Quality Indicators for Dementia in Vulnerable Community-Dwelling and Hospitalized Elders
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Dementia is defined by acquired, progressive impairment in two or more cognitive areas (for example, frontal executive function, mood, or memory) that is severe enough to render a person dependent on others. Dementia is a leading cause of disability among older adult patients; Alzheimer disease is the most common etiology. The prevalence of Alzheimer disease is approximately 2% among persons 60 to 64 years of age, and the prevalence increases exponentially every 5 years thereafter, reaching 40% among persons older than 80 years of age. The prevalence of the other common dementias, including vascular dementia, the combination of Alzheimer disease and vascular dementia, and dementia with Lewy bodies, ranges from 15% to 20%. The incidence of Alzheimer disease is approximately 266,000 cases per year. Because the older adult population will grow 50% over the next three decades, the need for dementia care will increase significantly. Alzheimer disease and vascular dementia are contributory causes of death among 19% of elders older than 85 years of age, decreasing life expectancy by to 4 years. The mortality rate among patients with newly diagnosed Alzheimer disease is twice that seen in age-matched, nonaffected persons in the community. Dementia is the most common reason for placement of older adults in nursing facilities. The advent of pharmacotherapy to forestall cognitive decline presents new opportunities to reduce disability during the course of Alzheimer disease and related dementias. This paper presents indicators to assess the quality of care for patients with dementia. Methods: The methods for developing these quality indicators, including literature review and expert panel consideration, are detailed in another paper in this issue. For dementia, the structured literature review identified 2277 titles, from which abstracts and articles relevant to this report were identified. On the basis of the literature and the authors' expertise, 30 potential quality indicators were proposed. Results: Of the 30 potential quality indicators, 14 were judged to be valid by the expert panel process 3 were folded into other indicators, and 13 were not accepted.
Originally published in: Annals of Internal Medicine, v. 135, no. 8, pt. 2, October 16, 2001, pp. 668-676.
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