H. Lee ◽

Max A. Woodbury ◽

Arthur S. Zbrozek ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Older People ◽

Care Requirements

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The Complex Role of Having Confidant on the Development of Alzheimer's Disease in a Community-Based Cohort of Older People in Brazil

Neuroepidemiology ◽

10.1159/000371521 ◽

2015 ◽

Vol 44 (2) ◽

pp. 78-82 ◽

Cited By ~ 3

Author(s):

Analuiza Camozzato ◽

Cláudia Godinho ◽

Juliana Varela ◽

Cristiano Kohler ◽

Juciclara Rinaldi ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Older People ◽

Mmse Score ◽

Living Arrangement ◽

Lifestyle Factor ◽

Elderly Subjects ◽

Community Based ◽

Incident Cases

Background: Social interaction is a lifestyle factor associated with a decreased risk of dementia in several studies. However, specific aspects of these social factors influencing dementia are unknown. This study aimed at evaluating the role of the distinct aspects of social support on the incidence of dementia in a community-based cohort of older people in Brazil. Methods: A total of 345 healthy and independent elderly subjects living in the community were followed by 12 years. Incident cases of dementia and probable Alzheimer's disease were defined by DSM-IV criteria and NINCDS-ADRDA criteria, respectively. Social variables evaluated were marital status, living arrangement, living children, living sibling, confidant and attending recreational groups. Sex, age, education, Mini-Mental State Examination (MMSE) score, depressive symptoms and family income were entered as co-variates in a Cox proportional hazard model. Results: The absence of confidant was the only social variable associated to higher risk of developing dementia (HR = 5.31; p < 0.001), even after adjustment for age (HR = 1.08; p = 0.048) and baseline MMSE score (HR = 0.79; p = 0.002). Conclusions: Our data suggest that to have a confidant could be an important lifestyle factor associated with dementia.

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Doing the Right Thing: A Geriatrician's Perspective on Medical Care for the Person with Advanced Dementia

The Journal of Law Medicine & Ethics ◽

10.1111/j.1748-720x.2012.00645.x ◽

2012 ◽

Vol 40 (1) ◽

pp. 51-56 ◽

Cited By ~ 11

Author(s):

Muriel R. Gillick

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Older People ◽

Medical Care ◽

Oldest Old ◽

Advanced Dementia ◽

People With Dementia ◽

Reasonable Approach ◽

The Right ◽

Number Of Individuals

America is aging. But even more striking than the rise in the proportion of the population over age 65 is the unprecedented number of individuals who are living into their eighties and nineties. While many people remain robust well into advanced age, the dramatic increase in the number of the oldest old has brought with it an epidemic of Alzheimer’s disease and other dementias. Dementia is a highly prevalent condition — currently 5.4 million Americans have Alzheimer’s disease, a number which may rise to 16 million by 2050 if there is no breakthrough in the prevention or treatment of the disease — but it disproportionately affects those over age 85, striking between one-third and one-half of this cohort. Developing a reasonable approach to the medical care of older people with dementia will be essential in the coming decades.

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