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Adverse Outcomes After Hospitalization and Delirium in Persons with Alzheimer Disease

Adverse Outcomes After Hospitalization and Delirium in Persons with Alzheimer Disease. Charles Wang, PharmD Candidate. 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

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Adverse Outcomes After Hospitalization and Delirium in Persons with Alzheimer Disease

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  1. Adverse Outcomes After Hospitalization and Delirium in Persons with Alzheimer Disease Charles Wang, PharmD Candidate

  2. 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

  3. 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

  4. Study Objective • To determine risks for institutionalization, cognitive decline, or death associated with hospitalization and delirium in patients with Alzheimer’s Disease

  5. 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)

  6. 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)

  7. 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

  8. 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

  9. 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

  10. 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

  11. Outcomes • Institutionalization • Cognitive Decline • Loss of 4 or more points from baseline • Death • All within 1 year of Hospitalization

  12. Demographics • Total Participants • 771 • Hospitalized patients with Delirium • 194 • Hospitalized patients without Delirium • 173 • Non-hospitalized patients • 404

  13. Demographics

  14. Demographics • Chronic Lung disease, CHF, fever, infections, dehydration, renal failure, PVD, psychiatric illness, and DM

  15. Results

  16. Results

  17. Results

  18. 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%

  19. 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

  20. Strengths • Large scale study examining outcomes of hospitalization of people with Alzheimer’s Disease • Even distribution of men and women • Large sample size

  21. 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

  22. Discussion • Traditionally, observational study cannot determine causality • Causative or associative?

  23. 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.

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