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Frailty and dementia in long‐term care: An analysis of the InterRAI data over the past decade
Author(s) -
Song Xiaowei,
Low Hilary,
Kelly Ronald,
McDermid Robert
Publication year - 2021
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.049471
Subject(s) - dementia , medicine , gerontology , long term care , medical diagnosis , minimum data set , multivariate analysis , demographics , disease , activities of daily living , frailty index , demography , psychiatry , nursing homes , nursing , pathology , sociology
Background Older adults in long‐term care are typically frail with multiple health problems and functional impairments; many have dementias of Alzheimer’s disease (AD) or other types. Frailty and dementia have a complex relationship; deterioration in one can make people more susceptible to the other. The association between frailty and dementia in long‐term care is not well understood. We conducted this study to investigate 1) how frailty differed by AD and dementia diagnoses in long‐term care residents, and 2) whether the relationship between frailty and dementia changes over time. Methods Data were retrieved from the InterRAI Residential Care assessments conducted in Fraser Health, Canada. Participants aged 65 years and over at the time of admission to one of the 83 long‐term care facilities between 2010 and 2019 (number of participants n=25,744; mean age=84.7±7.7 (85‐111) years; 63.2% females) were included in the study. Diagnosis of AD (n=4,055) and other dementias (n=11,882) were recorded during the assessment. A frailty index (FI) was calculated for each participant using 36 variables from their first full MDS2.0 assessment. Deficits included diseases, symptoms, functions, nutrition and other health conditions. The FI was presented as the ratio of deficits present over the total number of deficits considered (i.e., 36 here; higher FI indicating more deficits). Group mean differences of the FI were examined using ANOVA. Relations of the FI with AD and dementia diagnoses were examined using multivariate regressions, adjusted for year of assessment and demographics. Results The FI of the individuals increased exponentially with age (r=0.127, p<0.001) and differed significantly among diagnoses (no dementia=0.369±0.137, AD=0.394±0.144, other dementias=0.422±0.144, F=370.15, p<0.001). The 99% limits of the FI ranged 0.686 ‐ 0.736, depending on assessment year. Frailty increased dementia risks: a 1% increase of the FI was associated with 2.7% (95% confidence interval CI=2.4‐2.9) higher risk for other dementias and 1.4% (1.1‐1.6) for AD, independent of the effects of age, sex, and the year of admission. Conclusion Data demonstrate the robust characteristics of the frailty index. The consistent association between frailty and dementia in long‐term care over the decade has implications for integrated management strategies to delay frailty and dementia trajectories among at‐risk residents.