New or worsening symptoms and signs in community-dwelling persons with dementia: incidence and relation to use of acute medical services
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OBJECTIVES: To understand the range of symptoms that present to family caregivers of community-dwelling persons with Alzheimer's disease and related dementias (ADRD). DESIGN: Six-month longitudinal prospective study to identify the incidence of new or worsening symptoms and their association with acute care medical service use. SETTING: Community-based sample of volunteers from multiple states. PARTICIPANTS: A total of 136 patient-caregiver dyads with a range of dementia severity. MEASUREMENTS: Forty four symptoms and signs common in older persons and/or persons with dementia; frequency of emergency department visits, hospitalizations, and death; and associations between reported symptoms and acute medical care. RESULTS: During a mean of 5.7 months' follow-up, new or worsening organ-specific (90% of participants), nonspecific (89%), and behavioral (88%) symptoms were common, with the average caregiver reporting seven new or worsening symptoms. Most common were worsening confusion (74%), decreased activity (64%), agitation (57%), hallucinations/delusions (45%), voice and speaking problems (45%), not eating or drinking (44%), and stress/anxiety (41%). Hospitalization and emergency department use occurred respectively in 19% and 20% of participants, and were associated with organ-specific symptoms (OR 3.15, P = .02), less so with nonspecific symptoms (OR 2.27, P = .07), and very little with behavioral symptoms (OR 1.44, P = .38). Within each symptom category, certain symptoms were significantly associated with acute medical service use. CONCLUSION: Family caregivers of persons with ADRD must respond to a variety of medical, nonspecific, and behavioral symptoms. The high incidence of new or worsening symptoms and of acute medical care use suggests a need to better target symptom evaluation and management in caregiver education.
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The transition from skilled nursing facilities (SNF) to home is challenging for people with dementia (PWD), who are at risk for poor nutrition, hydration, pain control, and new health problems (e.g., respiratory infections) resulting in re-hospitalizations.
“The transition from SNF to home is challenging for people with dementia (PWD), who are at risk for poor nutrition, hydration, pain control, and new health problems (e.g., respiratory infections) resulting in re-hospitalizations.4, 5”
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Cites
Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing
Benjamini, Y., & Hochberg, Y. (1995) · Journal of the Royal Statistical Society Series B: Statistical Methodology · doi:10.1111/j.2517-6161.1995.tb02031.x · Cited by 109,482 · see citing works
Lyketsos, C. G., Lopez, O., Jones, B., Fitzpatrick, A. L., Breitner, J., & DeKosky, S. (2002) · JAMA · doi:10.1001/jama.288.12.1475 · Cited by 2,049 · see citing works
MDS Cognitive Performance Scale(C)
Morris, J. N., Fries, B. E., Mehr, D. R., Hawes, C., Phillips, C., Mor, V., & Lipsitz, L. A. (1994) · Journal of Gerontology · doi:10.1093/geronj/49.4.m174 · Cited by 1,852 · see citing works
2015 Alzheimer's disease facts and figures
Alzheimer's Association (2015) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2015.02.003 · Cited by 1,641 · see citing works
Delirium Superimposed on Dementia: A Systematic Review
Fick, D. M., Agostini, J. V., & Inouye, S. K. (2002) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2002.50468.x · Cited by 638 · see citing works
Hartmaier, S. L., Sloane, P. D., Guess, H. A., Koch, G. G., Mitchell, C. M., & Phillips, C. D. (1995) · The Journals of Gerontology Series A · doi:10.1093/gerona/50a.2.m128 · Cited by 521 · see citing works
Self-citationComorbidity and the Use of Primary Care and Specialist Care in the Elderly
Starfield, B. H. (2005) · The Annals of Family Medicine · doi:10.1370/afm.307 · Cited by 283 · see citing works
Szatloczki, G., Hoffmann, I., Vincze, V., Kalman, J., & Pakaski, M. (2015) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2015.00195 · Cited by 249 · see citing works
Okura, T., Plassman, B. L., Steffens, D. C., Llewellyn, D. J., Potter, G. G., & Langa, K. M. (2010) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2009.02680.x · Cited by 215 · see citing works
Hospitalization in Community‐Dwelling Persons with Alzheimer's Disease: Frequency and Causes
Rudolph, J. L., Zanin, N. M., Jones, R. N., Marcantonio, E. R., Fong, T. G., Yang, F. M., Yap, L., & Inouye, S. K. (2010) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2010.02924.x · Cited by 203 · see citing works
Feng, Z., Coots, L. A., Kaganova, Y., & Wiener, J. M. (2014) · Health Affairs · doi:10.1377/hlthaff.2013.1179 · Cited by 166 · see citing works
What Knowledge and Skills Do Caregivers Need?
Given, B. A., Sherwood, P. R., & Given, C. W. (2008) · AJN American Journal of Nursing · doi:10.1097/01.naj.0000336408.52872.d2 · Cited by 152 · see citing works
Visual impairment and cognitive dysfunction in Alzheimer’s disease
Uhlmann, R. F., Larson, E. B., Koepsell, T. D., Rees, T. S., & Duckert, L. G. (1991) · Journal of General Internal Medicine · doi:10.1007/bf02598307 · Cited by 132 · see citing works
High, K. P., Bradley, S., Gravenstein, S., Mehr, D. R., Quagliarello, V., Richards, C. L., & Yoshikawa, T. T. (2009) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2009.02175.x · Cited by 123 · see citing works
Cognitive-Behavioral Intervention for Homebound Caregivers of Persons with Dementia
Chang, B. L. (1999) · Nursing Research · doi:10.1097/00006199-199905000-00007 · Cited by 119 · see citing works
Borsje, P., Wetzels, R. B., Lucassen, P. L., Pot, A. M., & Koopmans, R. T. C. M. (2014) · International Psychogeriatrics · doi:10.1017/s1041610214002282 · Cited by 96 · see citing works
Bartels, S. J., Horn, S. D., Smout, R. J., Citters, A. D. V., Flaherty, E., Jones, J. K., Monane, M., Taler, G. A., & Voss, A. C. (2003) · American Journal of Geriatric Psychiatry · doi:10.1097/00019442-200303000-00014 · Cited by 93 · see citing works
Undiagnosed Illness and Neuropsychiatric Behaviors in Community Residing Older Adults With Dementia
Hodgson, N. A., Gitlin, L. N., Winter, L., & Czekanski, K. (2011) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0b013e3181f8520a · Cited by 85 · see citing works
Nonpharmacologic treatment of behavioral disturbance in dementia
Teri, L. L., Logsdon, R. G., & McCurry, S. M. (2002) · Medical Clinics of North America · doi:10.1016/s0025-7125(02)00006-8 · Cited by 81 · see citing works
Sundvall, P., Ulleryd, P., & Gunnarsson, R. K. (2011) · BMC Family Practice · doi:10.1186/1471-2296-12-36 · Cited by 72 · see citing works
Sleep disturbance and cognitive disorder: epidemiological analysis in a cohort of 263 patients
Pistacchi, M., Gioulis, M., Contin, F., Sanson, F., & Marsala, S. Z. (2014) · Neurological Sciences · doi:10.1007/s10072-014-1870-x · Cited by 65 · see citing works
Predictive Value of Nonspecific Symptoms for Acute Illness in Nursing Home Residents
Boockvar, K. S., & Lachs, M. S. (2003) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2003.51360.x · Cited by 52 · see citing works
Physician Perspectives on Medical Care Delivery in Assisted Living
Sloane, P. D., Zimmerman, S. I., Pérez, R., Reed, D., Harris‐Wallace, B., Khandelwal, C., Beeber, A., Mitchell, C. M., & Schumacher, J. G. (2011) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2011.03714.x · Cited by 43 · see citing works
Self-citationA Taxonomy of Passive Behaviors in People with Alzheimer's Disease
Colling, K. B. (2000) · Journal of Nursing Scholarship · doi:10.1111/j.1547-5069.2000.00239.x · Cited by 43 · see citing works
The association of daily physical symptoms with future health
Leger, K. A., Charles, S. T., Ayanian, J. Z., & Almeida, D. M. (2015) · Social Science & Medicine · doi:10.1016/j.socscimed.2015.08.050 · Cited by 40 · see citing works
Drennan, V. M., Rait, G., Cole, L., Grant, R., & Iliffe, S. (2012) · Neurourology and Urodynamics · doi:10.1002/nau.22333 · Cited by 40 · see citing works
Falls and Risk Factors for Falls in Community-Dwelling Adults With Dementia (NutriAlz Trial)
Salvà, A., Figuls, M. R. I., Luque, X. R. I., Inzitari, M., Andrieu, S., Schiffrin, E. J., Guigoz, Y., & Vellas, B. J. (2011) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0b013e318215ca90 · Cited by 39 · see citing works
Dementia and serious coexisting medical conditions: a double whammy
Maslow, K. (2004) · Nursing Clinics of North America · doi:10.1016/j.cnur.2004.02.011 · Cited by 36 · see citing works
Indicators for root caries in Danish persons with recently diagnosed Alzheimer’s disease
Ellefsen, B. S., Morse, D. E., Waldemar, G., et al. (2012) · Gerodontology · doi:10.1111/j.1741-2358.2011.00560.x · Cited by 21 · see citing works
Preventing, assessing and managing skin tears.
Bianchi, J. (2012) · PubMed · Cited by 13 · see citing works
Delusions and Hallucinations in Persons With Dementia
Cohen‐Mansfield, J., Golander, H., & Heinik, J. (2013) · Journal of Geriatric Psychiatry and Neurology · doi:10.1177/0891988713509136 · Cited by 11 · see citing works
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Research works printed but not linked: 2
- [24]Rudolph JL Zanin NM Jones RN Hospitalization in community-dwelling persons with Alzheimer’s disease: frequency and causes J Am Geriatr Soc 2010 58 8 1542 8 20553338 PMC2955171
- [29]Drennan VM Rait G Cole L The prevalence of incontinence in people with cognitive impairment or dementia living at home: a systematic review Neurourol Urodyn 2013 32 4 314 24 23129242
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Sorted by citations
Hospitalisation rates and predictors in people with dementia: a systematic review and meta-analysis
Shepherd, H., Livingston, G., Chan, J., & Sommerlad, A. (2019) · BMC Medicine · doi:10.1186/s12916-019-1369-7 · Cited by 232 · see citing works
Evidence-Based Interventions for Transitions in Care for Individuals Living With Dementia
Hirschman, K. B., & Hodgson, N. A. (2018) · The Gerontologist · doi:10.1093/geront/gnx152 · Cited by 129 · see citing works
Godard-Sebillotte, C., Le Berre, M., Schuster, T., Trottier, M., & Vedel, I. (2019) · PLOS ONE · doi:10.1371/journal.pone.0218426 · Cited by 50 · see citing works
Hunt, L. J., Coombs, L. A., & Stephens, C. E. (2018) · Journal of Gerontological Nursing · doi:10.3928/00989134-20171206-01 · Cited by 56 · see citing works
Primary care continuity and potentially avoidable hospitalization in persons with dementia
Godard‐Sebillotte, C., Strumpf, E., Sourial, N., Rochette, L., Pelletier, E., & Vedel, I. (2021) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17049 · Cited by 50 · see citing works
Toles, M., Leeman, J., Gwyther, L., Vu, M., Vu, T., & Hanson, L. C. (2022) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2022.06.021 · Cited by 16 · see citing works
Self-citation
- Authors
- Sloane, P. D., Schifeling, C. H., Beeber, A. S., Ward, K. T., Reed, D., Gwyther, L. P., Matchar, B., & Zimmerman, S.
- Affiliations
- University of Colorado Anschutz (US)
- University of North Carolina at Chapel Hill (US)
- Duke University (US)
- Corresponding author
- Sloane, Philip D.
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2017-02-02
- Volume
- 65
- Issue
- 4
- Pages
- 808-814
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC5397340
- OpenAlex
- W2584065904
- Cited by
- 27
- References
- 31
- Citations by year
- 2024: 3 · 2023: 2 · 2022: 4 · 2021: 2 · 2020: 7 · 2019: 4 · 2018: 4 · 2017: 1
- FWCI
- 3.59
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Nursing Research (R01 NR014199‐01)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- Alzheimer's disease and related dementias, dementia symptoms, family caregivers, hospitalization, emergency department visits, agitation, delusions and hallucinations, behavioral symptoms, non-specific symptoms, caregiver education, symptom management
- MeSH terms
- Acute Disease, Aged, Dementia, Female, Humans, Longitudinal Studies, Male, Patient Acceptance of Health Care, Prospective Studies, Incidence, Caregivers, Independent Living
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