Advanced cognitive impairment among older nursing home residents

Abstract Background Though work has been done studying nursing home (NH) residents with either advanced Alzheimer’s disease (AD) or Alzheimer’s disease related dementia (ADRD), none have distinguished between them; even though their clinical features affecting survival are different. In this study, we compared mortality risk factors and survival between NH residents with advanced AD and those with advanced ADRD. Methods This is a retrospective observational study, in which we examined a sample of 34,493 U.S. NH residents aged 65 and over in the Minimum Data Set (2011–2013). Incident assessment of advanced disease was defined as the first MDS assessment with severe cognitive impairment (Cognitive Functional Score equals to 4) and diagnoses of AD or ADRD. Demographics, functional limitations, and comorbidities were evaluated as mortality risk factors using Cox models. Survival was characterized with Kaplan-Maier functions. Results Of those with advanced cognitive impairment, 35 % had AD and 65 % ADRD. At the incident assessment of advanced disease, those with AD had better health compared to those with ADRD. Mortality risk factors were similar between groups (shortness of breath, difficulties eating, substantial weight-loss, diabetes mellitus, heart failure, chronic obstructive pulmonary disease, and pneumonia; all p < 0.01). However, stroke and difficulty with transfer (for women) were significant mortality risk factors only for those with advanced AD. Urinary tract infection, and hypertension (for women) only were mortality risk factors for those with advanced ADRD. Median survival was significantly shorter for the advanced ADRD group (194 days) compared to the advanced AD group (300 days). Conclusions There were distinct mortality and survival patterns of NH residents with advanced AD and ADRD. This may help with care planning decisions regarding therapeutic and palliative care.

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Development and psychometric evaluation of the Social Connectedness Index in nursing home residents with Alzheimer's disease and dementia using the Minimum Data Set 3.0

International Journal of Geriatric Psychiatry ◽

10.1002/gps.5516 ◽

2021 ◽

Author(s):

Carol A. Bova ◽

Bill M. Jesdale ◽

Attah Mbrah ◽

Lynn Botelho ◽

Kate L. Lapane

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Nursing Home ◽

Social Connectedness ◽

Nursing Home Residents ◽

Psychometric Evaluation ◽

Minimum Data Set ◽

Data Set ◽

Minimum Data ◽

The Social

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Longitudinal Comparison of Stability and Sensitivity in Quality of Life Scores Among Nursing Home Residents With and Without Diagnoses of Alzheimer’s Disease and Related Dementias

Innovation in Aging ◽

10.1093/geroni/igab024 ◽

2021 ◽

Author(s):

Xuanzi Qin ◽

Zachary G Baker ◽

Stephanie Jarosek ◽

Mark Woodhouse ◽

Haitao Chu ◽

...

Keyword(s):

Quality Of Life ◽

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Nursing Home ◽

Functional Status ◽

Nursing Home Residents ◽

Data Set ◽

The Stability ◽

Linear Probability

Abstract Background and Objectives Prevalence of nursing home residents with Alzheimer’s Disease and Related Dementias (ADRD) has increased along with a growing consensus that person-centered ADRD care in nursing homes should maximize quality of life (QoL). However, concerns about whether residents with ADRD can make appropriate QoL judgements persist. This study assesses the stability and sensitivity of a self-reported, multi-domain well-being QoL measure for nursing home residents with and without ADRD. Research Design and Methods This study linked the 2012-2015 Minnesota Nursing Home Resident QoL and Satisfaction with Care Survey, Minimum Data Set 3.0 (nursing home assessments), and Minnesota Department of Human Services Cost Reports. The QoL survey included cohort-resident pairs who participated for two consecutive years (N=12,949; 8,803 unique residents from 2012-2013, 2013-2014 and 2014-2015 cohorts). Change in QoL between two years was conceptualized as stable when within 1.5 standard deviations of the sample average. We used linear probability models to estimate associations of ADRD/cognitive function scale status with the stability of QoL summary and domain scores (e.g., social engagement) and the absolute change in QoL summary score, controlling for resident and facility characteristics. Results Most (86.82%) residents had stable QoL summary scores. Residents with moderate to severe cognitive impairment, irrespective of ADRD, were less likely to have stable summary scores than cognitively capable residents without ADRD (P<0.001), but associations varied by QoL domains. Among those with stable summary QoL scores, changes in health/functional status were associated with absolute changes in summary QoL score (P<0.001), suggesting sensitivity of the QoL measure. Discussion and Implications QoL scores were similarly stable over time for most residents with and without ADRD diagnoses and were sensitive to changes in health/functional status. This self-reported QoL measure may be appropriate for nursing home residents, regardless of ADRD diagnosis and can efficaciously be recommended to other states.

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Group Activity Participation in Relation to Contextual Isolation of United States Nursing Home Residents Living with Alzheimer’s Disease and Related Dementias

The Journal of Nursing Home Research Sciences ◽

10.14283/jnhrs.2021.7 ◽

2021 ◽

pp. 1-9

Author(s):

B.M. Jesdale ◽

C.A. Bova ◽

A.K. Mbrah ◽

K.L. Lapane

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Nursing Home ◽

Nursing Homes ◽

Nursing Home Residents ◽

Group Activity ◽

Activity Participation ◽

Data Set ◽

Group Activities ◽

Multiple Characteristics

Background: Residents of nursing homes frequently report loneliness and isolation, despite being in an environment shared with other residents and staff. Objective: To describe, among long-stay US nursing home residents living with Alzheimer’s disease and/or related dementias (ADRD), group activity participation in relation to contextual isolation: living in a nursing home where fewer than 20% of residents share socially salient characteristic(s). Design: A cross-sectional evaluation of group activity participation in relation to contextual isolation across 20 characteristics based on demographic characteristics, habits and interests, and clinical and care dimensions. Setting: US nursing homes. Participants: We included 335,421 residents with ADRD aged ≥50 years with a Minimum Data Set 3.0 annual assessment in 2016 reporting their preference for group activity participation, and 94,735 with participation observed by staff. Measurements: We identified 827,823 annual (any anniversary) assessments performed on nursing home residents in 2016, selecting one at random for each resident, after prioritizing the assessment with the least missing data (n=795,038). MDS 3.0 item F0500e assesses resident interest in group activities. Results: When considering all potential sources of contextual isolation considered, 30.7% were contextually isolated on the basis of a single characteristic and 13.7% were contextually isolated on the basis of two or more characteristics. Among residents reporting importance of group activity, 81% of those not contextually isolated reported that group activity participation was important, as did 78% of those isolated on one characteristic, and 75% of those isolated on multiple characteristics. Among residents with staff-observed group activity participation, 64% of those not contextually isolated reported were observed participating in group activities, as were 59% of those isolated on one characteristic, and 52% of those isolated on multiple characteristics. Conclusion: Residents with ADRD facing contextual isolation placed less importance on group activity than residents who were not contextually isolated.

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Elucidating the risk factors for progression from amyloid-negative amnestic mild cognitive impairment to dementia

Current Alzheimer Research ◽

10.2174/1567205017666201130094259 ◽

2020 ◽

Vol 17 ◽

Author(s):

Hyung-Ji Kim ◽

Jae-Hong Lee ◽

E-nae Cheong ◽

Sung-Eun Chung ◽

Sungyang Jo ◽

...

Keyword(s):

Risk Factors ◽

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Amnestic Mild Cognitive Impairment ◽

Amyloid Pet ◽

Clinical Progression ◽

Amnestic Mci

Background: Amyloid PET allows for the assessment of amyloid β status in the brain, distinguishing true Alzheimer’s disease from Alzheimer’s disease-mimicking conditions. Around 15–20% of patients with clinically probable Alzheimer’s disease have been found to have no significant Alzheimer’s pathology on amyloid PET. However, a limited number of studies had been conducted this subpopulation in terms of clinical progression. Objective: We investigated the risk factors that could affect the progression to dementia in patients with amyloid-negative amnestic mild cognitive impairment (MCI). Methods: This study was a single-institutional, retrospective cohort study of patients over the age of 50 with amyloidnegative amnestic MCI who visited the memory clinic of Asan Medical Center with a follow-up period of more than 36 months. All participants underwent brain magnetic resonance imaging (MRI), detailed neuropsychological testing, and fluorine-18[F18]-florbetaben amyloid PET. Results: During the follow-up period, 39 of 107 patients progressed to dementia from amnestic MCI. In comparison with the stationary group, the progressed group had a more severe impairment in verbal and visual episodic memory function and hippocampal atrophy, which showed an Alzheimer’s disease-like pattern despite the lack of evidence for significant Alzheimer’s disease pathology. Voxel-based morphometric MRI analysis revealed that the progressed group had a reduced gray matter volume in the bilateral cerebellar cortices, right temporal cortex, and bilateral insular cortices. Conclusion: Considering the lack of evidence of amyloid pathology, clinical progression of these subpopulation may be caused by other neuropathologies such as TDP-43, abnormal tau or alpha synuclein that lead to neurodegeneration independent of amyloid-driven pathway. Further prospective studies incorporating biomarkers of Alzheimer’s diseasemimicking dementia are warranted.

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Overlap of Pain and Depression Among Nursing Home Residents With Advanced Alzheimer’s Disease and Related Dementia

Innovation in Aging ◽

10.1093/geroni/igaa057.138 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 42-43

Author(s):

Emmanuelle Belanger ◽

Richard Jones ◽

Gary Epstein-Lubow ◽

Kate Lapane

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Nursing Home ◽

Depressive Symptoms ◽

Hospice Care ◽

Care Delivery ◽

Nursing Home Residents ◽

National Sample ◽

Fee For Service ◽

Minimum Dataset

Abstract Physical and psychological suffering are interrelated and should be assessed together as part of palliative care delivery. We aimed to describe the overlap of pain and depressive symptoms among long-stay nursing home (NH) residents with advanced Alzheimer’s disease and related dementia (ADRD), and to determine the incidence of pain and depressive symptoms. We conducted a retrospective study of a US national sample of fee-for-Service Medicare beneficiaries who became long-stay NH residents in 2014-2015, had two consecutive quarterly Minimum Dataset assessments (90 and 180 days +/- 30 days), and had a diagnosis of ADRD in the Chronic Condition Warehouse and moderate to severe cognitive impairment (N= 92,682). We used descriptive statistics and Poisson regression models to examine the incidence of each symptom controlling for age, sex, and concurrent hospice care. Sub-groups with self-reported and observer-rated symptoms (pain/PHQ-9) were modelled separately, as were those switching between the two. The prevalence of depressive symptoms was low (5.7%), while pain was more common (18.2%). Across various subgroups, 2% to 4% had both pain and depression, but between 20% and 25% were treated with both antidepressants and scheduled analgesia. Depressed residents at baseline had an incidence rate ratio (IRR) of pain of 1.2 at the second assessment, while the residents with pain at baseline had an IRR of depressive symptoms of 1.3 at the second assessment. Our results support the expected relationship between pain and depressive symptoms in a national sample of long-stay NH residents with advanced ADRD, suggesting the need for simultaneous clinical management.

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