Abstract TMP94: Outcomes in Hospitalized Stroke and TIA Patients with Dementia - A Population-based Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Charlotte Zerna ◽  
Patrice Lindsay ◽  
Jiming Fang ◽  
Richard H Swartz ◽  
Eric E Smith
Keyword(s):  
Care Facility ◽  
Population Based ◽  
Discharge Abstract Database ◽  
Chi Square ◽  
Dementia Prevalence ◽  
Diagnostic Codes ◽  
Dementia Patients ◽  
People With Dementia ◽  
Diagnosis Of Dementia ◽  
Time Of Admission

Background: Dementia prevalence is rising, and will double in the next 20 years. This study sought to understand the prevalence of dementia in hospitalized patients with stroke and TIA, differences in characteristics and impact on outcomes. Methods: Using the Canadian Institute of Health Information (CIHI) Discharge Abstract Database (DAD), all acute stroke and TIA admissions from April 2003 to March 2015 in Canada (excluding Quebec) were analyzed. Concurrent dementia at time of admission was assessed based on hospital diagnostic codes. Characteristics and in-hospital outcomes were compared in patients with vs. without dementia using chi-square and logistic regression. Results: During the observed period 464,741 patients were admitted to hospital for cerebrovascular syndromes (ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage (SAH) and TIA). Of those, 29,812 (6.4%) had a concurrent diagnosis of dementia, including 8.4% of patients ≥65 years. People with dementia had older median age (84 vs. 75 years; p<0.01), were more often female (59.6% vs. 49.3%; p<0.01) and more often had Charlson-Deyo comorbidity index ≥ 2 (62.1% v. 38.4%; p<0.01). They were less likely admitted with SAH (1.3% vs. 5.3%; p<0.01) and more likely coded as strokes with unidentified subtype (29.4% vs. 20.8%; p<0.01). Median length of stay (13 vs. 7 days; p<0.01) was longer. Patients with dementia were less likely discharged to another acute care facility (7.6% vs. 14.7%; p<0.01), rehabilitation facility (5.4% vs. 12.0%; p<0.01) or home independently (22.9% 48.9%; p<0.01); other outcomes are shown in the Table. Conclusions: Approximately 1 in 10 hospitalized stroke and TIA patients age ≥65 has coded dementia. Patients with stroke or TIA and dementia have higher mortality, face significantly more dependence after stroke and utilize greater healthcare resources than stroke patients without dementia. Early care planning and coordination are essential to optimize outcomes.

scholarly journals Outcomes in Hospitalized Ischemic Stroke Patients with Dementia on Admission: A Population-Based Cohort Study

2018 ◽  
Vol 45 (3) ◽  
pp. 290-294 ◽  
Author(s):  
Charlotte Zerna ◽  
Mary P. Lindsay ◽  
Jiming Fang ◽  
Richard H. Swartz ◽  
Eric E. Smith
Keyword(s):  
Ischemic Stroke ◽  
Negative Binomial ◽  
Population Based ◽  
Stroke Patients ◽  
Discharge Abstract Database ◽  
Adjusted Risk ◽  
Dementia Prevalence ◽  
People With Dementia ◽  
Administrative Data Source ◽  
Diagnosis Of Dementia

AbstractBackgroundDementia prevalence is rising, and it will double in the next 20 years. This study sought to understand the prevalence of dementia in hospitalized patients with ischemic stroke, and its impact on outcomes.MethodsUsing the Canadian Institute of Health Information’s (CIHI) Discharge Abstract Database (DAD), all acute ischemic stroke admissions from April 2003 to March 2015 in Canada (excluding Quebec) were analyzed. Concurrent dementia at the time of admission was assessed based on hospital diagnostic codes. Characteristics and in-hospital outcomes were compared in patients with and without dementia using χ2 and negative binomial, as well as Poisson regression analysis.ResultsDuring the observed period, 313,138 people were admitted to a hospital in Canada for an ischemic stroke. Of those, 21,788 (7.0%) had a concurrent diagnosis of dementia. People with dementia had older median age (84 vs. 76 years; p<0.0001), were more often female (59.6% vs. 48.4%; p<0.0001) and more often had Charlson-Deyo Comorbidity Index ≥2 (64.5% vs. 43.5%; p<0.0001). Patients with dementia were less likely to be discharged to a rehabilitation facility (adjusted risk ratio [RR] 3.089, 95% confidence interval [CI] 2.992-3.188, p<0.0001) or home independently (adjusted RR 0.756, 95% CI 0.737-0.776, p<0.0001).InterpretationApproximately 1 in 13 hospitalized ischemic stroke patients has coded dementia. Patients with ischemic stroke and concurrent dementia have higher mortality, face significantly more dependence after stroke and utilize greater healthcare resources than stroke patients without dementia. Causative conclusions are limited by the administrative data source. Early care planning and coordination could potentially optimize outcomes.

Curative treatments and survival benefit in elderly patients with hepatocellular carcinoma: A SEER population-based analysis.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 355-355
Author(s):  
Oxana V. Makarova-Rusher ◽  
Susanna Varkey Ulahannan ◽  
Austin G. Duffy ◽  
Tim F. Greten ◽  
Sean Altekruse
Keyword(s):  
Hepatocellular Carcinoma ◽  
Elderly Patients ◽  
Age Groups ◽  
Relative Survival ◽  
Population Based ◽  
Outcome Data ◽  
Chi Square ◽  
Diagnostic Codes ◽  
Kaplan Meier ◽  
Young Old

355 Background: Transplant, resection, and ablation are potentially curative treatments for hepatocellular carcinoma (HCC) with limited outcome data in young-old (65-74) and older (≥75) patients. Methods: We evaluated curative treatment and relative survival (RS) outcomes in patients with HCC in 3 age groups (<65 years, 65-74 years, and ≥75 years). Patients with HCC diagnostic codes (histology 8,170-8,175, morphology C22) were identified in the SEER 18 database from 2000 to 2011. Treatments included curative (transplant, resection, radiofrequency ablation (RFA), and other ablations) and palliative therapies. Primary outcome was 5 year RS. Statistical analysis was performed using Kaplan-Meier and Chi-Square tests. Results: We identified 29,654 cases. The mean age was 62 years with almost 40% of HCC cases in patients over 65 years old. Potentially curable, localized stage rates were similar in all age groups, 46%, 48% and 46%, respectively. As a result of less resection and rare transplant use, fewer cases underwent curative treatments in the group 75 years and older in comparison to all other age groups (15% vs. 27%, p = 0.001). Five-year RS in all 3 age groups (<65 years, 65-74 years, and ≥75 years) was better after resection relative to RFA (47% vs. 35% p<0.0001, 44% vs. 37%, p=0.0093, and 43% vs. 28% p=0.0002). The highest survival was seen after liver transplant. Interestingly, among transplanted patients with HCC, 13% were 65-75 years old. Five-year RS was similar in transplanted patients 65-75 vs. those under 65 (76% vs 74% p=0.65). Conclusions: The use of curative treatments for HCC significantly decreases with age, yet there are clear survival benefits in elderly patients receiving such. Even when considering transplant, the data shows that outcome is as good in elderly patients as in younger patients. The benefit of hepatic resection appears to be superior compared to RFA in all age groups, in our analysis. [Table: see text]

scholarly journals An Acceptance Test for Assistive Robots

Sensors ◽  
2020 ◽  
Vol 20 (14) ◽  
pp. 3912 ◽  
Author(s):  
Francisco Martín Rico ◽  
Francisco J. Rodríguez-Lera ◽  
Jonatan Ginés Clavero ◽  
Ángel Manuel Guerrero-Higueras ◽  
Vicente Matellán Olivera
Keyword(s):  
Neurological Diseases ◽  
Care Facility ◽  
Acceptance Test ◽  
Assistive Robots ◽  
Socially Assistive Robots ◽  
Dementia Patients ◽  
People With Dementia ◽  
Specialized Care ◽  
Care Of Elderly ◽  
Therapy Sessions

Socially assistive robots have been used in the care of elderly or dependent people, particularly with patients suffering from neurological diseases, like autism and dementia. There are some proposals, but there are no standardized mechanisms for assessing a particular robot’s suitability for specific therapy. This paper reports the evaluation of an acceptance test for assistive robots applied to people with dementia. The proposed test focuses on evaluating the suitability of a robot during therapy sessions. The test measures the rejection of the robot by the patient based on observational data. This test would recommend what kind of robot and what functionalities can be used in therapy. The novelty of this approach is the formalization of a specific validation process that only considers the reaction of the person to whom the robot is applied, and may be used more effectively than existing tests, which may not be adequate for evaluating assistance robots. The test’s feasibility was tested by applying it to a set of dementia patients in a specialized care facility.

scholarly journals The Voices of Persons Living With Dementia: Exploring Their Information Needs to Live Well

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 60-60
Author(s):  
Michelle Kimzey ◽  
Ramona Baucham ◽  
Chelsea Martin ◽  
Carol Howe
Keyword(s):  
Health Literacy ◽  
Health Information ◽  
Information Needs ◽  
Hybrid Approach ◽  
Convenience Sample ◽  
Health Decisions ◽  
People With Dementia ◽  
Care Partners ◽  
Diagnosis Of Dementia ◽  
Services And Supports

Abstract There are unique challenges and considerations when receiving the diagnosis of dementia. There are interventions, services, and supports for people with dementia and their care partners, yet they are often unknown, disconnected, and may not be widely available or easily accessible. Health literacy was defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Using a descriptive qualitative design, the purpose of this study was to describe how persons living with dementia and their care partners obtain, understand, and use information to make health decisions to live well with dementia. The convenience sample consisted of 28 care partners and 15 people living with dementia participating in 6 separate focus groups. To illuminate findings, data was analyzed using a hybrid approach (deductive followed by inductive). Four themes emerged deductively as persons gain health literacy in dementia (access, understand, appraise, and understand). The notable finding is the trend at diagnosis where they first are “seeking the expert” ,and as they move from dependence and gain understanding they are “becoming the expert”, and finally as they apply information they are “acting as the expert” for themselves and others. Engaging them in research not only gave them a voice but more importantly it influenced the health information that will be developed and implemented by them. These findings suggest there is a wealth of knowledge to be gained by persons living with dementia and their care partners.

scholarly journals Delivering and Embedding Dementia-Friendly Training in a Healthcare System

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 160-161
Author(s):  
Ellen Schneider ◽  
Maureen Dale ◽  
Krista Wells ◽  
John Gotelli ◽  
Carol Julian ◽  
...  
Keyword(s):  
North Carolina ◽  
Self Efficacy ◽  
Hospital Staff ◽  
Clinical Staff ◽  
Pilot Training ◽  
Readmission Rates ◽  
Dementia Patients ◽  
People With Dementia ◽  
Aging And Health ◽  
The University

Abstract Alzheimer’s disease is the 4th leading cause of death in North Carolina for people 65 and older. People with dementia are hospitalized more often and have prolonged stays, poorer outcomes, higher costs, and increased readmission rates. Hospital employees have expressed the desire to have specialized training to learn how to more effectively communicate with and provide better care to patients with dementia. To address identified patient and hospital employee needs, the University of North Carolina (UNC) Center for Aging and Health is disseminating hospital-specific dementia-friendly training at five hospitals within the UNC Health System. The training is being delivered via online modules and follow-up didactic sessions over a three-year period to clinical and non-clinical staff who interact with patients. To date, 1,948 employees at three of the five hospitals have launched the online training; 1,102 have completed the training. The pilot training took place at the UNC Hospitals--Hillsborough Campus (“Hillsborough Hospital”) in 2019. Hillsborough Hospital staff (n=195) who participated in the dementia friendly training completed a survey to assess their ability to recognize symptoms and provide appropriate care to dementia patients pre- and post-training. Clinical staff answered 23 Likert scale self-efficacy questions; non-clinical staff answered the first 12 of these questions. Positive change in self-efficacy ratings from pre- to post-training was significant for every question (p &lt; .0001). Additional results will be included in the poster. The dementia-friendly hospital initiative is preparing employees to provide better care for people with dementia and is effective in increasing employee self-efficacy.

scholarly journals Changes in cannabis use according to socioeconomic status among Finnish adolescents from 2000 to 2015

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Noora Knaappila ◽  
Mauri Marttunen ◽  
Sari Fröjd ◽  
Nina Lindberg ◽  
Riittakerttu Kaltiala
Keyword(s):  
Socioeconomic Status ◽  
Parental Education ◽  
Population Based ◽  
Cannabis Use ◽  
Chi Square ◽  
Socioeconomic Groups ◽  
Parental Unemployment ◽  
The Usa ◽  
Chi Square Test ◽  
School Survey

Abstract Background Despite reduced sanctions and more permissive attitudes toward cannabis use in the USA and Europe, the prevalences of adolescent cannabis use have remained rather stable in the twenty-first century. However, whether trends in adolescent cannabis use differ between socioeconomic groups is not known. The aim of this study was to examine trends in cannabis use according to socioeconomic status among Finnish adolescents from 2000 to 2015. Methods A population-based school survey was conducted biennially among 14–16-year-old Finns between 2000 and 2015 (n = 761,278). Distributions for any and frequent cannabis use over time according to socioeconomic adversities were calculated using crosstabs and chi-square test. Associations between any and frequent cannabis use, time, and socioeconomic adversities were studied using binomial logistic regression results shown by odds ratios with 95% confidence intervals. Results At the overall level, the prevalences of lifetime and frequent cannabis use varied only slightly between 2000 and 2015. Cannabis use was associated with socioeconomic adversities (parental unemployment in the past year, low parental education, and not living with both parents). The differences in any and frequent cannabis use between socioeconomic groups increased significantly over the study period. Conclusions Although the overall changes in the prevalence of adolescent cannabis use were modest, cannabis use increased markedly among adolescents with the most socioeconomic adversities. Socioeconomic adversities should be considered in the prevention of adolescent cannabis use.

Elevation of pulse pressure in middle age is associated with the risk of dementia: data from a population-based cohort

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Kim ◽  
H Jung ◽  
P.S Yang ◽  
H.T Yu ◽  
T.H Kim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pulse Pressure ◽  
Middle Age ◽  
Population Based ◽  
Entire Cohort ◽  
Incident Dementia ◽  
Increased Risk ◽  
Diagnosis Of Dementia ◽  
History Of ◽  
The Mean

Abstract Aims Pulse pressure (PP) is a well-known risk factor for cardiovascular disease. However, the association between the PP and dementia is not well identified. This study aimed to determine the effect of PP on the risk of dementia development in different age subgroups using a longitudinal, population-based, and stroke-free cohort from the general population. Methods The association of PP with the development of incident dementia was assessed from January 1, 2005, to December 31, 2013, in 433,154 participants without a history of dementia or stroke from the Korea National Health Insurance Service-Health Screening cohort. The diagnosis of dementia was defined using the 10th revision of the International Classification of Disease codes. Results The mean age of the cohort was 55.7±9.2 years, 45.7% were women. Hypertension was 23.6%. The mean systolic and diastolic blood pressure of the entire cohort were 125.9±16.6 and 78.4±10.7 mmHg, respectively. Mean PP was 47.5±10.9 mmHg. In the middle-age group (40 to 50 year-old), increasing of 10 mmHg of PP was associated with incident dementia after adjusting mean blood pressure and clinical variables with a hazard ratio (HR) of 1.21 (95% confidence interval [CI]: 1.19–1.23, p&lt;0.001). The association was still significant even after censoring for stroke (HR: 1.16, 95% CI: 1.08–1.22, p&lt;0.001). In the older population, elevation of PP was not associated with dementia development (HR: 0.98, 95% CI: 0.95–1.01, p=0.247) Conclusion PP was associated with increased risk of dementia only in middle-aged population beyond that of mean arterial pressure. Funding Acknowledgement Type of funding source: None

scholarly journals Changes in Six-Month Prevalence of Circulatory System Diseases among People Aged 20 Years and Older between 2013 and 2018 in Hunan, China

2021 ◽  
Vol 18 (5) ◽  
pp. 2599
Author(s):  
Zhenzhen Rao ◽  
Junjie Hua ◽  
Ruotong Li ◽  
Yanhong Fu ◽  
Jie Li ◽  
...  
Keyword(s):  
Age Groups ◽  
Circulatory System ◽  
Population Based ◽  
Hunan Province ◽  
Rural Residents ◽  
Chi Square ◽  
Circulatory System Diseases ◽  
Chi Square Test ◽  
Urban Rural ◽  
Socio Demographic Factors

Recent changes in population-based prevalence for circulatory system diseases (CSDs) remain unreported either nationally or locally for China. Data were from the two-round health service household interview survey of Hunan Province, China, in 2013 and 2018. A Rao–Scott chi-square test was performed to examine prevalence differences across socio-demographic variables. The overall age-standardized prevalence of CSDs increased substantially between 2013 and 2018 for inhabitants aged 20 years and older (14.25% vs. 21.25%; adjusted odds ratio (OR) = 1.59, 95% CI: 1.24–2.04). Hypertensive disease was the most prevalent type of CSD, accounting for 87.24% and 83.83% of all CSDs in 2013 and in 2018, respectively. After controlling for other socio-demographic factors, the prevalence of CSDs was significantly higher in 2018 (adjusted OR = 1.40), urban residents (adjusted OR = 1.43), females (adjusted OR = 1.12) and older age groups (adjusted OR = 5.36 for 50–59 years, 9.51 for 60–69 years, 15.19 for 70–79 years, and 12.90 for 80 years and older) than in 2013, rural residents, males and the youngest age group (20–49 years). The recent increase in the overall age-standardized CSD prevalence and the large prevalence disparities across urban/rural residents, sex and age groups merit the attention of policymakers and researchers. Further prevention efforts are needed to curb the increasing tendency and to reduce the prevalence of disparities across socio-demographic groups.

Global Perspectives on Brief Cognitive Assessments for Dementia Diagnosis

2021 ◽  
pp. 1-13
Author(s):  
Elena Tsoy ◽  
Alissa Bernstein Sideman ◽  
Stefanie D. Piña Escudero ◽  
Maritza Pintado-Caipa ◽  
Suchanan Kanjanapong ◽  
...  
Keyword(s):  
Older Adult ◽  
Adult Population ◽  
Dementia Diagnosis ◽  
Cognitive Assessments ◽  
Middle Income ◽  
Global Perspectives ◽  
Dementia Patients ◽  
Diagnosis Of Dementia ◽  
Theme Identification ◽  
Diagnostic Decision Making

Background: Timely diagnosis of dementia is a global healthcare priority, particularly in low to middle income countries where rapid increases in older adult populations are expected. Objective: To investigate global perspectives on the role of brief cognitive assessments (BCAs) in dementia diagnosis, strengths and limitations of existing measures, and future directions and needs. Methods: This is a qualitative study of 18 dementia experts from different areas of the world. Participants were selected using purposeful sampling based on the following criteria: 1) practicing in countries with projected growth of older adult population of over 100%by 2050; 2) expertise in dementia diagnosis and treatment; 3) involvement in clinical practice and training; and 4) recognition as a national dementia expert based on leadership positions within healthcare system, research, and/or policy work. Participants were individually interviewed in their language of choice over secure videoconference sessions. Interviews were analyzed by a multidisciplinary team using theme identification approach. Results: Four domains with subthemes emerged illustrating participants’ perspectives: 1) strengths of BCAs; 2) limitations of BCAs; 3) needs related to the use of BCAs; and 4) characteristics of an ideal BCA. While most experts agreed that BCAs were important and useful for dementia diagnosis, the themes emphasized the need for development and validation of novel measures that are sensitive, psychometrically sound, and culturally appropriate. Conclusion: BCAs are important for guiding diagnosis and care for dementia patients. Findings provide a roadmap for novel BCA development to assist in diagnostic decision making for clinicians serving a rapidly growing and diverse dementia population.

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