Lauren J. Hunt, R. Sean Morrison, Siqi Gan, Edie Espejo, W. John Boscardin, Rebecca Rodin, Katherine A. Ornstein, Alexander K. Smith
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Dementia status was determined using validated cognitive assessments (Hurd method); hip fracture and pneumonia were identified from Medicare claims. Outcomes were 1-year mortality and function, defined as a summary score of requiring assistance with 6 ADL's and 5 IADL's, with higher scores indicating better function.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Among people with dementia, predicted 1-year mortality was higher among those with hip fracture (35.4%) versus those without hip fracture (14.8%), with similar patterns for pneumonia (49.6% vs. 13.0%). Among people with dementia, function declined abruptly at time of hip fracture (−2.09 [95% CI −2.94, −1.25]) and continued to decline after (−0.48 [95% CI −0.87, −0.09]). There were similar patterns for pneumonia (drop at time of pneumonia of −1.49 [95% CI −2.0, −0.97] and after −0.05 [95% CI, −0.29, 0.19]). Compared to people without dementia with hip fracture, people with dementia had higher 1-year mortality (35.4%) versus people without dementia (24%), with similar patterns for pneumonia (49.6% vs. 39.7%). Function stabilized for people without dementia after hip fracture (−0.03, 95% CI −0.22, 0.16), which was significantly different than people without dementia (<i>p</i> < 0.0001). Function improved for people without dementia after pneumonia (0.13, 95% CI 0.03, 0.24), but was not statistically different than for people with dementia (<i>p</i> = 0.17).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Disruptive events such as hip fracture or pneumonia substantially alter the clinical trajectories of people with dementia.</p>\n </section>\n </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 4","pages":"1179-1188"},"PeriodicalIF":4.3000,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Mortality and Function After Hip Fracture or Pneumonia in People With and Without Dementia\",\"authors\":\"Lauren J. Hunt, R. Sean Morrison, Siqi Gan, Edie Espejo, W. John Boscardin, Rebecca Rodin, Katherine A. Ornstein, Alexander K. 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引用次数: 0
摘要
背景：破坏性手术或医疗事件影响死亡率和功能的程度对于预期计划和告知目标一致的护理至关重要。方法：使用2008-2018年健康与退休研究数据，我们采用倾向评分匹配法比较痴呆患者髋部骨折（手术事件）或肺炎（医疗事件）住院对两组患者的影响：(1)未经历这些事件的痴呆患者；(2)没有痴呆症的人经历了一个事件。使用经过验证的认知评估（Hurd方法）确定痴呆状态；髋部骨折和肺炎都是从医疗保险索赔中确定的。结果是1年死亡率和功能，定义为需要辅助的6个ADL和5个IADL的总得分，得分越高表明功能越好。结果：在痴呆患者中，髋部骨折患者的预测1年死亡率（35.4%）高于无髋部骨折患者（14.8%），肺炎患者的预测1年死亡率相似（49.6%对13.0%）。在痴呆患者中，髋部骨折时功能突然下降（-2.09 [95% CI -2.94, -1.25]），骨折后功能继续下降（-0.48 [95% CI -0.87, -0.09]）。肺炎也有类似的模式（肺炎时下降为-1.49 [95% CI, -2.0, -0.97]，肺炎后下降为-0.05 [95% CI, -0.29, 0.19]）。与无痴呆伴髋部骨折的患者相比，痴呆患者的1年死亡率（35.4%）高于无痴呆患者（24%），肺炎的模式相似（49.6%对39.7%）。髋部骨折后，无痴呆患者的功能稳定（-0.03,95% CI -0.22, 0.16），这与无痴呆患者有显著差异(p结论：髋部骨折或肺炎等破坏性事件显著改变了痴呆患者的临床轨迹。
Mortality and Function After Hip Fracture or Pneumonia in People With and Without Dementia
Background
The extent to which disruptive surgical or medical events impact mortality and function is critical for anticipatory planning and informing goal-aligned care.
Methods
Using Health and Retirement Study data (2008–2018), we employed propensity score matching to compare the impact of hospitalization for hip fracture (a surgical event) or pneumonia (a medical event) among people with dementia to two groups: (1) people with dementia who did not experience these events; and (2) people without dementia who experienced an event. Dementia status was determined using validated cognitive assessments (Hurd method); hip fracture and pneumonia were identified from Medicare claims. Outcomes were 1-year mortality and function, defined as a summary score of requiring assistance with 6 ADL's and 5 IADL's, with higher scores indicating better function.
Results
Among people with dementia, predicted 1-year mortality was higher among those with hip fracture (35.4%) versus those without hip fracture (14.8%), with similar patterns for pneumonia (49.6% vs. 13.0%). Among people with dementia, function declined abruptly at time of hip fracture (−2.09 [95% CI −2.94, −1.25]) and continued to decline after (−0.48 [95% CI −0.87, −0.09]). There were similar patterns for pneumonia (drop at time of pneumonia of −1.49 [95% CI −2.0, −0.97] and after −0.05 [95% CI, −0.29, 0.19]). Compared to people without dementia with hip fracture, people with dementia had higher 1-year mortality (35.4%) versus people without dementia (24%), with similar patterns for pneumonia (49.6% vs. 39.7%). Function stabilized for people without dementia after hip fracture (−0.03, 95% CI −0.22, 0.16), which was significantly different than people without dementia (p < 0.0001). Function improved for people without dementia after pneumonia (0.13, 95% CI 0.03, 0.24), but was not statistically different than for people with dementia (p = 0.17).
Conclusion
Disruptive events such as hip fracture or pneumonia substantially alter the clinical trajectories of people with dementia.
期刊介绍：
Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.
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