Risk of Developing Dementia at Older Ages in the United States.
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ABSTRACT:
SUBMITTER: Fishman E
PROVIDER: S-EPMC5624986 | biostudies-literature | 2017 Oct
REPOSITORIES: biostudies-literature
Publications
Risk of Developing Dementia at Older Ages in the United States.
Demography 20171001 5
Dementia is increasingly recognized as a major source of disease burden in the United States, yet little research has evaluated the lifecycle implications of dementia. To address this research gap, this article uses the Aging, Demographics, and Memory Study (ADAMS) to provide the first nationally representative, longitudinal estimates of the probability that a dementia-free person will develop dementia later in life. For the 1920 birth cohort, the average dementia-free 70-year-old male had an es ...[more]
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Project description:Background/objectivesIn older persons with dementia (PWD), extensive medication use is often unnecessary, discordant with goals of care, and possibly harmful. The objective of this study was to determine the prevalence and medication constituents of polypharmacy among older PWD attending outpatient visits in the United States.DesignCross-sectional analysis.Setting and participantsPWD and persons without dementia (PWOD) aged ≥65 years attending outpatient visits recorded in the nationally representative National Ambulatory Medical Care Survey (NAMCS), 2014-2016.MeasurementsPWD were identified as those with a diagnosis of dementia on the NAMCS encounter form and/or those receiving an anti-dementia medication. Visits with PWD and PWOD were compared in terms of sociodemographic, practice/physician factors, comorbidities, and prescribing outcomes. Regression analyses examined the effect of dementia diagnosis on contributions by clinically relevant medication categories to polypharmacy (defined as being prescribed ≥5 prescription and/or nonprescription medications).ResultsThe unweighted sample involved 918 visits for PWD and 26,543 visits for PWOD, representing 29.0 and 780 million outpatient visits. PWD had a median age of 81 and on average had 2.8 comorbidities other than dementia; 63% were female. The median number of medications in PWD was eight compared with three in PWOD (p < 0.001). After adjustment, PWD had significantly higher odds of being prescribed ≥5 medications (AOR 3.0; 95% CI: 2.1-4.3) or ≥10 medications (AOR 2.8; 95% CI: 2.0-4.2) compared with PWOD. The largest sources of medications among PWD were cardiovascular and central nervous system medications; usage from other categories was generally elevated in PWD compared with PWOD. PWD had higher odds of receiving at least one highly sedating or anticholinergic medication (AOR 2.5; 95% CI: 1.6-3.9).ConclusionIn a representative sample of outpatient visits, polypharmacy was extremely common among PWD, driven by a wide array of medication categories. Addressing polypharmacy in PWD will require cross-cutting and multidisciplinary approaches.
| S-EPMC8440349 | biostudies-literature
Project description:BackgroundPeople with dementia (PWD) take medications that may be unnecessary or harmful. This problem can be addressed through deprescribing, but it is unclear if PWD would be willing to engage in deprescribing with their providers. Our goal was to investigate attitudes toward deprescribing among PWD.MethodsThis was a cross-sectional study of 422 PWD aged ≥65 years who completed the medications attitudes module of the National Health and Aging Trends Study (NHATS) in 2016. Proxies provided responses when a participant was unable to respond due to health or cognitive problems. Attitudinal outcomes comprised responses to two statements from the patients' attitudes toward deprescribing questionnaire and its revised version (representing belief about the necessity of one's medications and willingness to deprescribe); another elicited the maximum number of pills that a respondent would be comfortable taking.ResultsThe weighted sample represented over 1.8 million PWD; 39% were 75 to 84 years old and 38% were 85 years or older, 60% were female, and 55% reported six or more regular medications. Proxies provided responses for 26% of PWD. Overall, 22% believed that they may be taking one or more medicines that they no longer needed, 87% were willing to stop one or more of their medications, and 50% were uncomfortable taking five or more medications. Attitudinal outcomes were similar across sociodemographic and clinical factors. PWD taking ≥6 medications were more likely to endorse a belief that at least one medication was no longer necessary compared to those taking <6 (adjusted probability 29% [95% confidence interval (CI), 22%-38%] vs. 13% [95% CI, 8%-20%]; p = 0.004); the same applied for willingness to deprescribe (92% [95% CI, 87%-95%] vs. 83% [95% CI, 76%-89%]; p = 0.04).ConclusionsA majority of PWD are willing to deprescribe, representing an opportunity to improve quality of life for this vulnerable population.
| S-EPMC9177826 | biostudies-literature
Project description:ImportanceHearing and vision problems are individually associated with increased dementia risk, but the impact of having concurrent hearing and vision deficits, ie, dual sensory impairment (DSI), on risk of dementia, including its major subtypes Alzheimer disease (AD) and vascular dementia (VaD), is not well known.ObjectiveTo evaluate whether DSI is associated with incident dementia in older adults.Design, setting, and participantsThis prospective cohort study from the Cardiovascular Health Study (CHS) was conducted between 1992 and 1999, with as many as 8 years of follow-up. The multicenter, population-based sample was recruited from Medicare eligibility files in 4 US communities with academic medical centers. Of 5888 participants aged 65 years and older in CHS, 3602 underwent cranial magnetic resonance imaging and completed the modified Mini-Mental State Examination in 1992 to 1994 as part of the CHS Cognition Study. A total of 227 participants were excluded due to prevalent dementia, leaving a total of 3375 participants without dementia at study baseline. The study hypothesis was that DSI would be associated with increased risk of dementia compared with no sensory impairment. The association between the duration of DSI with risk of dementia was also evaluated. Data analysis was conducted from November 2019 to February 2020.ExposuresHearing and vision impairments were collected via self-report at baseline and as many as 5 follow-up visits.Main outcomes and measuresAll-cause dementia, AD, and VaD, classified by a multidisciplinary committee using standardized criteria.ResultsA total of 2927 participants with information on hearing and vision at all available study visits were included in the analysis (mean [SD] age, 74.6 [4.8] years; 1704 [58.2%] women; 455 [15.5%] African American or Black; 2472 [85.5%] White). Compared with no sensory impairment, DSI was associated with increased risk of all-cause dementia (hazard ratio [HR], 2.60; 95% CI, 1.66-2.06; P < .001), AD (HR, 3.67; 95% CI, 2.04-6.60; P < .001) but not VaD (HR, 2.03; 95% CI, 1.00-4.09; P = .05).Conclusions and relevanceIn this cohort study, DSI was associated with increased risk of dementia, particularly AD. Evaluation of hearing and vision in older adults may help to identify those at high risk of developing dementia.
| S-EPMC9073563 | biostudies-literature
Project description:ObjectivesTo identify levels and trends in life expectancy at age 65 (e65) by geographic region and metropolitan status in the United States.MethodsUsing county-level data on population and deaths from the Census and National Center for Health Statistics, we consider spatial inequality in e65 across 4 metropolitan types and 10 geographic regions from 2000 to 2016. We examine whether changes in e65 are driven by mortality developments in metro types or geographic regions, and compare spatial patterns in the United States to mortality trends in other Organization of Economic Cooperation and Development (OECD) countries. We use decomposition and regression methods to estimate the contributions of 10 causes of death to changes and inequalities in e65.ResultsLife expectancy at age 65 increased in all spatial units from 2000 to 2016. Areas with higher e65 in 2000 also experienced larger gains. Longevity increases were greatest in large metropolitan areas and coastal regions. Nonmetropolitan areas and the interior lagged far behind not only other parts of the United States but all OECD comparison countries. Metropolitan status was a better predictor of mortality changes than geographic region. Circulatory diseases and diseases associated with smoking were the principal sources of life expectancy gains and spatial differentiation in those gains. Larger gains in smoking-related mortality accounted for greater improvements among men than women.DiscussionEven at advanced ages, large geographic disparities in life expectancy remain. And as mortality has declined, these disparities have widened. Public health efforts should pay special attention to identifying and ameliorating the sources of lagging life expectancy in nonmetropolitan regions.
| S-EPMC7161363 | biostudies-literature
Project description:BackgroundStudies examining risk factors for dementia have typically focused on testing a priori hypotheses within specific risk factor domains, leaving unanswered the question of what risk factors across broad and diverse research fields may be most important to predicting dementia. We examined the relative importance of 65 sociodemographic, early-life, economic, health and behavioral, social, and genetic risk factors across the life course in predicting incident dementia and how these rankings may vary across racial/ethnic (non-Hispanic white and black) and gender (men and women) groups.Methods and findingsWe conducted a prospective analysis of dementia and its association with 65 risk factors in a sample of 7,908 adults aged 51 years and older from the nationally representative US-based Health and Retirement Study. We used traditional survival analysis methods (Fine and Gray models) and a data-driven approach (random survival forests for competing risks) which allowed us to account for the semi-competing risk of death with up to 14 years of follow-up. Overall, the top five predictors across all groups were lower education, loneliness, lower wealth and income, and lower self-reported health. However, we observed variation in the leading predictors of dementia across racial/ethnic and gender groups such that at most four risk factors were consistently observed in the top ten predictors across the four demographic strata (non-Hispanic white men, non-Hispanic white women, non-Hispanic black men, non-Hispanic black women).ConclusionsWe identified leading risk factors across racial/ethnic and gender groups that predict incident dementia over a 14-year period among a nationally representative sample of US aged 51 years and older. Our ranked lists may be useful for guiding future observational and quasi-experimental research that investigates understudied domains of risk and emphasizes life course economic and health conditions as well as disparities therein.
| S-EPMC7540891 | biostudies-literature
Project description:ObjectivesTo develop three prognostic indices of varying degree of required detail for 2-year pneumonia risk in older adults.DesignRetrospective cohort study.SettingGroup Health (GH), an integrated healthcare delivery system.ParticipantsCommunity-dwelling dementia-free individuals aged 65 and older who had been GH members for at least 2 years before start of follow-up and were enrolled in the Adult Changes in Thought study (N = 3,375; development cohort, n = 2,250; validation cohort, n = 1,125.MeasurementsPotential pneumonia risk factors were identified from questionnaire data and interviewer assessments of functional status, medical history, smoking and alcohol use, cognitive function, personal care, and problem solving. Risk factors were also identified based on physical measures such as grip strength and gait speed and administrative database information on comorbid illnesses, laboratory tests, and prescriptions dispensed. Incident community-acquired pneumonia was defined presumptively from administrative data and validated using medical record review.ResultsParticipants (59% female) contributed 12,998 visits at which risk factors were assessed; 642 pneumonia events were observed during follow-up. Age, sex, chronic obstructive pulmonary disease, congestive heart failure, body mass index, and use of inhaled or oral corticosteroids were critical predictors in all prognostic indices. A risk score based on these seven variables, information on which is commonly available in electronic medical records (EMRs), had equal or better performance (c-index = 0.69 in the validation cohort) than scores including more-detailed data such as functional status.ConclusionData commonly available in EMRs can stratify older adults into groups with varying subsequent 2-year pneumonia risk.
| S-EPMC4943660 | biostudies-literature
Project description:BackgroundLittle is known about the incidence of clinical events and treatment patterns among older adults with dementia-related psychosis. Given that dementia-related psychosis comprises various dementia types, this study describes the incidence of clinical events and treatment patterns by dementia type after patients with dementia are diagnosed with psychosis.MethodsAdults aged ≥ 65 years with dementia and newly diagnosed with psychosis were identified in US Medicare claims during 2013-2018. Baseline characteristics were evaluated at the time of the psychosis diagnosis. After the initial psychosis diagnosis, incidence rates (IRs) of clinical events (e.g., falls/fractures, infections, healthcare utilization), mortality, and patterns of antipsychotic treatment were described for each dementia type (Alzheimer's disease [AD], Parkinson's disease dementia [PDD], dementia with Lewy bodies [DLB], frontotemporal dementia [FTD], vascular dementia [VD], and unspecified dementia). Daily mean cumulative counts were estimated to describe the incidence of recurrent events over time. Mortality was described using Kaplan-Meier survival curves.ResultsWe identified 484,520 patients with dementia-related psychosis: mean age, 84 years (standard deviation, 7.8); female, 66%. At the time of psychosis diagnosis, the most prevalent type of dementia was unspecified dementia (56%), followed by AD (31%), VD (12%), PDD (10%), DLB (3%), and FTD (< 1%), and most patients had scores indicating severe illness on the Charlson Comorbidity Index (71%) and frailty index (62%). Across all dementia types, IRs (per 100 person-years) were high for emergency department visits, oral anti-infective use, and urinary tract infections after the initial psychosis diagnosis. Patients with DLB had the highest incidence of most clinical outcomes. After 1 year of follow-up, the cumulative probability of death was about 30% for all dementia types, and after 5 years, was about 80% among patients with DLB, VD, AD, or PDD and about 60%-65% among patients with FTD or unspecified dementia.ConclusionsPatients with dementia-related psychosis had a high burden of comorbidities, frailty, emergency department visits, infections, and death. Specifically, after DRP diagnosis, patients with DLB and VD had the highest burden of clinical events of interest.
| S-EPMC9541053 | biostudies-literature
Project description:IntroductionSystematic disparities in misdiagnosis of dementia across racial/ethnic groups have implications for health disparities. We compared the risk of dementia under- and overdiagnosis in clinical settings across racial/ethnic groups from 2000 to 2010.MethodsWe linked fee-for-service Medicare claims to participants aged ≥70 from the nationally representative Health and Retirement Study. We classified dementia status using an algorithm with similar sensitivity and specificity across racial/ethnic groups and assigned clinical dementia diagnosis status using ICD-9-CM codes from Medicare claims. Multinomial logit models were used to estimate relative risks of clinical under- and overdiagnosis between groups and over time.ResultsNon-Hispanic blacks had roughly double the risk of underdiagnosis as non-Hispanic whites. While primary analyses suggested a shrinking disparity over time, this was not robust to sensitivity analyses or adjustment for covariates. Risk of overdiagnosis increased over time in both groups.DiscussionOur results suggest that efforts to reduce racial disparities in underdiagnosis are warranted.
| S-EPMC6926355 | biostudies-literature
Project description:BackgroundThere is mixed evidence for an association between cardiometabolic risk factors and dementia incidence. This study aimed to determine whether different latent classes of cardiometabolic conditions were associated with dementia risk in older adults across England, the United States, and China.MethodsA total of 4 511 participants aged 50 and older were drawn from the English Longitudinal Study of Ageing (ELSA), 5 112 from Health and Retirement Study (HRS), and 9 022 from China Health and Retirement Longitudinal Study (CHARLS). Latent class analyses were performed across each data set utilizing 7 baseline cardiometabolic conditions: obesity, low high-density lipoprotein cholesterol, systolic and diastolic blood pressure, hyperglycemia, diabetes, and inflammation. Confounder-adjusted Cox proportional hazards regressions were conducted to estimate dementia incidence by cardiometabolic latent classes.ResultsThree similar cardiometabolic classes were identified across all countries: (i) "relatively healthy/healthy obesity," (ii) "obesity-hypertension," and (iii) "complex cardiometabolic." Across the 3 samples, a total of 1 230 individuals developed dementia over a median of 6.8-12.2 years. Among ELSA and HRS participants, the "complex cardiometabolic" group had a higher dementia risk when compared to the "healthy obesity" groups (England: adjusted hazard ratio [AdjHR] = 1.62 [95% confidence interval {CI} = 1.11-2.37]; United States: AdjHR = 1.31 [95% CI = 1.02-1.68]). However, in CHARLS participants, the "obesity-hypertension" group had a greater risk of dementia when compared to the "relatively healthy" group (AdjHR = 1.28 [95% CI = 1.04-1.57]).ConclusionThis study provides evidence that in western populations, complex cardiometabolic clusters are associated with higher rates of dementia incidence, whereas in a Chinese sample, a different cardiometabolic profile seems to be linked to an increased risk of dementia.
| S-EPMC10465082 | biostudies-literature
Project description:PurposeAlthough visual impairment (VI) has been associated with worse cognitive performance among older adults, the temporal relationship between the 2 remains subject to debate. Our objective was to investigate the longitudinal impact of VI on cognitive function and vice versa.DesignRetrospective, time-to-event study.ParticipantsNational Health and Aging Trends Study (NHATS) participants from 2011 to 2018 cycles.MethodsA total of 10 676 participants aged 65 years and older were included. Cox proportional hazards regression models evaluated the impact of baseline VI on subsequent dementia and impact of baseline dementia on subsequent VI. Models were adjusted for potential confounding variables, including demographics, clinical comorbidities, and hearing and physical function limitations.Main outcome measuresHazard ratio (HR) for incident dementia among participants with baseline self-reported VI and HR for incident VI among participants with baseline dementia.ResultsOf the 10 676 participants included in the analysis, approximately 40% were aged 65-74 years, 40% were aged 75-84 years, and the remaining 20% were aged 85 years and older. The majority were female (59%), and 68% self-identified as non-Hispanic White. Among participants with normal cognitive status at baseline, subsequent dementia was observed in 1753 (16%), and among participants with normal self-reported vision at baseline, subsequent VI was reported in 2371 (22%). In adjusted regression models, participants with baseline VI had higher likelihood of developing dementia over subsequent follow-up (HR, 2.3; 95% confidence interval [CI], 2.0-2.6; P < 0.001). Likewise, participants with baseline dementia had a higher likelihood of developing self-reported VI over time (HR, 2.5; 95% CI, 2.2-2.8; P < 0.001).ConclusionsSelf-reported VI in the US Medicare population is associated with greater dementia likelihood over time, and dementia is similarly associated with greater VI likelihood over time. Associations are likely multifactorial and bidirectional and could be explained by intervening variables in the path from VI to dementia, or vice versa, or by common risk factors for pathological processes in both eyes and brain. These findings suggest the need for early identification of older adults with visual compromise and consideration of visual disability in the cognitively impaired.
| S-EPMC10728499 | biostudies-literature