Association between comorbidity indices and nursing home admission in patients with Alzheimer's disease: a longitudinal observational study using the MEMORA cohort.

BACKGROUND

Alzheimer's disease (AD) is among the leading cause of nursing home admission (NHA). Identifying potentially modifiable factors associated with the risk of NHA is crucial to reduce this risk in individuals with AD.

OBJECTIVE

We aimed to assess the relationship between comorbidity burden, as measured by the Charlson comorbidity index, the multimorbidity-weighted index and the health related quality of life comorbidity index, and NHA in patients with AD.

METHODS

We conducted an observational longitudinal study including patients from the MEMORA real-life cohort. Patients had to be aged 60 years or older, with a diagnosis of AD. The association between comorbidity indices and occurrence of NHA was assessed using Cox proportional-hazards models and competing-risks regressions considering mortality as a competing event. All analyses were adjusted for age, sex, educational level, stage of AD and the presence of neuropsychiatric symptoms.

RESULTS

Overall, 488 AD patients were included (68.2% with dementia). There were 125 (26%) NHA that occurred during the follow-up, with a median time of 25 months until NHA. Higher level of comorbidity burden as measured by the three comorbidity indices was associated with higher risk of NHA compared to lower level of comorbidity burden. Similar findings were found after considering mortality as a competing event, with a HR of 2.41(95%CI:1.36-4.28, p = 0.003) for MWI, an HR of 1.96(95%CI:1.22-3.17, p = 0.006), and an HR of 1.68(95%CI:1.04-2.71, p = 0.034).

CONCLUSION

The implementation of appropriate interventions that aim to improve the management of the comorbidity burden could help to reduce the risk of NHA in individuals with AD.