Mortality and Adverse Health Events in Newly Admitted Nursing Home Residents with and without Dementia

Authors

  • Jay Magaziner PhD,

    1. From the *Department of Epidemiology and Preventive MedicineDepartment of Medicine, School of Medicine, University of Maryland, Baltimore, MarylandCecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina, Chapel Hill, North Carolina§Department of Health Policy and Management, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MarylandDepartment of Medicine, Division of Geriatrics and Long-Term Care, Washington Hospital Center, Washington, DC.
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  • Sheryl Zimmerman PhD,

    1. From the *Department of Epidemiology and Preventive MedicineDepartment of Medicine, School of Medicine, University of Maryland, Baltimore, MarylandCecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina, Chapel Hill, North Carolina§Department of Health Policy and Management, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MarylandDepartment of Medicine, Division of Geriatrics and Long-Term Care, Washington Hospital Center, Washington, DC.
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  • Ann L. Gruber-Baldini PhD,

    1. From the *Department of Epidemiology and Preventive MedicineDepartment of Medicine, School of Medicine, University of Maryland, Baltimore, MarylandCecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina, Chapel Hill, North Carolina§Department of Health Policy and Management, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MarylandDepartment of Medicine, Division of Geriatrics and Long-Term Care, Washington Hospital Center, Washington, DC.
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  • Carol Van Doorn PhD,

    1. From the *Department of Epidemiology and Preventive MedicineDepartment of Medicine, School of Medicine, University of Maryland, Baltimore, MarylandCecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina, Chapel Hill, North Carolina§Department of Health Policy and Management, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MarylandDepartment of Medicine, Division of Geriatrics and Long-Term Care, Washington Hospital Center, Washington, DC.
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  • J. Richard Hebel PhD,

    1. From the *Department of Epidemiology and Preventive MedicineDepartment of Medicine, School of Medicine, University of Maryland, Baltimore, MarylandCecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina, Chapel Hill, North Carolina§Department of Health Policy and Management, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MarylandDepartment of Medicine, Division of Geriatrics and Long-Term Care, Washington Hospital Center, Washington, DC.
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  • Pearl German ScD,

    1. From the *Department of Epidemiology and Preventive MedicineDepartment of Medicine, School of Medicine, University of Maryland, Baltimore, MarylandCecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina, Chapel Hill, North Carolina§Department of Health Policy and Management, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MarylandDepartment of Medicine, Division of Geriatrics and Long-Term Care, Washington Hospital Center, Washington, DC.
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  • Lynda Burton ScD,

    1. From the *Department of Epidemiology and Preventive MedicineDepartment of Medicine, School of Medicine, University of Maryland, Baltimore, MarylandCecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina, Chapel Hill, North Carolina§Department of Health Policy and Management, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MarylandDepartment of Medicine, Division of Geriatrics and Long-Term Care, Washington Hospital Center, Washington, DC.
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  • George Taler MD,

    1. From the *Department of Epidemiology and Preventive MedicineDepartment of Medicine, School of Medicine, University of Maryland, Baltimore, MarylandCecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina, Chapel Hill, North Carolina§Department of Health Policy and Management, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MarylandDepartment of Medicine, Division of Geriatrics and Long-Term Care, Washington Hospital Center, Washington, DC.
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  • Conrad May MD,

    1. From the *Department of Epidemiology and Preventive MedicineDepartment of Medicine, School of Medicine, University of Maryland, Baltimore, MarylandCecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina, Chapel Hill, North Carolina§Department of Health Policy and Management, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MarylandDepartment of Medicine, Division of Geriatrics and Long-Term Care, Washington Hospital Center, Washington, DC.
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  • Charlene C. Quinn PhD,

    1. From the *Department of Epidemiology and Preventive MedicineDepartment of Medicine, School of Medicine, University of Maryland, Baltimore, MarylandCecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina, Chapel Hill, North Carolina§Department of Health Policy and Management, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MarylandDepartment of Medicine, Division of Geriatrics and Long-Term Care, Washington Hospital Center, Washington, DC.
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  • Cynthia L. Port PhD,

    1. From the *Department of Epidemiology and Preventive MedicineDepartment of Medicine, School of Medicine, University of Maryland, Baltimore, MarylandCecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina, Chapel Hill, North Carolina§Department of Health Policy and Management, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MarylandDepartment of Medicine, Division of Geriatrics and Long-Term Care, Washington Hospital Center, Washington, DC.
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  • Mona Baumgarten PhD,

    1. From the *Department of Epidemiology and Preventive MedicineDepartment of Medicine, School of Medicine, University of Maryland, Baltimore, MarylandCecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina, Chapel Hill, North Carolina§Department of Health Policy and Management, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MarylandDepartment of Medicine, Division of Geriatrics and Long-Term Care, Washington Hospital Center, Washington, DC.
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  • for the Epidemiology of Dementia in Nursing Homes Research Group

    1. From the *Department of Epidemiology and Preventive MedicineDepartment of Medicine, School of Medicine, University of Maryland, Baltimore, MarylandCecil G. Sheps Center for Health Services Research and the School of Social Work, University of North Carolina, Chapel Hill, North Carolina§Department of Health Policy and Management, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MarylandDepartment of Medicine, Division of Geriatrics and Long-Term Care, Washington Hospital Center, Washington, DC.
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Address correspondence to Jay Magaziner, PhD, Professor and Director, Division of Gerontology, School of Medicine, University of Maryland, 660 W. Redwood Street, Suite 200, Baltimore, MD 21201. E-mail: jmagazin@epi.umaryland.edu

Abstract

Objectives: To evaluate the association between dementia and mortality, adverse health events, and discharge disposition of newly admitted nursing home residents. It was hypothesized that residents with dementia would die at a higher rate and develop more adverse health events (e.g., infections, fevers, pressure ulcers, falls) than residents without dementia because of communication and self-care difficulties.

Design: An expert clinician panel diagnosed an admission cohort from a stratified random sample of 59 Maryland nursing homes, between 1992 and 1995. The cohort was followed for up to 2 years or until discharge.

Setting: Fifty-nine Maryland nursing homes.

Participants: Two thousand one hundred fifty-three newly admitted residents aged 65 and older not having resided in a nursing home for 8 or more days in the previous year.

Measurements: Mortality, infection, fever, pressure ulcers, fractures, and discharge home.

Results: Residents with dementia had significantly lower overall rates of infection (relative risk (RR)=0.77, 95% confidence interval (CI)=0.70–0.85) and mortality (RR=0.61, 95% CI=0.53–0.71) than those without dementia, whereas rates of fever, pressure ulcers, and fractures were similar for the two groups. These results persisted when rates were adjusted for demographic characteristics, comorbid conditions, and functional status. During the first 90 days of the nursing home stay, residents with dementia had significantly lower rates of mortality if not admitted for rehabilitative care under a Medicare qualifying stay (RR=0.25, 95% CI=0.14–0.45), were less often discharged home (RR=0.33, 95% CI=0.28–0.38), and tended to have lower fever rates (RR=0.78, 95% CI=0.63–0.96) than residents without dementia.

Conclusion: Newly admitted nursing home residents with dementia have a profile of health events that is distinct from that of residents without dementia, indicating that the two groups have different long-term care needs. Results suggest that further investigation of whether residents with dementia can be well managed in alternative residential settings would be valuable.

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