Undiagnosed Dementia Puts Older Adults at Risk

More than 20% of older people with dementia are still engaged in potentially unsafe complex activities, according to a new study.

“Those who are not aware of the dementia diagnosis are much more likely to be engaging in these activities,” said lead study author Halima Amjad, MD, MPH, of the Division of Geriatric Medicine and Gerontology at Johns Hopkins University School of Medicine. “Safety may therefore be an area where early diagnosis could be important.”
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The researchers classified 7609 participants, drawn from the National Health and Aging Trends Study, into 4 groups based on self-report of dementia diagnosis, proxy screening interview, and cognitive testing: probable dementia with reported dementia diagnosis (n=457); probable dementia without reported dementia diagnosis (n=581); possible dementia (n=996); and no dementia (n=5575). They examined potentially unsafe activities (driving, preparing hot meals, managing finances or medications, and attending doctor visits alone) and living conditions (falls, living alone, and unmet needs) by dementia status subgroups in stratified analyses and multivariate models, adjusting for sociodemographic factors, medical comorbidities, and physical capacity.

The investigators found the prevalence of driving (22.9%), preparing hot meals (31%), managing finances (21.9%), managing medications (36.6%), and attending doctor visits alone (20.6%) lowest in people with probable dementia. However, among those with probable dementia, the covariate-adjusted rates of driving, preparing hot meals, managing finances, managing medications, and attending doctor visits alone were significantly higher in those without reported dementia diagnosis than for those with reported diagnosis (odds ratios ≥ 2.00, P < .01, for all).

For primary care providers, Amjad stressed 3 big takeaways from this research.

“First, in older adults with probable dementia, almost everyone who was still engaged in the activities we assessed reported difficulty in an activity. Understanding not just what activities older patients are engaged in but also if they are having any difficulties might help identify which patients should undergo screening and evaluation for dementia,” she said. “Second, making an early diagnosis of dementia and communicating it clearly to patients and families may help families be more vigilant in ensuring that patients are engaging in activities they can safely conduct and help them prepare for future disability. Lastly, providers should not assume that a patient has stopped these complex, potentially unsafe activities, such as driving, but rather specifically ask about what they are and are not doing.”

Amjad said that this study has sparked her interest in the population of people with undiagnosed dementia. She is now going to use the data from the National Health and Aging Trends Study linked to Medicare claims data to understand what happens to this population over time to identify other areas where early diagnosis and intervention might improve outcomes. Amjad will also look at whether certain potentially unsafe activities in this study, such as medication management, are linked to adverse outcomes over time.

—Mike Bederka

Reference:

Amjad H, Roth DL, Samus QM, Yasar S, Wolff JL. Potentially unsafe activities and living conditions of older adults with dementia [published online June 2, 2016]. J Am Geriatr Soc. doi:10.1111/jgs.14164.