Bouvé College of Health Sciences, School of Pharmacy, Northeastern University, Boston, Massachusetts, USA.
Center of Geriatric Nursing Excellence, Penn State College of Nursing, University Park, Pennsylvania, USA.
J Am Geriatr Soc. 2024 Nov;72(11):3501-3509. doi: 10.1111/jgs.19112. Epub 2024 Aug 22.
Whether cognitive and functional recovery in skilled nursing facilities (SNF) following hospitalization differs by delirium and Alzheimer's disease related dementias (ADRD) has not been examined.
To compare change in cognition and function among short-stay SNF patients with delirium, ADRD, or both.
Retrospective cohort study using claims data from 2011 to 2013.
Centers for Medicare and Medicaid certified SNFs.
A total of 740,838 older adults newly admitted to a short-stay SNF without prevalent ADRD who had at least two assessments of cognition and function.
Incident delirium was measured by the Minimum Data Set (MDS) Confusion Assessment Method and ICD-9 codes, and incident ADRD by ICD-9 codes and MDS diagnoses. Cognitive improvement was a better or maximum score on the MDS Brief Interview for Mental Status, and functional recovery was a better or maximum score on the MDS Activities of Daily Living Scale.
Within 30 days of SNF admission, the rate of cognitive improvement in patients with both delirium/ADRD was half that of patients with neither delirium/ADRD (HR = 0.45, 95% CI:0.43, 0.46). The ADRD-only and delirium-only groups also were 43% less likely to have improved cognition or function compared to those with neither delirium/ADRD (HR = 0.57, 95% CI:0.56, 0.58 and HR = 0.57, 95% CI:0.55, 0.60, respectively). Functional improvement was less likely in patients with both delirium/ADRD, as well (HR = 0.85, 95% CI:0.83, 0.87). The ADRD only and delirium only groups were also less likely to improve in function (HR = 0.93, 95% CI:0.92, 0.94 and HR = 0.92, 95% CI:0.90, 0.93, respectively) compared to those with neither delirium/ADRD.
Among older adults without dementia admitted to SNF for post-acute care following hospitalization, a positive screen for delirium and a new diagnosis of ADRD, within 7 days of SNF admission, were both significantly associated with worse cognitive and functional recovery. Patients with both delirium and new ADRD had the worst cognitive and functional recovery.
在住院后入住熟练护理设施（SNF）的患者中，认知和功能恢复是否因谵妄和阿尔茨海默病相关痴呆症（ADRD）而异尚未得到检验。
比较伴有谵妄、ADRD 或两者兼有短住 SNF 患者的认知和功能变化。
使用 2011 年至 2013 年的索赔数据进行回顾性队列研究。
医疗保险和医疗补助认证的 SNF。
共有 740838 名新入住短期 SNF 且无常见 ADRD 的老年人，他们至少接受了两次认知和功能评估。
谵妄的发生率通过最小数据集（MDS）混乱评估方法和 ICD-9 代码来衡量，ADRD 的发生率通过 ICD-9 代码和 MDS 诊断来衡量。认知改善是 MDS 简短精神状态测试的更好或最高分，功能恢复是 MDS 日常生活活动量表的更好或最高分。
在入住 SNF 后 30 天内，同时患有谵妄/ADRD 的患者认知改善的比例是既无谵妄/ADRD 的患者的一半（HR=0.45，95%CI：0.43，0.46）。ADRD 组和谵妄组认知或功能改善的可能性也分别比既无谵妄/ADRD 的患者低 43%（HR=0.57，95%CI：0.56，0.58 和 HR=0.57，95%CI：0.55，0.60）。同时患有谵妄/ADRD 的患者功能改善的可能性也较低（HR=0.85，95%CI：0.83，0.87）。仅 ADRD 组和仅谵妄组在功能上改善的可能性也较低（HR=0.93，95%CI：0.92，0.94 和 HR=0.92，95%CI：0.90，0.93），与既无谵妄/ADRD 的患者相比。
在因住院后接受急性后护理而入住 SNF 的无痴呆老年人中，SNF 入院后 7 天内对谵妄进行阳性筛查和新诊断的 ADRD 与认知和功能恢复较差均显著相关。同时患有谵妄和新 ADRD 的患者认知和功能恢复最差。
