Comorbidity and clinical features in elderly patients with dementia: differences according to dementia severity.

OBJECTIVES: To evaluate comorbidity and clinical features in elderly patients with dementia to determine differences according to dementia severity. DESIGN: Observational study with medical record review. SETTING: Eight hospitals in the Barcelona area. PARTICIPANTS: 515 consecutive admissions aged > 64 years with dementia, 89.1% of whom lived in the community. MEASUREMENTS: We collected data on sociodemographic variables, type of dementia, Barthel Index (BI), Lawton and Brody Index (LI), Mini-Mental State Examination (MMSE), Charlson Index and the total number of drugs chronically prescribed. We stratified the population into two groups according to disease severity with the Global Deterioration Scale (GDS): mild-moderate (GDS 3-5) and severe (GDS 6-7). RESULTS: There were a total of 515 participants of which 364 females (70%) and 151 males with a mean age of 81 +/- 6 years old. The total number of chronic prescription drugs was 5.6 +/- 2.4. The mean Charlson Index score was 2 +/- 1.2. The 270 (52.5%) patients with a GDS score of 3-5 were compared with the 245 patients with a GDS score of 6-7. In the multivariate analysis, a GDS score of 6-7 was associated with poorer LI, BI, and MMSE scores and greater neuroleptic therapy. CONCLUSIONS: Important comorbidity conditions are common in elderly individuals with dementia. The patients with more severe dementia had poor functional status and higher frequency of neuroleptic use. Medical comorbidities should be taken into account in the management of patients with dementia.

[Features differentiating comorbidity in elderly patients with Alzheimer-type dementia or with vascular dementia]. / Aspectos diferenciales de comorbilidad en pacientes ancianos con demencia tipo Alzheimer o con demencia vascular.

INTRODUCTION: Alzheimer's disease (AD) and vascular dementia (VD) are the two most common forms of dementia. In the elderly subjects with dementia, there is a significant comorbidity associated and often cause greater morbidity and mortality. AIM: To investigate some aspects of comorbidity in the patients with these two types of dementia in order to analyze possible differences. PATIENTS AND METHODS: A total of 365 patients > 64 years old were prospectively evaluated. Of them 289 patients (79.1%) had probable AD, and 76 patients probable VD. Data were collected on sociodemographic variables, Barthel index, Lawton index), Minimental State Examination, total number of drugs, history of high blood pressure (HBP), diabetes mellitus (DM), dyslipidemia (DL), heart failure (HF), chronic obstructive pulmonary disease (COPD) and cancer. RESULTS: The sample consisted of 264 women (72.3%) and 101 men. Mean age was 81.1 +/- 6 years. Patients were taken an average of 5.5 +/- 2.5 drugs. 54% had HBP, 26.6% DM, 25.8% DL, 12.1% HF, 13.7% COPD and 8.2% cancer. When in multivariate analysis differences were analyzed according the type of dementia, we found a higher percentage of men, taken more than three drugs and lower percentage of taken specific dementia therapy in the VD group. CONCLUSIONS: Our results showed the presence of high comorbidity and chronic drugs prescription in elderly people with dementia. There are some differences according the type of dementia, highlighting a higher percentage of polypharmacy in patients with vascular dementia group.

Aspectos diferenciales de comorbilidad en pacientes ancianos con demencia tipo Alzheimer o con demencia vascular / Features differentiating comorbidity in elderly patients with Alzheimer-type dementia or with vascular dementia

La enfermedad de Alzheimer (EA) y la demencia vascular (DV) son los dos tipos más frecuentes dedemencia. En los ancianos con demencia existe una importante comorbilidad asociada que frecuentemente ocasionará una mayor morbimortalidad. Objetivo. Evaluar algunos aspectos de la comorbilidad en pacientes con ambos tipos de demencia para analizar posibles diferencias. Pacientes y métodos. Se evaluaron prospectivamente 365 pacientes mayores de 64 años.De ellos, 289 (79,1%) tenían EA probable, y 76 DV, probable. Se recogieron variables sociodemográficas, tipo de demencia, índice de Barthel, índice de Lawton, test minimental, número total de medicamentos, antecedentes de hipertensión (HTA), diabetesmellitus (DM), dislipemia, insuficiencia cardíaca, enfermedad pulmonar obstructiva crónica (EPOC) y neoplasia. Resultados. Se trataba de 264 mujeres (72,3%) y 101 varones. La edad media era de 81,1 ± 6 años. La media de medicamentos fue de 5,5 ± 2,5. El 54% recibía tratamiento para la HTA, el 26,6% para la DM y el 25,8% para la dislipemia. En el 12,1% delos pacientes existía el diagnóstico de insuficiencia cardíaca, en el 13,7% de EPOC y en el 8,2% coexistía el diagnóstico de neoplasia. En el análisis multivariable se objetivaron algunas diferencias significativas según el tipo de demencia; así, en el grupo de pacientes con DV había predominio de varones, mayor porcentaje de pacientes con más de tres medicamentos y menorporcentaje de ellos con tratamiento específico para su demencia. Conclusiones. Los pacientes ancianos con demencia tienen alta comorbilidad e importante consumo de fármacos de prescripción crónica. Existen algunas variaciones en los pacientesmayores según el tipo de demencia, y destaca un mayor porcentaje de pacientes con polifarmacia en el grupo de demencia vascular

Alzheimer’s disease (AD) and vascular dementia (VD) are the two most common forms of dementia.In the elderly subjects with dementia, there is a significant comorbidity associated and often cause greater morbidity and mortality. Aim. To investigate some aspects of comorbidity in the patients with these two types of dementia in order to analyzepossible differences. Patients and methods. A total of 365 patients > 64 years old were prospectively evaluated. Of them 289 patients (79.1%) had probable AD, and 76 patients probable VD. Data were collected on sociodemographic variables, Barthelindex, Lawton index), Minimental State Examination, total number of drugs, history of high blood pressure (HBP), diabetes mellitus (DM), dyslipidemia (DL), heart failure (HF), chronic obstructive pulmonary disease (COPD) and cancer. Results. The sample consisted of 264 women (72.3%) and 101 men. Mean age was 81.1 ± 6 years. Patients were taken an average of 5.5 ± 2.5 drugs. 54% had HBP, 26.6% DM, 25.8% DL, 12.1% HF, 13.7% COPD and 8.2% cancer. When in multivariate analysis differences were analyzed according the type of dementia, we found a higher percentage of men, taken more thanthree drugs and lower percentage of taken specific dementia therapy in the VD group. Conclusions. Our results showed the presence of high comorbidity and chronic drugs prescription in elderly people with dementia. There are some differences according the type of dementia, highlighting a higher percentage of polypharmacy in patients with vascular dementia group

[Factors predicting return home of hospitalized aged patients]. / Factores predictivos de retorno al domicilio en pacientes ancianos hospitalizados.

BACKGROUND: The identification of predictors of return home and nursing home placement in elderly patients, at the moment of admission to a Geriatric Convalescence Unit, may allow to make a discharge planning for these patients, and also may improve efficiency in the unit. PATIENTS AND METHODS: A number of 445 patients over 65 years were consecutively admitted to the unit. Analyzed variables at admission were; age, sex, diagnostic, comorbidity, functional status prior to admission, degree of independence in activities of daily living (Barthel index), cognitive function (Folstein Mini-Mental) and social support (modified version of social-familiar evaluation scale of Gijón). All these variables were used in two models of logistic regression analysis: 1 [symbol: see text] (dependent variable: return home after discharge versus other destinations), and 2 [symbol: see text] (dependent variable: nursing home placement on discharge versus other destinations). RESULTS: The variables significatively associated with greater probability of at home discharge were: moderate dependency for activities of daily living (Barthel index = 31-59), odds ratio (OR) = 2.46 (95% confidence interval: 1.43-4.22); mild dependency (Barthel index > or = 60), OR = 3.67 (1.96-6.87); normal cognitive function (Mini-Mental > or = 21), OR = 3.14 (1.76-5.60), and a favourable social support (social-familiar scale < 12), OR = 7.33 (3.18-16.91). The only variable significatively associated with the probability of nursing home placement after discharge was an impaired social function (social-familiar scale > or = 12), OR = 4.53 (2.25-9.12). CONCLUSIONS: Probability of return home after discharge is associated with functional status, cognitive function and social support. Definitively nursing home placement was only related with de degree of familiar support.

Factores predictivos de retorno al domicilio en pacientes ancianos hospitalizados / Predictors of return home on discharge in hospitalized elderly patients

Fundamento: La identificación de aquellos factores relacionados con la probabilidad de ser dado de alta al domicilio, en una Unidad Geriátrica de Convalecencia, permitiría planificar el alta de estos pacientes y mejorar la eficiencia en la gestión de las camas. Pacientes y métodos: Se analizaron 445 pacientes con edad =65 años, que ingresaron de forma consecutiva en la unidad. Las variables estudiadas en el momento del ingreso fueron: edad, sexo, diagnóstico, comorbilidad, situación funcional antes del ingreso actual, nivel de independencia para las actividades de la vida diaria (índice de Barthel), función cognitiva (Mini-Mental de Folstein) y la situación social (escala de valoración socio-familiar de Gijón modificada). Todas estas variables se introdujeron en dos modelos de regresión logística múltiple: 1º (variable dependiente: alta a domicilio versus otros destinos) y 2º (variable dependiente: alta a una institución versus otros destinos). Resultados: Variables significativas asociadas con mayor probabilidad de retorno al domicilio : dependencia moderada para actividades de la vida diaria (índice de Barthel=31-59), odds ratio (OR)=2,46 (intervalo de confianza al 95%: 1,43-4,22); dependencia leve (índice de Barthel =60), OR =3,67 (1,96-6,87); función cognitiva conservada (Mini-Mental =21), OR= 3,14 (1,76-5,60) y situación social favorable (escala socio-familiar<12), OR=7,33 (3,18-16,91). La única variable significativa asociada con mayor probabilidad de institucionalización definitiva tras el alta fue la situación social deteriorada (escala socio-familiar =12), OR=4,53 (2,25-9,12). Conclusiones: La probabilidad de retorno al domicilio esta relacionada con la capacidad funcional, la función cognitiva y la situación social. El ingreso definitivo en una institución, está relacionado únicamente con el grado de soporte familiar (AU)