Bartley, Mairead M.

AbstractBackgroundPeople living with dementia have high rates of emergency department (ED) use and hospitalizations. Identifying factors that influence acute care utilization is important. We examined the influence of physical activity levels on risk of hospitalization and emergency department (ED) use in a population of older people living with mild cognitive impairment (MCI) or dementia.MethodsWe included people with a diagnosis of MCI or dementia followed in Community Internal Medicine at Mayo Clinic, age 55 years and older, who had a clinic visit between June 1, 2019 and June 30, 2021 and had completed a social determinants of health questionnaire about physical activity levels. Physical activity was classified based on responses to questions about time spent exercising per week and rated as sufficiently active (≥150 minutes per week), insufficiently active (10‐140 minutes) or physically inactive (0 minutes). The risk of hospitalization and ED visits across physical activity levels was examined using quasi‐Poisson regression and presented as rate ratios (95% confidence interval (CI)), with adjustment for demographics, Charlson Comorbidity Index, marital status, living arrangement and body mass index.ResultsA total of 3090 persons living with MCI (n = 1308) or dementia (n = 1782) were included. People who were physically inactive were more likely to be older, female, not married, obese, have higher comorbid burden and a dementia diagnosis (p<0.001). Hospitalization and ED visit rates in those who were physically inactive were approximately double the rates for the sufficiently active group (p<0.001). Compared with those who were sufficiently active, people who were physically inactive had a significantly higher risk of hospitalization (rate ratio 1.73, 95% CI 1.30‐2.31) and ED visits (rate ratio 1.59, 95% CI 1.26‐2.01).ConclusionsPhysical inactivity in older people living with MCI or dementia is associated with an increased risk of ED visits and hospitalization. Targeted physical activity interventions could potentially impact on acute care utilization in this population. Our findings emphasize an area for public health promotion in people living with MCI or dementia.

Objectives To characterize frailty in cognitively normal older adults at baseline and to investigate the relationship between frailty and mortality. Design Population‐based prospective cohort study: Mayo Clinic Study of Aging. Setting Olmsted County, Minnesota. Participants Cognitively normal older persons aged 70 and older (mean age 78.8 ± 5.2, 50.2% male; N = 2,356). Measurements Frailty was assessed at baseline using a 36‐item Frailty Index. Four frailty subgroups were identified based on the Frailty Index (≤0.10 (fit), 0.11–0.20 (at risk), 0.21–0.30 (frail), >0.30 (frailest)). All participants underwent comprehensive clinical and cognitive assessments. The association between frailty and mortality was assessed using Cox proportional hazards models. Results The median Frailty Index was 0.17 (interquartile range 0.11–0.22). Frailty increased with age and was more common in older men than in older women. Over a median follow‐up of 6.5 years (range 7 days to 8.9 years), 500 of the 2,356 participants died, including 292 men. The frailest participants had the greatest risk of death (hazard ratio ( HR ) = 3.91, 95% confidence interval ( CI ) = 2.69–5.68). The association was stronger in women ( HR = 5.26, 95% CI = 2.88–9.61) than men ( HR = 3.15, 95% CI = 1.98–5.02). Conclusion Baseline frailty was common, especially in older men, and increased with age. Frailty was associated with significantly greater risk of death, particularly in women. These sex differences should be considered when designing a geriatric care plan.