Influenza vaccination is recommended for older people irrespective of cognitive decline or residential setting.
To examine the effect of dementia diagnosis on flu vaccination uptake in community and care home residents in England and Wales.
Retrospective analysis of a primary care database with 378,462 community and 9,106 care (nursing and residential) home residents aged 65-104 in 2008-09. Predictors of vaccine uptake were examined adjusted for age, sex, area deprivation and major chronic diseases.
Age and sex standardised uptake of influenza vaccine was 74.7% (95% CI: 73.7-75.8%) in community patients without dementia, 71.4% (69.3-73.5%) in community patients with dementia, 80.5% (78.9-82.2%) in care home patients without dementia and 83.3% (81.4-85.3%) in care home patients with dementia. In a fully adjusted model, compared with community patients without dementia, patients with dementia in the community were less likely to receive vaccination (RR: 0.96, 95% CI: 0.94-0.97) while care home patients with (RR: 1.06, 1.03-1.09) and without (RR: 1.03, 1.01-1.05) dementia were more likely to receive vaccination. Area deprivation and chronic diseases were, respectively, negative and positive predictors of uptake.
Lower influenza vaccine uptake among community patients with dementia, compared with care home residents, suggests organisational barriers to community uptake but high uptake among patients with dementia in care homes does not suggest concern over informed consent acts as a barrier. Primary care for community patients with dementia needs to ensure that they receive all appropriate preventive interventions.
[Show abstract][Hide abstract] ABSTRACT: Dementia increases the risk of death in older patients hospitalized for acute illnesses. However, the effect of dementia on the risks of developing acute organ dysfunction and severe sepsis as well as on the risk of hospital mortality in hospitalized older patients remains unknown, especially when treatments for these life-threatening situations are considered.
In this population-based cohort study, we analyzed 41,672 older (≥ 65 years) patients, including 3,487 (8.4%) with dementia, from the first-time admission claim data between 2005 and 2007 for a nationally representative sample of one million beneficiaries enrolled in the Taiwan National Health Insurance Research Database. Outcomes included acute organ dysfunction, severe sepsis, and hospital mortality. The effect of dementia on outcomes was assessed using multivariable logistic regression.
Dementia was associated with a 32% higher risk of acute organ dysfunction (adjusted odds ratio [aOR] 1.32, 95% confidence interval [CI] 1.19-1.46), a 50% higher risk of severe sepsis (aOR 1.50, 95% CI 1.32-1.69) and a 28% higher risk of hospital mortality (aOR 1.28, 95% CI 1.10-1.48) after controlling age, sex, surgical condition, comorbidity, principal diagnosis, infection status, hospital level, and length of hospital stay. However, the significant adverse effect of dementia on hospital mortality disappeared when life-support treatments, including vasopressor use, hemodialysis, mechanical ventilation, and intensive care, were also controlled.
In hospitalized older patients, the presence of dementia increased the risks of acute organ dysfunction, severe sepsis and hospital mortality. However, after intervention using life-support treatments, dementia only exhibited a minor role on short-term mortality.
PLoS ONE 08/2012; 7(8):e42751. DOI:10.1371/journal.pone.0042751 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Bereavement is a period of increased risk of cardiovascular death. There is limited understanding of the potential contribution of quality of cardiovascular disease management to this increased risk.
In a UK primary care database, 12,722 older individuals with pre-existing cardiovascular disease (CHD, Hypertension, Diabetes, Stroke) and a partner bereavement were matched with a non-bereaved control group (n=33,911). We examined key routine annual process measures of care in the year before and after bereavement and cardiovascular medication prescribing (lipid lowering, antiplatelet, renin-angiotensin system drugs). Odds ratios for change after bereavement in comparison to the change in non-bereaved matched controls are presented. In the bereaved, uptake of all annual measures was lower in the year before bereavement, with improvement in the year after, while in the controls uptake was relatively stable. The odds ratio for change was 1.30 (95% CI 1.15-1.46) for cholesterol measurement and 1.40 (1.22-1.61) for blood pressure measurement. For all medication, there was a transient fall in prescribing in the peri-bereavement period lasting approximately until three months after bereavement. The odds ratio for at least 80% prescription coverage in the 30 days after bereavement was 0.80 (0.73-0.88) for lipid lowering medication and 0.82 (0.74-0.91) for antiplatelet medication compared to the change in non-bereaved individuals.
Lower uptake of key cardiovascular care measures in the year before bereavement and reduced medication coverage after bereavement may contribute to increased cardiovascular risk. Clinicians need to ensure that quality of cardiovascular care is maintained in the pre and post bereavement period.
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