TY - JOUR
T1 - Association of Positive Delirium Screening with Incident Dementia in Skilled Nursing Facilities
AU - Briesacher, Becky A.
AU - Koethe, Benjamin
AU - Olivieri-Mui, Brianne
AU - Saczynski, Jane S.
AU - Fick, Donna Marie
AU - Devlin, John W.
AU - Marcantonio, Edward R.
N1 - Funding Information:
Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under award number R21AG057979. In addition, National Institute on Aging of the National Institutes of Health under award numbers R01 AG030618, K24 AG035075, and R01AG030618, Network for Investigation of Delirium Across the United States award number R24 AG054259, and National Institute of Nursing Research award numbers R01NR011042 and K24AG035075.
Funding Information:
Thanks to Lauren Bigger, MPH, for her assistance in the submission of this manuscript. Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under award number R21AG057979. In addition, National Institute on Aging of the National Institutes of Health under award numbers R01 AG030618, K24 AG035075, and R01AG030618, Network for Investigation of Delirium Across the United States award number R24 AG054259, and National Institute of Nursing Research award numbers R01NR011042 and K24AG035075. The authors have no conflict. B.K.: analysis and interpretation of data. B.O.-M.: analysis and interpretation of data, and preparation of manuscript. J.S.S.: interpretation of data, and preparation of manuscript. D.M.F.: interpretation of data, and preparation of manuscript. J.W.D.: interpretation of data, and preparation of manuscript. E.R.M. interpretation of data, and preparation of manuscript. L.B.: assisted in the submission of this manuscript. Becky A. Briesacher, PhD, was involved in study concept and design, acquisition of subjects and/or data, analysis and interpretation of data, and preparation of manuscript.
Publisher Copyright:
© 2020 The American Geriatrics Society
PY - 2020/12
Y1 - 2020/12
N2 - BACKGROUND AND OBJECTIVE: Early detection of delirium in skilled nursing facilities (SNFs) is a priority. The extent to which delirium screening leads to a potentially inappropriate diagnosis of Alzheimer's disease and related dementia (ADRD) is unknown. DESIGN: Nationwide retrospective cohort study from 2011 to 2013. SETTING: An SNF. PARTICIPANTS: A total of 1,175,550 Medicare enrollees who entered the SNF from a hospital and had no prior diagnosis of dementia. EXPOSURE: A positive screen for delirium using the validated Confusion Assessment Method (CAM), performed as part of the federally mandated Minimum Data Set (MDS) assessment. MEASUREMENTS: Incident all-cause dementia, ascertained through International Classification of Diseases, Ninth Revision (ICD-9), diagnosis in Medicare claims or active diagnoses in MDS. RESULTS: Positive screening for delirium was identified in 7.7% of cases (n = 90,449), and most occurred within the first 7 days of SNF admission (62.5%). The overall incidence of ADRD was 6.3% (n = 73,542). Nearly all new diagnoses of ADRD (93.5%) occurred within the first 30 days of SNF admission. Patients who screened CAM positive for delirium had a nearly threefold increased risk of receiving an incident ADRD diagnosis on the same day (hazard ratio (HR) = 2.63; 95% confidence interval (CI) = 1.50–4.63). Among patients who screened CAM positive for delirium, those who were cognitively intact or had mild cognitive impairments were, on average, six times more likely to receive an incident ADRD diagnosis (HR = 6.64; 95% CI = 1.76–25.0) relative to those testing CAM negative. CONCLUSION AND RELEVANCE: Among older adults not previously diagnosed with dementia, a positive screen for delirium was significantly associated with higher risk of ADRD diagnosis after admission to a SNF. This risk was highest for patients in the first days of their stay and with the least cognitive impairment, suggesting that the ADRD diagnosis was potentially inappropriate.
AB - BACKGROUND AND OBJECTIVE: Early detection of delirium in skilled nursing facilities (SNFs) is a priority. The extent to which delirium screening leads to a potentially inappropriate diagnosis of Alzheimer's disease and related dementia (ADRD) is unknown. DESIGN: Nationwide retrospective cohort study from 2011 to 2013. SETTING: An SNF. PARTICIPANTS: A total of 1,175,550 Medicare enrollees who entered the SNF from a hospital and had no prior diagnosis of dementia. EXPOSURE: A positive screen for delirium using the validated Confusion Assessment Method (CAM), performed as part of the federally mandated Minimum Data Set (MDS) assessment. MEASUREMENTS: Incident all-cause dementia, ascertained through International Classification of Diseases, Ninth Revision (ICD-9), diagnosis in Medicare claims or active diagnoses in MDS. RESULTS: Positive screening for delirium was identified in 7.7% of cases (n = 90,449), and most occurred within the first 7 days of SNF admission (62.5%). The overall incidence of ADRD was 6.3% (n = 73,542). Nearly all new diagnoses of ADRD (93.5%) occurred within the first 30 days of SNF admission. Patients who screened CAM positive for delirium had a nearly threefold increased risk of receiving an incident ADRD diagnosis on the same day (hazard ratio (HR) = 2.63; 95% confidence interval (CI) = 1.50–4.63). Among patients who screened CAM positive for delirium, those who were cognitively intact or had mild cognitive impairments were, on average, six times more likely to receive an incident ADRD diagnosis (HR = 6.64; 95% CI = 1.76–25.0) relative to those testing CAM negative. CONCLUSION AND RELEVANCE: Among older adults not previously diagnosed with dementia, a positive screen for delirium was significantly associated with higher risk of ADRD diagnosis after admission to a SNF. This risk was highest for patients in the first days of their stay and with the least cognitive impairment, suggesting that the ADRD diagnosis was potentially inappropriate.
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U2 - 10.1111/jgs.16830
DO - 10.1111/jgs.16830
M3 - Article
C2 - 32965034
AN - SCOPUS:85091373882
SN - 0002-8614
VL - 68
SP - 2931
EP - 2936
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 12
ER -