Deficit accumulation in relation to dementia and survival outcomes in residential care older adults

BackgroundAs people age, they are more likely to accumulate health deficits leading to an increased risk of adverse outcomes, including dementia. In community-dwelling older adults, even combining only the deficits traditionally unrelated to dementia predicts dementia. Previously, we reported an association between deficit accumulation and dementia in residential care. Here, our objectives are to 1) understand the profiles of deficit accumulation and the relationships between traditional and non-traditional dementia risk factors in older residents with or without dementia and 2) investigate the impact of deficit accumulation on dementia and survival outcomes in residential-care older adults.MethodWe analyzed the first full-assessment data of older adults in InterRAI Residential Care (RAI-RC MDS2.0) who enrolled in facilities under the care of Fraser Health Canada between 2010 and 2019 (female = 63.8%, mean age = 84.6±8.0 years). Dementia diagnoses (n = 18169), including pure Alzheimer’s disease (AD), mixed AD, other dementia, and no dementia (n = 11,589), were recorded at annual assessments. Two indices were constructed as the mean of the coded deficits between 0 (absent) and 1 (present), employing the same descriptive levels as in the original assessment. One index contained 20 traditional dementia risk factors (e.g., cognition, hypertension, and heart disease); the other contained 20 non-traditional ones (e.g., vision, hearing, arthritis, and continence). Participants were followed until 2021. Relationships between the indices and their impact on survival were tested. Incidental dementia outcome was examined for the non-demented sub-sample.ResultOver 92% of residents had at least one daily-living dependency. The two indices were highly correlated (R = 0.59, p<.001), and each positively related to mortality, regardless of dementia diagnoses. People with dementia accumulated more deficits and had a higher mean traditional risk index than those without dementia (F = 334.72, p<.001), while the latter group accumulated more non-traditional risk factors on average (F = 135.39, p<.001). A higher level of the indices showed variable risks of incidental dementia at follow-ups (p’s<.05).ConclusionOlder residents without dementia are dominated by dependent living with a distinct deficit accumulation profile than those with dementia. Deficit accumulation has negative impact on both dementia and survival outcomes in residential care.

https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.071052