Marcia J. Lane

Co-morbidity associated with dementia.

Purpose: The purpose of this study was to identify common co-morbid conditions associated with dementia subtypes and to evaluate the association of hypertension, diabetes mellitus, atrial fibrillation, congestive heart failure, and anemia with dementia subtypes relative to controls. Methods: Hospital discharge data were used to identify 15,013 subjects from South Carolina with a diagnosis of dementia between 1998 and 1999. A control group of 15,013 persons without dementia was randomly sampled from hospital discharge records and matched to persons with dementia on the basis of age, race, and gender. Multiple hospitalizations for each patient were merged, and repeated diagnoses during separate hospitalizations were counted once. Results: After adjusting for age, race, and gender, persons with Alzheimers disease and dementia associated with medical conditions were less likely to be diagnosed with hypertension, diabetes, congestive heart failure, and atrial fibrillation than were controls. Patients with multiinfarct dementia were also less likely to have congestive heart failure, but were more likely to have diabetes. Anemia was not associated with any dementia subtype. Conclusions: There are distinct differences in comorbid conditions among dementia subtypes. Our research does not support previous studies that suggest a circulatory component to the development of Alzheimers disease.

The value of strength training for older adults.

Health in older adults can best be measured in terms of functional status. Skeletal muscle strength has been reported to be a determinant of functional status in older individuals. Two major contributors to the decline in muscle function as a person ages are disuse and physical inactivity. Declining muscle function through a loss of muscular strength may decrease functional independence and mobility and increase the risk for falls and injuries, physical frailty, and disability. Older individuals lacking an appropriate amount of muscular strength may not be able to perform various activities of daily living, which are important indicators of independence.

Impact of a Medication Management System on Nursing Home Admission Rate in a Community-Dwelling Nursing Home–Eligible Medicaid Population

BACKGROUND Community-dwelling frail elderly have an increased need for effective medication management to reside in their homes and delay or avoid admission to nursing homes. OBJECTIVE The objective of this study was to examine the impact of a medication management system on nursing home admission within the community-dwelling frail elderly. METHODS This prospective cohort study compared nursing home admission rates in intervention and control clients of a state Medicaid home and community-based waiver program. Groups were matched on age (±5 years), race, gender, and waiver program start date (±120 days). The medication management service consisted of 2 parts: 1) prescription medicines dispensed from the clients local pharmacy in a calendar card, and 2) a coordinating service by a health educator to address medication-related problems as they arose. The primary dependent variable was admission to a nursing home. RESULTS A total of 273 clients agreed to participate, enrolled, and had at least 1 prescription dispensed. The matched control group was composed of 800 other clients. The client sample was 72 years of age, 73% (785/1073) non-white, 75% (804/1073) female, and enrolled in the waiver program approximately 50 months. The 2 groups were similar on all demographic variables examined. Six clients (2.2%) in the intervention group and 40 clients (5.0%) in the control group were admitted to a nursing home at least once during the study period. Logistic regression was used to test the model predicting at least 1 nursing home admission. Control group clients were 2.94 times more likely to be admitted to a nursing home than clients in the intervention group. CONCLUSIONS The medication management service implemented within this study was effective in reducing nursing home admissions in a group of frail community-dwelling elderly.

Application of capture-recapture methodology to estimate the prevalence of dementia in South Carolina

PURPOSE The purpose of this study was to estimate the prevalence of dementia in individuals 65 years of age and older in the state of South Carolina using capture-recapture methodology. METHODS We linked data from the Department of Mental Health admissions, inpatient admissions, and emergency room visits. Separate log-linear models were used to obtain estimates of the underascertainment-corrected prevalence of dementia in twelve age-gender-race subgroups, which were summed to estimate the prevalence of dementia in the total population. RESULTS We found an overall prevalence of dementia of 14% in South Carolina for persons 65 years of age and older using capture-recapture methodology. This estimate of persons with dementia is 25% higher than the identified cases of dementia in the South Carolina Alzheimers Disease Registry (10.5%). CONCLUSIONS Although capture-recapture methods are prone to limitations, they can be used to more accurately estimate the prevalence of dementia in a geographic area.

The influence of caregivers and behavioral and psychological symptoms on nursing home placement of persons with Alzheimer's disease: A matched case-control study.

Objectives: Behavioral and psychological symptoms of dementia in individuals with Alzheimer’s disease and caregiver characteristics may influence the decision to provide care at home or in a nursing home, though few studies examine this association near the actual time of nursing home placement. Using a matched case–control design, this study investigates the association between (1) total Neuropsychiatric Inventory score, (2) the Neuropsychiatric Inventory-4 (an agitation/aggression subscale), and (3) individual domains of the Neuropsychiatric Inventory and nursing home placement. Methods: Data from the South Carolina Alzheimer’s disease Registry provides an opportunity to expand the literature by looking at cases at the time of nursing home care eligibility/placement and allowing for propensity-score-matched controls. Cases (n = 352) entered a nursing home within 6 months of study initiation; controls (n = 289) remained in the community. Registry data were combined with caregiver survey data, including the Neuropsychiatric Inventory. Conditional logistic regression was applied. Results: A 10% increase in the Neuropsychiatric Inventory score implied a 30% increase in odds of nursing home admission (odds ratio: 1.30; 95% confidence interval: 1.14–1.50), having married or male caregivers predicted nursing home placement. Cases versus controls were significantly more likely to have behavioral and psychological symptoms of dementia related to agitation/aggression 1 month prior to nursing home admission. Conclusion: Interventions targeting behavioral and psychological symptoms of dementia without available effective interventions in individuals with Alzheimer’s disease and caregiver support services are necessary to prevent or delay nursing home admission.

Location of death as an indicator of end-of-life costs for the person with dementia:

Decreasing health resources and an aging population highlight the importance of end-of-life decisions. Estimates suggest that end-of-life care in a hospital is more expensive than other alternatives. This study examined the location of death for 3,109 Medicaid-eligible persons with dementia identified through the South Carolina Alzheimers Disease Registry between 1988 and 1994 and estimated daily end-of-life costs. Results indicated that (1) daily costs for hospital care are six times higher than hospice/home care and (2) almost half of persons resided at home but only 8 percent died at home while 51 percent died in hospitals, the most expensive option. These findings suggest home or hospice end-of-life care might be a reasonable and cost-effective option for elderly patients with dementia. Families should be encouraged to explore this alternative.

Person-centered planning training for consumer-directed care for the elderly and disabled.

Based on the need for a training program for person-centered planning, SC Choice, a Real Choice/Independent Living Grant, included the development of training materials and a training program for the implementation of the transformation from agency case manager to care advisor. The development of this training included receiving the person-centered planning training currently used by the developmentally disabled agencies, as well as interviews and focus groups with interested staff and participants. A training program for the Elderly/Disabled Waiver population using adult learning techniques is described in detail. Included in this training are the philosophy, the activities, and the necessary steps to complete person-centered planning for the transition of a case manager to a care advisor in a consumer-directed program for the elderly.