Mortality and Discharge Location of Intensive Care Patients With Alzheimer Disease and Related Dementia.

BACKGROUND: Intensive care unit (ICU) utilization has increased among patients with Alzheimer disease and related dementia (ADRD), although outcomes are poor. OBJECTIVES: To compare ICU discharge location and subsequent mortality between patients with and patients without ADRD enrolled in Medicare Advantage. METHODS: This observational study used Optum's Clinformatics Data Mart Database from years 2016 to 2019 and included adults aged >67 years with continuous Medicare Advantage coverage and a first ICU admission in 2018. Alzheimer disease and related dementia and comorbid conditions were identified from claims. Outcomes included discharge location (home vs other facilities) and mortality (within the same calendar month of discharge and within 12 months after discharge). RESULTS: A total of 145 342 adults met inclusion criteria; 10.5% had ADRD and were likely to be older, female, and have more comorbid conditions. Only 37.6% of patients with ADRD were discharged home versus 68.6% of patients who did not have ADRD (odds ratio [OR], 0.40; 95% CI, 0.38-0.41). Both death in the same month as discharge (19.9% vs 10.3%; OR, 1.54; 95% CI, 1.47-1.62) and death in the 12 months after discharge (50.8% vs 26.2%; OR, 1.95; 95% CI, 1.88-2.02) were twice as common among patients with ADRD. CONCLUSIONS: Patients with ADRD have lower home discharge rates and greater mortality after an ICU stay than patients without ADRD.

Nutritional Assessment of Denture Wearers Using Matched Electronic Dental-Health Record Data.

PURPOSE: To assess the nutritional profile of denture wearers through a retrospective cohort study using nutritional biomarkers from matched electronic dental and health record (EDR-EHR) data. MATERIALS AND METHODS: The case group (denture wearers) included matched EDR-EHR data of patients who received removable partial, complete, and implant-supported prosthodontic treatments between January 1, 2010 and December 31, 2018, study time. The control (nondenture wearers) group did not have recorded denture treatments and included patient records within 1 year of the denture index date (first date of case patients' receiving complete or partial denture) of the matching cases. The qualified patients' EDR were matched with their EHR based on the availability of laboratory reports within 2 years of receiving the dentures (index date). Nutritional biomarkers were selected from laboratory reports for complete blood count, comprehensive and basic metabolic profile, lipid, and thyroid panels. Summary statistics were performed, and general linear mixed effect models were used to evaluate the rate of change over time (slope) of nutritional biomarkers before and after the index date. Likelihood ratio tests were performed to determine the differences between dentures and controls. RESULTS: The final cohort included 10,481 matched EDR-EHR data with 3,519 denture wearers and 6,962 controls that contained laboratory results within the study time. The denture wearers' mean age was 57 ±10 years and the control group was 56 ±10 years with 55% females in both groups. Pre-post analysis among denture wearers revealed decreased serum albumin (p = 0.002), calcium (p = 0.039), creatinine (p < 0.001) during the post-index time. Hemoglobin (Hb) was higher pre-index, and was decreasing during the time period but did not change post-index (p < 0.001). Among denture wearers, completely edentulous patients had a significant decrease in serum albumin, creatinine, blood urea nitrogen (BUN), but increased estimated glomerular filtration rate (eGFR). In partially edentulous patients, total cholesterol decreased (p = 0.018) and TSH (p = 0.004), BUN (p < 0.001) increased post-index. Patients edentulous in either upper or lower arch had decreased BUN and eGFR during post-index. Compared to controls, denture wearers showed decreased serum albumin and protein (p = 0.008), serum calcium (p = 0.001), and controls showed increased Hb (p = 0.035) during post-index. CONCLUSIONS: The study results indicate nutritional biomarker variations among denture wearers suggesting a risk for undernutrition and the potential of using selected nutritional biomarkers to monitor nutritional profile.