Lauren J Hunt1,2, R Sean Morrison3,4, Siqi Gan5, Edie Espejo5, Katherine A Ornstein3, W John Boscardin5,6, Alexander K Smith4,5. 1. Department of Physiological Nursing, University of California, San Francisco, California, USA. 2. Global Brain Health Institute, University of California, San Francisco, California, USA. 3. Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 4. James J. Peters VA Medical Center, Bronx, New York, USA. 5. Division of Geriatrics, Department of Medicine, University of California, San Francisco, California, USA. 6. Department of Epidemiology & Biostatistics, University of California, San Francisco, California, USA.
Abstract
BACKGROUND: Potentially disruptive medical, surgical, and social events-such as pneumonia, hip fracture, and widowhood-may accelerate the trajectory of decline and impact caregiving needs in older adults, especially among people with dementia (PWD). Prior research has focused primarily on nursing home residents with dementia. We sought to assess the incidence of potentially disruptive events in community-dwelling people with and without dementia. METHODS: Retrospective cohort study of participants aged 65+ enrolled in the Health and Retirement Study between 2010 and 2018 (n = 9346), including a subset who were married-partnered at baseline (n = 5105). Dementia was defined with a previously validated algorithm. We calculated age-adjusted and gender-stratified incidence per 1000 person-years and incidence rate ratios of: 1) hospitalization for pneumonia, 2) hip fracture, and 3) widowhood in people with and without dementia. RESULTS: PWD (n = 596) were older (mean age 84 vs. 75) and a higher proportion were female (67% vs. 57%) than people without dementia (PWoD) (n = 8750). Age-adjusted incidence rates (per 1000 person-years) of pneumonia were higher in PWD (113.1; 95% CI 94.3, 131.9) compared to PWoD (62.1; 95% CI 54.7, 69.5), as were hip fractures (12.3; 95% CI 9.1, 15.6 for PWD compared to 8.1; 95% CI 6.9, 9.2 in PWoD). Point estimates of widowhood incidence were slightly higher for PWD (25.3; 95% CI 20.1, 30.5) compared to PWoD (21.9; 95% CI 20.3, 23.5), but differences were not statistically significant. The association of dementia with hip fracture-but not pneumonia or widowhood-was modified by gender (male incidence rate ratio [IRR] 2.24, 95% CI 1.34, 3.75 versus female IRR 1.31 95% CI 0.92,1.86); interaction term p = 0.02). CONCLUSIONS: Compared to PWoD, community-dwelling PWD had higher rates of pneumonia and hip fracture, but not widowhood. Knowing how often PWD experience these events can aid in anticipatory guidance and care planning for this growing population.
BACKGROUND: Potentially disruptive medical, surgical, and social events-such as pneumonia, hip fracture, and widowhood-may accelerate the trajectory of decline and impact caregiving needs in older adults, especially among people with dementia (PWD). Prior research has focused primarily on nursing home residents with dementia. We sought to assess the incidence of potentially disruptive events in community-dwelling people with and without dementia. METHODS: Retrospective cohort study of participants aged 65+ enrolled in the Health and Retirement Study between 2010 and 2018 (n = 9346), including a subset who were married-partnered at baseline (n = 5105). Dementia was defined with a previously validated algorithm. We calculated age-adjusted and gender-stratified incidence per 1000 person-years and incidence rate ratios of: 1) hospitalization for pneumonia, 2) hip fracture, and 3) widowhood in people with and without dementia. RESULTS: PWD (n = 596) were older (mean age 84 vs. 75) and a higher proportion were female (67% vs. 57%) than people without dementia (PWoD) (n = 8750). Age-adjusted incidence rates (per 1000 person-years) of pneumonia were higher in PWD (113.1; 95% CI 94.3, 131.9) compared to PWoD (62.1; 95% CI 54.7, 69.5), as were hip fractures (12.3; 95% CI 9.1, 15.6 for PWD compared to 8.1; 95% CI 6.9, 9.2 in PWoD). Point estimates of widowhood incidence were slightly higher for PWD (25.3; 95% CI 20.1, 30.5) compared to PWoD (21.9; 95% CI 20.3, 23.5), but differences were not statistically significant. The association of dementia with hip fracture-but not pneumonia or widowhood-was modified by gender (male incidence rate ratio [IRR] 2.24, 95% CI 1.34, 3.75 versus female IRR 1.31 95% CI 0.92,1.86); interaction term p = 0.02). CONCLUSIONS: Compared to PWoD, community-dwelling PWD had higher rates of pneumonia and hip fracture, but not widowhood. Knowing how often PWD experience these events can aid in anticipatory guidance and care planning for this growing population.
Authors: Alexander K Smith; Irena Stijacic Cenzer; W John Boscardin; Christine S Ritchie; Margaret L Wallhagen; Kenneth E Covinsky Journal: J Am Geriatr Soc Date: 2015-10 Impact factor: 5.562
Authors: Forest W Arnold; Andrea M Reyes Vega; Vidyulata Salunkhe; Stephen Furmanek; Christian Furman; Laura Morton; Anna Faul; Pam Yankeelov; Julio A Ramirez Journal: J Am Geriatr Soc Date: 2020-01-09 Impact factor: 5.562
Authors: Ann L Gruber-Baldini; Sheryl Zimmerman; R Sean Morrison; Lynn M Grattan; J Richard Hebel; Melissa M Dolan; William Hawkes; Jay Magaziner Journal: J Am Geriatr Soc Date: 2003-09 Impact factor: 5.562
Authors: Krista L Harrison; Christine S Ritchie; Kanan Patel; Lauren J Hunt; Kenneth E Covinsky; Kristine Yaffe; Alexander K Smith Journal: J Am Geriatr Soc Date: 2019-08-07 Impact factor: 5.562
Authors: Christopher J Brereton; Daniel Lennon; Sarah Browning; Emily Dunn; John K Ferguson; Joshua S Davis Journal: Int J Antimicrob Agents Date: 2018-05-18 Impact factor: 5.283
Authors: Irena S Cenzer; Victoria Tang; W John Boscardin; Alexander K Smith; Christine Ritchie; Margaret I Wallhagen; Roxanne Espaldon; Kenneth E Covinsky Journal: J Am Geriatr Soc Date: 2016-06-13 Impact factor: 5.562