Experts estimate that by the year 2050, 13.8 million older adults in the United States will develop Alzheimer’s disease and related Dementias (ADRD). Alzheimer’s disease is the most common form of dementia, but other forms include Lewy Body dementia, frontotemporal dementia, and vascular dementia which all gradually degrade cognitive function such as memory and decision-making.
Because there is no cure or treatment for ADRD, the focus for healthcare providers is to prevent treatable risk factors. Doing so could potentially slow the onset and progression of ADRD.
Hospitalization is extremely dangerous for people with ADRD. It can predispose them to delirium which can worsen the course of an illness, accelerate mental and physical decline, lengthen hospital stays, increase readmission rates, and increase death rates. One in eight hospitalized patients with ADRD will experience at least one of these serious problems.
Until now, the effect of delirium on older patients with and without ADRD has not been studied. However, researchers have recently published findings from the Better Assessment of Illness (BASIL) study which was designed to examine delirium, severe delirium, and its aftermath. The findings are published in the Journal of the American Geriatrics Society.
The study included 352 patients 70 years or older and admitted or transferred to Beth Israel Deaconess Medical Center (BIDMC) in Boston. The average age of study participants was 80 and most of them had at least one chronic health condition. Eighty-five participants were diagnosed with likely ADRD. Enrollment took place between 2015 and 2017 and the study continued for 12 months.
Researchers reported that 88 of the 352 participants (25 percent) experienced delirium. Patients with ADRD experienced delirium in higher rates (45 percent compared to 19 percent of patients without ADRD) and greater severity. The risk of being placed in a nursing home was increased for all patients who experienced severe delirium.
Experts say that up to 40 percent of delirium are preventable and the results of this study suggest that there is a strong need to prevent delirium, particularly severe cases, in patients with and without ADRD.
Delirium can be prevented in many cases by employing “low-tech, high-touch” interventions such as orienting patients to time and place, preserving the sleep-wake cycle, helping patients be mobile as soon as possible, making sure they are well hydrated, and correcting any vision or hearing problems. These techniques have been shown to prevent delirium and mental and physical decline in older patients both with and without ADRD.
By: Samuel Won, PharmD Candidate 2021