The Effect of Race and Dementia Prevalence on a COVID-19 Infection Control Intervention in Massachusetts Nursing Homes

Background Nursing home (NH) residents, especially those who were Black or with dementia, had the highest infection rates during the COVID-19 pandemic. A 9-week COVID-19 infection control intervention in 360 Massachusetts NHs showed adherence to an infection control checklist with proper personal protective equipment (PPE) use and cohorting was associated with declines in weekly infection rates. NHs were offered weekly webinars, answers to infection control questions, resources to acquire PPE, backup staff, and SARS-CoV-2 testing. We asked whether the effect of this intervention differed by racial and dementia composition of the NHs. Methods Data were obtained from 4 state audits using infection control checklists, weekly infection rates, and Minimum Data Set variables on race and dementia to determine whether adherence to checklist competencies was associated with decline in average weekly rates of new COVID-19 infections. Results Using a mixed-effects hurdle model, adjusted for county COVID-19 prevalence, we found the overall effect of the intervention did not differ by racial composition, but proper cohorting of residents was associated with a greater reduction in infection rates among facilities with ≥20% non-Whites (n = 83). Facilities in the middle (>50%–62%; n = 121) and upper (>62%; n = 115) tertiles of dementia prevalence had the largest reduction in infection rates as checklist scores improved. Cohorting was associated with greater reductions in infection rates among facilities in the middle and upper tertiles of dementia prevalence. Conclusions Adherence to proper infection control procedures, particularly cohorting of residents, can reduce COVID-19 infections, even in facilities with high percentages of high-risk residents (non-White and dementia).

Global Research On Cognitive Frailty: A Bibliometric and Visual Analysis of Papers Published During 2013 – 2021

Background: Cognitive frailty relates to various adverse health outcomes of older adults and is proposed as a new target of healthy ageing. This study aimed to analyze the status, hotspots, and emerging trends / frontiers of global research on cognitive frailty.Methods: Articles and reviews related to cognitive frailty of older people published from 2013 to 2021 were retrieved from the Web of Science Core Collection (WoSCC) database on 26 November 2021. CiteSpace 5.8.R3 was used to conduct the collaboration analysis, document co-citation analysis, and keyword co-occurrence analysis.Results: A total of 2,077 publications were included. There has been a rapid growth of publications on cognitive research since 2016. The United States, Italy, England, and Australia were the leading research centers of cognitive frailty; however, China has recently focused on this topic. The National Center for Geriatrics and Gerontology and Shimada H. were found to be the most prolific institution and author, respectively. Co-citation analysis identified 16 clusters, of which the largest was cognitive frailty. The most frequently occurred keyword was older adult, followed by cognitive impairment, frailty, risk, dementia, prevalence, mortality, health, and Alzheimer’s disease. Burst keyword detection revealed a rising interest in cognitive frailty models.Conclusions: By analyzing the publications over the past years, this study provides a comprehensive analysis of cognitive frailty research. A variety of visualized networks offer an in-depth understanding of the countries / regions, institutions, authors, hotspots, and research frontiers.

Use of Benzodiazepines and Z-Drugs in Nursing Home Residents with Dementia: Prevalence and Appropriateness

Background: Guidelines worldwide recommend restricted prescription of benzodiazepine receptor agonists (BZRAs), i.e., benzodiazepines and Z-drugs, for the treatment of dementia-associated behavioral and psychological symptoms and insomnia. Objective: To assess the prevalence and appropriateness of BZRA use among nursing home residents with dementia. Methods: This is a post-hoc analysis of BZRA prescriptions from two intervention studies on psychotropic drug use, conducted from 2016 to 2018. It includes 1,111 residents of dementia special care units from 24 Dutch long-term care organizations. We assessed the prevalence of use of continuous and as-needed BZRA prescriptions and their association with registered symptoms. Continuous BZRA prescriptions were evaluated for appropriateness, i.e., whether indication, dosage, duration, and evaluation accorded with guidelines for the treatment of challenging behavior in dementia and sleep disorders. Results: The prevalence of BZRA use is 39.2%(95%CI: 36.3%–42.0%): continuous 22.9%; only as-needed 16.3%. Combinations of preferred BZRAs and appropriate indications occur in 19.0%of continuous anxiolytic prescriptions and 44.8%of hypnotic prescriptions. Frequently registered inappropriate indications are aggression/agitation for anxiolytics (continuous: 75.7%; as-needed: 75.2%) and nighttime agitation for hypnotics (continuous: 40.3%; as-needed: 26.7%). None of the continuous prescriptions with appropriate indications were appropriate for all other items. For most of the prescriptions, duration and time to evaluation exceeded 4 weeks. Conclusion: BZRA use in nursing home residents with dementia is highly frequent. A large proportion of prescriptions do not follow the guidelines with regard to indication, exceed the recommended duration and are not evaluated in a timely manner. The discrepancy between evidence-based guidelines and daily practice calls for an exploration of factors maintaining inappropriate use.

Trends in Dementia Prevalence in the United States, 1995-2019: An Age-Period-Cohort-Interaction Analysis

Previous studies have indicated that age-specific dementia prevalence has declined in the United States and other high-income countries. However, these studies have been limited by estimating temporal change in dementia rates on a strictly period basis, with little attention to possible cohort effects. Distinguishing age, period, and cohort effects is both methodologically and theoretically important for identifying the etiological factors driving dementia decline in the population. In this study, we apply the novel Age-Period-Cohort-Interaction (APC-I) model, which defines cohort effects as the interaction between age and period main effects. The APC-I model improves on earlier APC models (e.g., the accounting method) by solving the linear dependence between predictors through theoretical clarification instead of statistical manipulation. We use the APC-I model to estimate period and cohort trends in dementia prevalence using data from the Health and Retirement Study (HRS). Our analysis points to significant period and cohort effects. Dementia prevalence declined significantly between the periods 1995-1999 and 2015-2019. At the same time, cohorts born in the 1940s had significantly lower odds of dementia than would be expected given age and period main effects. This cohort’s unique protection from dementia has been relatively stable as they have aged. Our study identifies the periods during which and cohorts for whom dementia risk has declined in the United States. Further research is needed to specify the period factors (e.g., broad based improvements in nutrition) and cohort factors (e.g., increases in educational attainment) that are responsible for these trends.

Rural and Urban Difference in Longitudinal Trends in Prevalence of Dementia in Medicare Claims and Survey Data

Shortage of physicians in rural areas can lead to lower diagnosis and underestimation of dementia prevalence in these communities. We used data from the nationally representative Health and Retirement Study and a 20-percent sample of Medicare claims to study rural-urban differences in dementia prevalence. The survey dementia diagnosis is free from medical assessment while the claims diagnosis needs a physician diagnosis. We estimated the trends in dementia prevalence from (2002-2016) based on cognitive tests (using survey data) and diagnosis codes (using claims data) utilizing ordinary least squares regression. Dementia prevalence based on diagnosis codes declined in both urban and rural areas over the course of the study, with a sharper decline in urban areas. Dementia prevalence using diagnosis codes showed significantly higher rates in urban areas during all years (0.024 vs 0.018 in 2002 and 0.017 vs 0.013 in 2014 in rural vs urban areas, respectively). Dementia in the cognitive test sample was higher in rural areas (0.11 vs 0.08 in 2000 and 0.08 vs 0.7 in 2014 in rural vs urban areas), a difference that was significant only in 2004. Our results indicate lower dementia prevalence rates in rural areas in claims based sample compared to survey sample which its dementia prevalence is free medical assessment. Claims data are valuable sources for tracking dementia in the US population, however they are based on medical diagnosis.In rural areas, where there is shortage of physicians and a lack of access to health care services, claims based studies may underestimate dementia rates.

Prevalence of Dementia Among the Elderly in Latin America and the Caribbean: A Systematic Review and Meta-Analysis

Background Over the last decades, life expectancy in Latin America and the Caribbean showed a rapid increase, which led to a significant increase in the number of people with dementia. Moreover, 9% of the population in this part of the world are aged 65 or older, and by 2050 this percentage is projected to at least double. For this reason, it is essential to estimate the prevalence of dementia in LAC countries with the aim to determine suitable actions to enhance the quality of life of those affected. Methods Database searches for articles were conducted September 2020 throughout Pubmed, Web of knowledge, Scopus, Lilacs, and SciELO. The inclusion criteria comprised population- or community-based studies, published in English, Spanish, or Portuguese, reporting data on the prevalence of dementia collected in LAC countries. The complete data search retrieved 1719 non-duplicates. Results A total of 58 studies met the high-quality inclusion criteria, published 1991-2020, including participants in the following countries: Brazil, Mexico, Argentina, Colombia, Peru, Cuba, Dominican Republic, Venezuela, Ecuador, Trinidad and Tobago, and Jamaica. The most common form of dementia studied was Alzheimer’s disease with prevalence ranging from 5.9% to 23.4%. Estimates differed by age, gender, and education, with oldest, women, and lower-educated adults living in rural areas presenting higher dementia prevalence. Conclusion This is the first study giving a comprehensive overview of dementia prevalence in LAC countries, which is relevant to estimate care needs and economic costs related to dementia treatment and care.

Effect of Race and Dementia Prevalence on a COVID-19 Infection Control Intervention in Massachusetts Nursing Homes

Nursing home (NH) residents, especially those who were Black or had dementia, had the highest infection rates during the COVID-19 pandemic. A 9-week COVID-19 infection control intervention in 360 Massachusetts NHs showed that adherence to an infection control checklist with proper PPE use and cohorting, was associated with declines in weekly infection rates. NHs were offered weekly webinars, answers to infection control questions, resources to acquire personal protective equipment, backup staff, and SARS-CoV-2 testing. We asked whether the effect of this intervention differed by racial and dementia composition of the NHs. Data were obtained from 4 state audits using infection control checklists, weekly infection rates, and Minimum Data Set variables on race and dementia to determine whether adherence to the checklist competencies was associated with decline in average weekly rates of new COVID-19 infections. Using a mixed effects hurdle model, adjusted for county COVID-19 prevalence, we found that the overall effect of the intervention did not differ by race, but proper cohorting of residents was associated with a greater reduction in infection rates among facilities with ≥20% non-whites (n=83). Facilities in the middle (50-61%; n=116) and upper (>61%; n=118) tertiles of dementia prevalence had the largest reduction in infection rates as checklist scores improved. Cohorting was associated with greater reductions in infection rates among facilities in the middle and upper tertiles of dementia prevalence. Thus, adherence to proper infection control procedures, particularly cohorting, can reduce COVID-19 infections, even in facilities with high percentages of high-risk residents (non-white and dementia).

Temporal Trends in the Prevalence of Dementia in South Korea

Background. Secular decreases in the prevalence of cognitive impairment and dementia have been observed in several Western countries, however, few systematic investigations of temporal trends in dementia have been conducted in South Korea. Method. Data came from N=8,006 individuals (N=2,110 assessed twice) aged 65 years and older participating in the Korean Longitudinal Study of Aging 2008 and 2018. Dementia was indicated by a score ≤ 17 on the Korean Mini-Mental State Examination (K-MMSE). Dementia was regressed on the year of survey, adjusting for multiple demographic and socio-economic confounders, and, in additional models, also chronic diseases and lifestyle factors related to health, social, and religious activities. Results. Across waves, the share of individuals with low socio-economic status decreased. The prevalence of chronic diseases, including diabetes, heart diseases, stroke, and psychiatric diseases, increased over time. Alcohol consumption increased, whereas smoking rates, religious affiliation, and participation in religious activities decreased. Controlling for all covariates and compared to 2008, we observe decreases in dementia prevalence in 2018 by 52% (2018: OR 0.48, CI 0.42, 0.56). Women’s MMSE scores were more than two times as likely as men’s to indicate dementia (OR 2.59, CI 2.15, 3.14). Discussion. Decreases in dementia prevalence in Korea are partly attributable to improved socio-economic conditions and can be observed despite the increased prevalence of chronic conditions. However, secular trends were not fully explained by these and lifestyle factors. We discuss further individual-level and contextual-level mechanisms that may have contributed to these findings.