Nursing Home Use Across The Spectrum of Cognitive Decline: Merging Mayo Clinic Study of Aging With CMS MDS Assessments

Jane A. Emerson, Carin Y. Smith, Kirsten H. Long, Jeanine E. Ransom, Rosebud O Roberts, Steven L. Hass, Amy M. Duhig, Ronald Carl Petersen, Cynthia L. Leibson

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background/objectives: Objective, complete estimates of nursing home (NH) use across the spectrum of cognitive decline are needed to help predict future care needs and inform economic models constructed to assess interventions to reduce care needs. Design: Retrospective longitudinal study. Setting: Olmsted County, MN. Participants: Mayo Clinic Study of Aging participants assessed as cognitively normal (CN), mild cognitive impairment (MCI), previously unrecognized dementia, or prevalent dementia (age = 70-89 years; N = 3,545). Measurements: Participants were followed in Centers for Medicare and Medicaid Services (CMS) Minimum Data Set (MDS) NH records and in Rochester Epidemiology Project provider-linked medical records for 1-year after assessment of cognition for days of observation, NH use (yes/no), NH days, NH days/days of observation, and mortality. Results: In the year after cognition was assessed, for persons categorized as CN, MCI, previously unrecognized dementia, and prevalent dementia respectively, the percentages who died were 1.0%, 2.6%, 4.2%, 21%; the percentages with any NH use were 3.8%, 8.7%, 19%, 40%; for persons with any NH use, median NH days were 27, 38, 120, 305, and median percentages of NH days/days of observation were 7.8%, 12%, 33%, 100%. The year after assessment, among persons with prevalent dementia and any NH use, >50% were a NH resident all days of observation. Pairwise comparisons revealed that each increase in cognitive impairment category exhibited significantly higher proportions with any NH use. One-year mortality was especially high for persons with prevalent dementia and any NH use (30% vs 13% for those with no NH use); 58% of all deaths among persons with prevalent dementia occurred while a NH resident. Conclusions: Findings suggest reductions in NH use could result from quality alternatives to NH admission, both among persons with MCI and persons with dementia, together with suitable options for end-of-life care among persons with prevalent dementia.

Original languageEnglish (US)
JournalJournal of the American Geriatrics Society
DOIs
StateAccepted/In press - 2017

Fingerprint

Centers for Medicare and Medicaid Services (U.S.)
Nursing Homes
Dementia
Observation
Datasets
Cognitive Dysfunction
Cognition
Nursing Records
Home Nursing
Economic Models
Terminal Care
Mortality

Keywords

  • Dementia
  • Long-term care
  • Mild cognitive impairment
  • Nursing home

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Emerson, J. A., Smith, C. Y., Long, K. H., Ransom, J. E., Roberts, R. O., Hass, S. L., ... Leibson, C. L. (Accepted/In press). Nursing Home Use Across The Spectrum of Cognitive Decline: Merging Mayo Clinic Study of Aging With CMS MDS Assessments. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.15022

Nursing Home Use Across The Spectrum of Cognitive Decline : Merging Mayo Clinic Study of Aging With CMS MDS Assessments. / Emerson, Jane A.; Smith, Carin Y.; Long, Kirsten H.; Ransom, Jeanine E.; Roberts, Rosebud O; Hass, Steven L.; Duhig, Amy M.; Petersen, Ronald Carl; Leibson, Cynthia L.

In: Journal of the American Geriatrics Society, 2017.

Research output: Contribution to journalArticle

Emerson, Jane A. ; Smith, Carin Y. ; Long, Kirsten H. ; Ransom, Jeanine E. ; Roberts, Rosebud O ; Hass, Steven L. ; Duhig, Amy M. ; Petersen, Ronald Carl ; Leibson, Cynthia L. / Nursing Home Use Across The Spectrum of Cognitive Decline : Merging Mayo Clinic Study of Aging With CMS MDS Assessments. In: Journal of the American Geriatrics Society. 2017.
@article{1a1ae91b15c14f2a80675f40ba192fc5,
title = "Nursing Home Use Across The Spectrum of Cognitive Decline: Merging Mayo Clinic Study of Aging With CMS MDS Assessments",
abstract = "Background/objectives: Objective, complete estimates of nursing home (NH) use across the spectrum of cognitive decline are needed to help predict future care needs and inform economic models constructed to assess interventions to reduce care needs. Design: Retrospective longitudinal study. Setting: Olmsted County, MN. Participants: Mayo Clinic Study of Aging participants assessed as cognitively normal (CN), mild cognitive impairment (MCI), previously unrecognized dementia, or prevalent dementia (age = 70-89 years; N = 3,545). Measurements: Participants were followed in Centers for Medicare and Medicaid Services (CMS) Minimum Data Set (MDS) NH records and in Rochester Epidemiology Project provider-linked medical records for 1-year after assessment of cognition for days of observation, NH use (yes/no), NH days, NH days/days of observation, and mortality. Results: In the year after cognition was assessed, for persons categorized as CN, MCI, previously unrecognized dementia, and prevalent dementia respectively, the percentages who died were 1.0{\%}, 2.6{\%}, 4.2{\%}, 21{\%}; the percentages with any NH use were 3.8{\%}, 8.7{\%}, 19{\%}, 40{\%}; for persons with any NH use, median NH days were 27, 38, 120, 305, and median percentages of NH days/days of observation were 7.8{\%}, 12{\%}, 33{\%}, 100{\%}. The year after assessment, among persons with prevalent dementia and any NH use, >50{\%} were a NH resident all days of observation. Pairwise comparisons revealed that each increase in cognitive impairment category exhibited significantly higher proportions with any NH use. One-year mortality was especially high for persons with prevalent dementia and any NH use (30{\%} vs 13{\%} for those with no NH use); 58{\%} of all deaths among persons with prevalent dementia occurred while a NH resident. Conclusions: Findings suggest reductions in NH use could result from quality alternatives to NH admission, both among persons with MCI and persons with dementia, together with suitable options for end-of-life care among persons with prevalent dementia.",
keywords = "Dementia, Long-term care, Mild cognitive impairment, Nursing home",
author = "Emerson, {Jane A.} and Smith, {Carin Y.} and Long, {Kirsten H.} and Ransom, {Jeanine E.} and Roberts, {Rosebud O} and Hass, {Steven L.} and Duhig, {Amy M.} and Petersen, {Ronald Carl} and Leibson, {Cynthia L.}",
year = "2017",
doi = "10.1111/jgs.15022",
language = "English (US)",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Nursing Home Use Across The Spectrum of Cognitive Decline

T2 - Merging Mayo Clinic Study of Aging With CMS MDS Assessments

AU - Emerson, Jane A.

AU - Smith, Carin Y.

AU - Long, Kirsten H.

AU - Ransom, Jeanine E.

AU - Roberts, Rosebud O

AU - Hass, Steven L.

AU - Duhig, Amy M.

AU - Petersen, Ronald Carl

AU - Leibson, Cynthia L.

PY - 2017

Y1 - 2017

N2 - Background/objectives: Objective, complete estimates of nursing home (NH) use across the spectrum of cognitive decline are needed to help predict future care needs and inform economic models constructed to assess interventions to reduce care needs. Design: Retrospective longitudinal study. Setting: Olmsted County, MN. Participants: Mayo Clinic Study of Aging participants assessed as cognitively normal (CN), mild cognitive impairment (MCI), previously unrecognized dementia, or prevalent dementia (age = 70-89 years; N = 3,545). Measurements: Participants were followed in Centers for Medicare and Medicaid Services (CMS) Minimum Data Set (MDS) NH records and in Rochester Epidemiology Project provider-linked medical records for 1-year after assessment of cognition for days of observation, NH use (yes/no), NH days, NH days/days of observation, and mortality. Results: In the year after cognition was assessed, for persons categorized as CN, MCI, previously unrecognized dementia, and prevalent dementia respectively, the percentages who died were 1.0%, 2.6%, 4.2%, 21%; the percentages with any NH use were 3.8%, 8.7%, 19%, 40%; for persons with any NH use, median NH days were 27, 38, 120, 305, and median percentages of NH days/days of observation were 7.8%, 12%, 33%, 100%. The year after assessment, among persons with prevalent dementia and any NH use, >50% were a NH resident all days of observation. Pairwise comparisons revealed that each increase in cognitive impairment category exhibited significantly higher proportions with any NH use. One-year mortality was especially high for persons with prevalent dementia and any NH use (30% vs 13% for those with no NH use); 58% of all deaths among persons with prevalent dementia occurred while a NH resident. Conclusions: Findings suggest reductions in NH use could result from quality alternatives to NH admission, both among persons with MCI and persons with dementia, together with suitable options for end-of-life care among persons with prevalent dementia.

AB - Background/objectives: Objective, complete estimates of nursing home (NH) use across the spectrum of cognitive decline are needed to help predict future care needs and inform economic models constructed to assess interventions to reduce care needs. Design: Retrospective longitudinal study. Setting: Olmsted County, MN. Participants: Mayo Clinic Study of Aging participants assessed as cognitively normal (CN), mild cognitive impairment (MCI), previously unrecognized dementia, or prevalent dementia (age = 70-89 years; N = 3,545). Measurements: Participants were followed in Centers for Medicare and Medicaid Services (CMS) Minimum Data Set (MDS) NH records and in Rochester Epidemiology Project provider-linked medical records for 1-year after assessment of cognition for days of observation, NH use (yes/no), NH days, NH days/days of observation, and mortality. Results: In the year after cognition was assessed, for persons categorized as CN, MCI, previously unrecognized dementia, and prevalent dementia respectively, the percentages who died were 1.0%, 2.6%, 4.2%, 21%; the percentages with any NH use were 3.8%, 8.7%, 19%, 40%; for persons with any NH use, median NH days were 27, 38, 120, 305, and median percentages of NH days/days of observation were 7.8%, 12%, 33%, 100%. The year after assessment, among persons with prevalent dementia and any NH use, >50% were a NH resident all days of observation. Pairwise comparisons revealed that each increase in cognitive impairment category exhibited significantly higher proportions with any NH use. One-year mortality was especially high for persons with prevalent dementia and any NH use (30% vs 13% for those with no NH use); 58% of all deaths among persons with prevalent dementia occurred while a NH resident. Conclusions: Findings suggest reductions in NH use could result from quality alternatives to NH admission, both among persons with MCI and persons with dementia, together with suitable options for end-of-life care among persons with prevalent dementia.

KW - Dementia

KW - Long-term care

KW - Mild cognitive impairment

KW - Nursing home

UR - http://www.scopus.com/inward/record.url?scp=85029284045&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85029284045&partnerID=8YFLogxK

U2 - 10.1111/jgs.15022

DO - 10.1111/jgs.15022

M3 - Article

C2 - 28892128

AN - SCOPUS:85029284045

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

ER -