Abstract
Background and aims
Many older adults with dementia are hospitalized for diagnoses other than dementia. We aimed to determine the prevalence of comorbid dementia among hospitalized older adults and evaluate its effects on their hospital course.
Methods
This retrospective case–control study reviewed the hospital records of all adults aged over 60 years admitted to one tertiary hospital in China from 2002 to 2012. In total, 34,888 patients meeting the age criterion were included. Patients admitted to departments of pediatrics, obstetrics and gynecology were not included. Demographic, clinical and outcome data from computerized discharge records were collected. Patients diagnosed with dementia at discharge by DSM-IV-TR criteria and MMSE scores formed the dementia group. All other patients were controls. Illness rating scale, comorbidities, mortality at discharge, dementia subtypes and long-term follow-up status for dementia patients were analyzed using comparative statistical methods (e.g., one-way ANOVA with Bonferroni pairwise comparison, Kruskal–Wallis and Mann–Whitney U test pairwise comparisons).
Results
A total of 918 patients (2.6 % prevalence) had comorbid dementia, including Alzheimer’s disease (39.1 %) and vascular dementia (39.4 %). Neurologic and respiratory system diseases were the most common main diagnoses for patients with comorbid dementia, who also had a higher percentage of level III or IV severity of main illness compared to controls and longer hospital stays (both P < 0.01). Mortality at discharge included 9.80 % of the dementia group and 8.84 % of controls (P = 0.312).
Conclusion
Comorbid dementia has significant effects on hospital course of older adults with various main diagnoses, affecting length of stay, severity of illness, and mortality.
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References
Fratiglioni L, DeRonchi D, Aguero-Torres H (1999) Worldwide prevalence and incidence of dementia. Drugs Aging 15:365–375
Reitz C, Brayne C, Mayeux R (2011) Epidemiology of Alzheimer disease. Nat Rev Neuril. doi:10.1038/nmeurol.2011.2
Ferri CP, Prince M, Brayne C et al (2005) Global prevalence of dementia: a Delhi consensus study. Lancet 366:2112–2117
Zhang YD, Xu Y, Nie HW, Lei T, Wu Y, Zhang L, Zhang M (2012) Prevalence of dementia and major dementia subtypes in the Chinese population: a meta-analysis of dementia prevalence surveys, 1980–2010. J Clin Neuro 19:1333–1337
Suh GH, Shah A (2001) A review of the epidemiological transition in dementia: cross-national comparisons of the indices related to Alzheimer’s disease and vascular dementia. Acta Psychiatr Scand 104:4–11
Schubert CC, Boustani M, Callahan CM et al (2006) Comorbidity profile of dementia patients in primary care: are they sicker? J Am Geriatr Soc 54:104–109
Solomon A, Dobranici L, Kåreholt I, Tudose C, Lăzărescu M (2011) Comorbidity and the rate of cognitive decline in patients with Alzheimer dementia. Int J Geriatr Psychiatry 26:1244–1251
Peltz CB, Corrada MM, Berlau DJ et al (2011) Incidence of dementia in oldest-old with amnestic MCI and other cognitive impairments. Neurology 77:1906–1912
Zuliani G, Galvani M, Sioulis F et al (2012) Discharge diagnosis and comorbidity profile in hospitalized older patients with dementia. Int J Geriatr Psychiatry 27:313–320
Malone DC, McLaughlin TP, Wahl PM (2009) Burden of Alzheimer’s disease and association with negative health outcomes. Am J Manag Care 15:181–188
Zilkens RR, Spilsbury K, Bruce DG, Semmens JB (2009) Clinical epidemiology and in-patient hospital use in the last year of life (1990–2005) of 29,884 Western Australians with dementia. J Alzheimers Dis 17:399–407
Brunnström HR, Englund EM (2009) Cause of death in patients with dementia disorders. Eur J Neurol 16:488–492
Wu XG, Tang Z, Fang XH et al (2011) A cohort study on mortality and risk of death among population diagnosis as dementia, at base-line survey, in Beijing. Zhonghua Liu Xing Bing Xue Za Zhi 32:973–977
Sanderson M, Wang J, Davis DR, Lane MJ, Cornman CB, Fadden MK (2002) Co-morbidity associated with dementia. Am J Alzheimers Dis Other Demen 17:73–78
Wen H, Zhang Z, Huang J, Duan L, Wang Q (2011) Mortality of dementia and its major subtypes in urban and rural communities of Beijing. Biomed Environ Sci 24:483–490
Hill JW, Futterman R, Duttagupta S et al (2002) Alzheimer’s disease and related dementias increase costs of comorbidities in managed Medicare. Neurology 58:62–70
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadian EM (1984) Clinical diagnosis of Alzheimer’s disease: report of the NINCDS–ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 34:939–944
Roman GC, Tatemichi TK, Erkinjuntti T et al (1993) Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 43:250–260
Hachinski VC, Iliff LD, Zihka E, DuBoulay GH, McAllister VL, Marshall J, Russell RW, Symon L (1975) Cerebral blood flow in dementia. Arch Neurol 32:632–637
Miller MD, Paradis CF, Houck PR (1992) Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res 41:237–248
Helmer C, Stengel B, Metzger M et al (2011) Chronic kidney disease, cognitive decline, and incident dementia: the 3C Study. Neurology 77:2043–2051
Aarsland D, Kurz MW (2010) The epidemiology of dementia associated with Parkinson’s disease. Brain Pathol 20:633–639
Wu JH, Guo Z, Kumar S, Lapuerta P (2011) Incidence of serious upper and lower gastrointestinal events in older adults with and without Alzheimer’s disease. J Am Geriatr Soc 59:2053–2061
Driver JA, Beiser A, Au R et al (2012) Inverse association between cancer and Alzheimer’s disease: results from the Framingham Heart Study. BMJ 344:e1442
Zekry D, Herrmann FR, Graf CE et al (2011) High levels of comorbidity and disability cancel out the dementia effect in predictions of long-term mortality after discharge in the very old. Dement Geriatr Cogn Disord 32:103–110
Bharmal MF, Dedhiya S, Craig BA et al (2012) Incremental dementia-related expenditures in a medicaid population. Am J Geriatr Psychiatry 20:73–83
Zieschang T, Dutzi I, Müller E et al (2010) Improving care for patients with dementia hospitalized for acute somatic illness in a specialized care unit: a feasibility study. Int Psychogeriatr 22:139–146
Formiga F, Fort I, Robles MJ, Rodriguez D, Regalado P (2010) Lower Barthel Index scores predict less prescription of pharmacological therapy in elderly patients with Alzheimer disease. Dement Geriatr Cogn Disord 29:198–203
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Li, F., Wang, F. & Jia, J. Evaluating the prevalence of dementia in hospitalized older adults and effects of comorbid dementia on patients’ hospital course. Aging Clin Exp Res 25, 393–401 (2013). https://doi.org/10.1007/s40520-013-0068-z
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DOI: https://doi.org/10.1007/s40520-013-0068-z