title: Mortality and adverse health events in newly admitted nursing home residents with and without dementia.
abstract: OBJECTIVE
  To evaluate the association between dementia and mortality, adverse health events, and discharge disposition of newly admitted nursing home residents. It was hypothesized that residents with dementia would die at a higher rate and develop more adverse health events (e.g., infections, fevers, pressure ulcers, falls) than residents without dementia because of communication and self-care difficulties.
  
  
  METHODS
  An expert clinician panel diagnosed an admission cohort from a stratified random sample of 59 Maryland nursing homes, between 1992 and 1995. The cohort was followed for up to 2 years or until discharge.
  
  
  METHODS
  Fifty-nine Maryland nursing homes.
  
  
  METHODS
  Two thousand one hundred fifty-three newly admitted residents aged 65 and older not having resided in a nursing home for 8 or more days in the previous year.
  
  
  METHODS
  Mortality, infection, fever, pressure ulcers, fractures, and discharge home.
  
  
  RESULTS
  Residents with dementia had significantly lower overall rates of infection (relative risk (RR)=0.77, 95% confidence interval (CI)=0.70-0.85) and mortality (RR=0.61, 95% CI=0.53-0.71) than those without dementia, whereas rates of fever, pressure ulcers, and fractures were similar for the two groups. These results persisted when rates were adjusted for demographic characteristics, comorbid conditions, and functional status. During the first 90 days of the nursing home stay, residents with dementia had significantly lower rates of mortality if not admitted for rehabilitative care under a Medicare qualifying stay (RR=0.25, 95% CI=0.14-0.45), were less often discharged home (RR=0.33, 95% CI=0.28-0.38), and tended to have lower fever rates (RR=0.78, 95% CI=0.63-0.96) than residents without dementia.
  
  
  CONCLUSIONS
  Newly admitted nursing home residents with dementia have a profile of health events that is distinct from that of residents without dementia, indicating that the two groups have different long-term care needs. Results suggest that further investigation of whether residents with dementia can be well managed in alternative residential settings would be valuable.
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, Maryland 21201, USA. jmagazin@epi.umaryland.edu
authors.forename: Jay
authors.initials: J
authors.lastname: Magaziner
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
authors.forename: Ann L
authors.initials: AL
authors.lastname: Gruber-Baldini
authors.forename: Carol
authors.initials: C
authors.lastname: van Doorn
authors.forename: J Richard
authors.initials: JR
authors.lastname: Hebel
authors.forename: Pearl
authors.initials: P
authors.lastname: German
authors.forename: Lynda
authors.initials: L
authors.lastname: Burton
authors.forename: George
authors.initials: G
authors.lastname: Taler
authors.forename: Conrad
authors.initials: C
authors.lastname: May
authors.forename: Charlene C
authors.initials: CC
authors.lastname: Quinn
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Port
authors.forename: Mona
authors.initials: M
authors.lastname: Baumgarten
mesh_terms: D000058:Accidental Falls / Q000401:mortality*; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D003428:Cross Infection / Q000401:mortality*; D005260:Female; D005334:Fever / Q000401:mortality*; D050723:Fractures, Bone / Q000401:mortality*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D008396:Maryland; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D003668:Pressure Ulcer / Q000401:mortality*; D012306:Risk; D013223:Statistics as Topic