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Adverse Outcomes After Hospitalization and Delirium in Persons with Alzheimer Disease
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Transcript of Adverse Outcomes After Hospitalization and Delirium in Persons with Alzheimer Disease
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Adverse Outcomes After Hospitalization and Delirium in Persons with Alzheimer DiseaseCharles Wang, PharmD Candidate
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Study•Adverse Outcomes After Hospitalization and
Delirium in Persons with Alzheimer Disease▫Fong T, Jones R, et al.▫Annals of Internal Medicine▫Volume 156 Number 12▫June 19, 2012
•Funding▫National Institute on Aging ▫Massachusetts Alzheimer’s Disease Research
Center
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Background•Hospitalization can have potentially
catastrophic consequences for patients with AD▫Delirium▫Loss of independence▫Institutionalization▫Death
•Every year, 20% to 40% of patients with AD are hospitalized with an average of 3.7 days per year
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Study Objective•To determine risks for institutionalization,
cognitive decline, or death associated with hospitalization and delirium in patients with Alzheimer’s Disease
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Design•Enrollment
▫Prospective Cohort enrolled between 1991 and 2006 into the Massachusetts Alzheimer’s Disease Research Center (MADRC) patient registry
•Population▫Persons aged 65 or older with a clinical
diagnosis of Alzheimer's Disease (AD)
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Methods•Drew study population from 5,600
patients that have been evaluated by MADRC at the Massachusetts General Hospital, a Harvard affiliated teaching hospital
•Data was merged from MADRC with data from the Medicare Provider Analysis and Review (MEDPAR) database, medical records, the Social Security Death Index database, and the National Death Index (NDI)
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Methods•Hospitalizations were determined using the
MEDPAR database and corresponding medical charts
•Hospitalization group were participants hospitalized within 18 months of a MADRC visit
•Non-hospitalization group were participants without an hospitalizations for up to 36 months
•Participants hospitalized between 18 months and 36 months were excluded
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Methods•Inclusion criteria
▫≥65 years of age▫Diagnosis of probable or possible AD
according to guidelines from the National Institute of Neurological and Communicative Diseases and Stroke and the Alzheimer’s Disease and Related Disorders Association
▫Were not enrolled in a Medicare HMO▫Had at least 3 MADRC visits during study
interval
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Methods•Exclusion Criteria
▫Participants hospitalized after January 1, 2006 1 year follow up would not be complete
within the study time frame▫Participants hospitalized between 18
months and 36 months were excluded
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Methods•Baseline was determined by the MADRC
visit prior to hospitalization▫Demographic characteristics▫Medical history▫Neurologic examination▫Cognitive testing
Information-Memory-Concentration subtest of the Blessed Dementia Scale test
Dementia Severity Rating
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Outcomes•Institutionalization•Cognitive Decline
▫Loss of 4 or more points from baseline•Death
▫All within 1 year of Hospitalization
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Demographics•Total Participants
▫771•Hospitalized patients with Delirium
▫194•Hospitalized patients without Delirium
▫173•Non-hospitalized patients
▫404
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Demographics
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Demographics
•Chronic Lung disease, CHF, fever, infections, dehydration, renal failure, PVD, psychiatric illness, and DM
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Results
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Results
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Results
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Discussion•Poor outcomes is greater among patients
who develop delirium, even after adjusting for cofounders
•Substantial proportion of risk could be attributed to delirium▫Death: 6.2%▫Institutionalization: 15.2%▫Cognitive Decline: 20.6%▫Overall adverse outcomes: 12.4%
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Author’s Conclusions•Approximately 1 in 8 hospitalized patient
with AD who develop delirium will have at least 1 adverse outcome, including death, institutionalization, or cognitive decline, associated with delirium
•Delirium prevention may represent an important strategy for reducing adverse outcomes in this population
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Strengths•Large scale study examining outcomes of
hospitalization of people with Alzheimer’s Disease
•Even distribution of men and women•Large sample size
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Limitations•Population mainly white (95%)•Cognitive outcome was missing from 291
patients•Non-randomized•Patients that were hospitalized with
delirium were most cognitively impaired•All data was obtained from a single site•Data from multiple databases were
combined to create a single cohort
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Discussion•Traditionally, observational study cannot
determine causality•Causative or associative?
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References•Fong T, Jones R, et al. “Adverse outcomes
after hospitalization and delirium in persons with alzheimer’s disease” Annals of internal medicine 156(2012):848-856.