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ADVANCED ILLNESS AMONG ELDERLY NURSING HOME RESIDENTS WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIA

Alzheimer’s disease and related dementia (AD/ADRD) are leading causes of mortality in the United States. Identifying advanced illness (AI) in NH residents is key for developing therapeutic and palliative care plans for end of life. We refined and extended existing measures of AI in NH residents with...

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Autores principales: Gracner, Tadeja, Sorbero, Mark, Stone, Patricia W, Agarwal, Mansi, Dick, Andrew W
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6845827/
http://dx.doi.org/10.1093/geroni/igz038.1882
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author Gracner, Tadeja
Sorbero, Mark
Stone, Patricia W
Agarwal, Mansi
Dick, Andrew W
author_facet Gracner, Tadeja
Sorbero, Mark
Stone, Patricia W
Agarwal, Mansi
Dick, Andrew W
author_sort Gracner, Tadeja
collection PubMed
description Alzheimer’s disease and related dementia (AD/ADRD) are leading causes of mortality in the United States. Identifying advanced illness (AI) in NH residents is key for developing therapeutic and palliative care plans for end of life. We refined and extended existing measures of AI in NH residents with AD/ADRD and described patterns of survival for each measure. Using the Minimum Data Set (MDS; 2011 to 2013) linked to vital status (through 2016), we defined categories of AD/ADRD residents at AI onset: (1) those with ADRD, (2) and those with both, AD and ADRD. We estimated survival functions and multivariable duration models to describe patterns of survival from AI onset until death, stratified by AD/ADRD classifications, sex and functional status at AI onset, conditional on socio-demographics and co-morbidities. We limited our sample to adults ages >64 for whom we observed the incident AI assessment in the MDS. Median survival was 229 days for all classifications of AI, but higher for those with only ADRD (300 days). Survival declined substantially for residents with eating difficulties; to 122 days for residents with AD and ADRD. A stark survival decline (40 days) occurred among residents with shortness of breath. Across all AI classifications, survival was negatively associated with male sex, age, diabetes, substantial weight-loss and events such as heart failure. Depression, hypertension, and UTI were associated with small or insignificant increases in mortality risk. AI can be defined using MDS data, allowing for examination of policies designed to improve end of life care.
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spelling pubmed-68458272019-11-18 ADVANCED ILLNESS AMONG ELDERLY NURSING HOME RESIDENTS WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIA Gracner, Tadeja Sorbero, Mark Stone, Patricia W Agarwal, Mansi Dick, Andrew W Innov Aging Session 2390 (Poster) Alzheimer’s disease and related dementia (AD/ADRD) are leading causes of mortality in the United States. Identifying advanced illness (AI) in NH residents is key for developing therapeutic and palliative care plans for end of life. We refined and extended existing measures of AI in NH residents with AD/ADRD and described patterns of survival for each measure. Using the Minimum Data Set (MDS; 2011 to 2013) linked to vital status (through 2016), we defined categories of AD/ADRD residents at AI onset: (1) those with ADRD, (2) and those with both, AD and ADRD. We estimated survival functions and multivariable duration models to describe patterns of survival from AI onset until death, stratified by AD/ADRD classifications, sex and functional status at AI onset, conditional on socio-demographics and co-morbidities. We limited our sample to adults ages >64 for whom we observed the incident AI assessment in the MDS. Median survival was 229 days for all classifications of AI, but higher for those with only ADRD (300 days). Survival declined substantially for residents with eating difficulties; to 122 days for residents with AD and ADRD. A stark survival decline (40 days) occurred among residents with shortness of breath. Across all AI classifications, survival was negatively associated with male sex, age, diabetes, substantial weight-loss and events such as heart failure. Depression, hypertension, and UTI were associated with small or insignificant increases in mortality risk. AI can be defined using MDS data, allowing for examination of policies designed to improve end of life care. Oxford University Press 2019-11-08 /pmc/articles/PMC6845827/ http://dx.doi.org/10.1093/geroni/igz038.1882 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Session 2390 (Poster)
Gracner, Tadeja
Sorbero, Mark
Stone, Patricia W
Agarwal, Mansi
Dick, Andrew W
ADVANCED ILLNESS AMONG ELDERLY NURSING HOME RESIDENTS WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIA
title ADVANCED ILLNESS AMONG ELDERLY NURSING HOME RESIDENTS WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIA
title_full ADVANCED ILLNESS AMONG ELDERLY NURSING HOME RESIDENTS WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIA
title_fullStr ADVANCED ILLNESS AMONG ELDERLY NURSING HOME RESIDENTS WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIA
title_full_unstemmed ADVANCED ILLNESS AMONG ELDERLY NURSING HOME RESIDENTS WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIA
title_short ADVANCED ILLNESS AMONG ELDERLY NURSING HOME RESIDENTS WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIA
title_sort advanced illness among elderly nursing home residents with alzheimer’s disease and related dementia
topic Session 2390 (Poster)
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6845827/
http://dx.doi.org/10.1093/geroni/igz038.1882
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