New research examines one-year health-care costs associated with delirium in older hospitalized patients with and without Alzheimer’s disease and related dementias that have not been examined previously. 

Researchers found:

• Increased 1-year costs of $34,828 in Alzheimer’s disease and related dementias patients with delirium (vs. without).
• Increased costs for delirium in Alzheimer’s disease and related dementias occur later during the 365-day study period.
• For Alzheimer’s disease and related dementias patients, cost differences between those with and without delirium increased over 1 year after hospitalization.
• For non-Alzheimer’s disease and related dementias patients, the parallel cost differences were consistent over time after hospitalization. 

“Our findings suggest an increasing cost difference across one year for Alzheimer’s disease and related dementias patients with delirium compared to Alzheimer’s disease and related dementias patients without delirium,” said Dr. Tammy T. Hshieh of the Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife and Brigham and Women’s Hospital.  “Because delirium is preventable – patients and their families can advocate for nonpharmacologic interventions and vigilance during hospitalization to try to prevent the costly downstream cascade,” she said.

The findings appeared in “One-year Medicare costs associated with delirium in older hospitalized patients with and without Alzheimer’s disease dementia and related disorders”, published today in Alzheimer's & Dementia: The Journal of the Alzheimer's Association.

Methods

Medicare costs were determined prospectively at discharge, and at 30, 90, and 365 days in a cohort (n = 311) of older adults after hospital admission.

Results

Seventy-six (24%) patients had ADRD and were more likely to develop delirium (51% vs. 24%, P < 0.001) and die within 1 year (38% vs. 21%, P = 0.002). In ADRD patients with versus without delirium, adjusted mean difference in costs associated with delirium were $34,828; most of the excess costs were incurred between 90 and 365 days (P = 0.03). In non-ADRD patients, delirium was associated with increased costs at all timepoints. Excess costs associated with delirium in ADRD patients increased progressively over one year, whereas in non-ADRD patients the increase was consistent across time periods.

Discussion

The study findings highlight the complexity of health-care costs for ADRD patients who develop delirium, a potentially preventable source of expenditures.

Authors

Tammy T. Hshieh ¹,²,³ Ray Yun Gou ¹ Richard N. Jones ⁴ Douglas L. Leslie ⁵ Edward R. Marcantonio ³,⁶,⁷ Guoquan Xu ¹ Thomas G. Travison ¹,³ Tamara G. Fong ¹,³,⁸ Eva M. Schmitt ¹ Sharon K. Inouye ¹,³,⁷ for the BASIL I Study Group.  
¹ Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA 
² Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA 
³ Harvard Medical School, Boston, Massachusetts, USA 
⁴ Department of Psychiatry and Human Behavior, Department of Neurology, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA 
⁵ Center for Applied Studies in Health Economics, Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA 
⁶ Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA 
⁷ Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA 
⁸ Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.  
Dr. Inouye also holds the Milton and Shirley F. Levy Family Chair at the Marcus Institute.

About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Hebrew SeniorLife cares for more than 3,000 seniors a day across six campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; and Jack Satter House, Revere. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of more than $63 million, making it the largest gerontological research facility in the U.S. in a clinical setting. It also trains more than 1,000 geriatric care providers each year. For more information about Hebrew SeniorLife, visit our website or follow us on our blog, Facebook, Instagram, Twitter, and LinkedIn.

About the Hinda and Arthur Marcus Institute for Aging Research
Scientists at the Marcus Institute seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity, and productivity into advanced age. The Marcus Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment, and cure of disease; advance the standard of care for older people; and inform public decision-making.

BOSTON — Researchers from Hebrew SeniorLife’s Institute for Aging Research, and Boston Medical Center have reported that one-third of people 40-59 years have image-based evidence of moderate to severe degenerative disc disease and more than half had moderate to severe spinal osteoarthritis. Beyond that, the prevalence of disc height narrowing and joint osteoarthritis increased 2 to 4 fold in those aged 60-69 and 70-89 respectively. Furthermore, scientists observed that progression of these conditions occurred 40 – 70% more frequently in women than men.

To uncover these results, scientists used CT scans taken six years apart to evaluate the severity of disc disease and spinal osteoarthritis in 1200 cohort members of the Framingham Study – a collection of data from Framingham, MA residents and their offspring dating back to the 1940s. The results of this study were published recently in The Spine Journal.

Elizabeth Samelson, Ph.D., Associate Scientist at the Institute for Aging Research and author of this study said, “Spinal degenerative conditions, including disc height narrowing and joint osteoarthritis are common causes of pain, reduced function, and health care costs in older adults. Despite the clinical importance, little is known about the frequency and progression of spinal degenerative disease in the general population. Therefore, we conducted a study to describe the prevalence and progression in a population-based cohort.”

Research reported in this publication was supported by the National Institute on Aging of the National Institutes of Health under Award Numbers R01 AG041658, R01 AR053986, R01 AR041398, T32-AG023480 and the National Heart, Lung and Blood Institute’s Framingham Heart Study under HHSN268201500001I. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

About Institute for Aging Research

Scientists at the Institute for Aging Research seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity and productivity into advanced age. The Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment and cure of disease; advance the standard of care for older people; and inform public decision-making. The Musculoskeletal Center within IFAR studies conditions affecting bone, muscle, and joint health with aging.

About Hebrew SeniorLife

Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching and redefining the possibilities of aging. Based in Boston, the non-profit, non-sectarian organization has provided communities and health care for seniors, research into aging, and education for geriatric care providers since 1903. For more information about Hebrew SeniorLife, visit http://www.hebrewseniorlife.org, follow us on Twitter @H_SeniorLife, like us on Facebook or read our blog.

BOSTON – The Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife provides outpatient memory care services, in person and virtually, for people living with memory disorders at any stage. Services include behavioral and cognitive neurology, such as assessing cognitive function, identifying early signs of dementia, addressing behavioral changes, and recommending personalized interventions and lifestyles. The center’s care manager can help develop a personalized care plan to address the medical, behavioral, and social elements of daily life. 

Another important part of the center’s services includes providing support and resources for families and caregivers. It recently started a Virtual Caregiver Support Group, a biweekly virtual forum to enable caregivers to share struggles, ideas, and gain support from one another. The group is facilitated by the center’s social worker, Lori Feldman, LICSW, who has extensive experience helping families and caregivers cope with the various situations that can arise when caring for an individual with Alzheimer’s disease or other forms of memory loss.

“We know caring for a person showing signs of dementia can be overwhelming, especially now, during the COVID-19 pandemic, when normal routines for everyone have been disrupted,” said Feldman.

Join a virtual support group to help you manage in caring for family members with memory loss

If you’re caring for someone with dementia, it helps to know you’re not alone. A support group facilitated by a caring expert could help you cope with the challenges, learn new strategies, and care for yourself while caring for your loved one. Participants in the Wolk Center’s online support group will need a smartphone or another device with a camera, and the cost is covered by most insurance plans.

If you’re interested in joining or would like to learn more, contact us today.

About Hebrew SeniorLife
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Based in Boston, the nonprofit organization has provided communities and health care for seniors, research into aging, and education for geriatric care providers since 1903. For more information about Hebrew SeniorLife, visit http://www.hebrewseniorlife.org and our blog, or follow us on Facebook, Instagram, Twitter, and LinkedIn.

Boston, MA - New research finds that sleep can be most efficient and restful for older adults when nighttime bedroom ambient temperature ranges between 68 to 77 degrees Fahrenheit. 

The authors observed an overall trend: a 5-10% drop in sleep efficiency as the nighttime ambient temperature increases from 77 to 86 Fahrenheit. Importantly, this research also reveals substantial between-individual differences in optimal bedroom temperature.

“These results highlight the potential to enhance sleep quality in older adults by optimizing home thermal environments and emphasizing the importance of personalized temperature adjustments based on individual needs and circumstances,” said lead researcher Amir Baniassadi, PhD, Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, and Harvard Medical School.

“Additionally, the study underscores the potential impact of climate change on sleep quality in older adults, particularly those with lower socioeconomic status, and supports increasing their adaptive capacity as nighttime temperatures increase in cities across the country,” Baniassadi said.

This longitudinal observational study examines the association between bedroom nighttime temperature and sleep quality in a sample of community dwelling older adults. Using wearable sleep monitors and environmental sensors, researchers monitored sleep duration, efficiency, and restlessness over an extended period within participants’ homes while controlling for potential confounders and covariates. The study collected nearly 11,000 person-nights of sleep and environmental data from 50 older adults. The associations were primarily nonlinear, and substantial between-subject variations were observed. 

The findings were published in the article Nighttime ambient temperature and sleep in community-dwelling older adults in Science of The Total Environment.  Authors were Amir Baniassadi, PhD; Brad Manor, PhD, Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, and Harvard Medical School; Wanting Yu, ME, Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife; Thomas Travison, PhD, Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, and Harvard Medical School; and Lewis Lipsitz, MD, Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, and Harvard Medical School.

Older adults often experience inadequate, restless, and disrupted sleep which in turn influences many outcomes related to their health and wellbeing such as cognitive and physical function, mood and affect, irritability and reaction to stress, productivity, diabetes management, and risk of cardiovascular diseases. Indeed, poor sleep is disproportionately more common among older adults.  Meanwhile, research on its causes has been mostly focused on physiological and behavioral factors despite evidence suggesting that the environment the person sleeps in can be as influential. 

As a result, while numerous medical and behavioral interventions have been developed to improve outcomes related to sleep, the potential of environmental interventions have been largely overlooked.  Within this context, the link between home ambient temperature and sleep within older adults can be a potential target for improving sleep, which motivated the researchers to conduct this study. The authors plan to continue this line of work by focusing on the potential impact of climate change on sleep in low-income older adults and developing interventions to optimize their environment.

This study was supported by TMCITY foundation. Additionally, Baniassadi acknowledges support by a T32 fellowship through National Institute on Aging (T32AG023480).

Read more about this subject in this blog post by Dr. Baniassadi: Sleep and Rising Temperatures: The Hidden Impact of Climate Change on Older Adults.

About Hebrew SeniorLife 
Hebrew SeniorLife, an affiliate of Harvard Medical School, is a national senior services leader uniquely dedicated to rethinking, researching, and redefining the possibilities of aging. Hebrew SeniorLife cares for more than 4,500 seniors a day across six campuses throughout Greater Boston. Locations include: Hebrew Rehabilitation Center-Boston and Hebrew Rehabilitation Center-NewBridge in Dedham; NewBridge on the Charles, Dedham; Orchard Cove, Canton; Simon C. Fireman Community, Randolph; Center Communities of Brookline, Brookline; and Jack Satter House, Revere. Founded in 1903, Hebrew SeniorLife also conducts influential research into aging at the Hinda and Arthur Marcus Institute for Aging Research, which has a portfolio of more than $85 million, making it one of the largest gerontological research facilities in the U.S. in a clinical setting. It also trains more than 1,000 geriatric care providers each year. For more information about Hebrew SeniorLife, visit our website or follow us on our blog, Facebook, Instagram, Twitter, and LinkedIn.

About the Hinda and Arthur Marcus Institute for Aging Research
Scientists at the Marcus Institute seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity, and productivity into advanced age. The Marcus Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment, and cure of disease; advance the standard of care for older people; and inform public decision-making.