15 Aug Apathy Is a Risk Factor for Mortality in Nursing Home Patients
MedicalResearch.com Interview with:
Johanna MH Nijsten, Msc
Archipel Landrijt, Knowledge Center for Specialized Care
Eindhoven, the Netherlands
Department of Primary and Community Care, Radboudumc Alzheimer Center
Radboud University Medical Center
Nijmegen, the Netherlands
MedicalResearch.com: What is the background for this study?
Response: Apathy is common in nursing home (NH) patients with dementia and is repeatedly found to be the most prevalent neuropsychiatric symptom. Apathy is defined by diminished or lack of motivational, goal-directed behavior, and a lack of cognition and emotional affect. Apathy leads to reduced interest and participation in the main activities of daily living, diminished initiative, early withdrawal from initiated activities, indifference, and flattening of affect.
Over the last two decades, more scientific knowledge has become available about specific fronto-subcortical systems in the brain that may be highly involved in apathy. Disruptions in these systems are found in patients with frontal lobe damage resulting from, for instance, (early-onset) dementia, traumatic brain injury, stroke, or multiple sclerosis. Fronto-subcortical circuits also play an important role in neurological disorders involving the basal ganglia such as Parkinson’s disease and Huntington’s disease. The neurodegenerative diseases and acquired brain injuries mentioned here are highly prevalent in patients receiving long-term NH care and the widespread clinical manifestation of apathy in NH-patients is thought to be related.
Since apathy is very common in nursing home-patients and may lead to a poor prognosis, clear insight into its risk for mortality is needed and NH-staff need to understand this risk.
MedicalResearch.com: What are the main findings?
Response: Apathy is present in half of the nursing home (NH) patients of both Somatic care units and Dementia special care units and is associated with highly increased risk for mortality (Hazard Ratio [HR]=1.77; 95% confidence interval [CI]=1.35 to 2.31, p<0001), also when accounting for depressive symptoms (HR=1.64; 95% CI=1.23 to 2.19, p><0.001). Considered as both a categorical and dimensional construct, apathy reflects poor prognosis in nursing home-patients. When regarded as a dimensional variable, even a small increase of apathy reflects a greater risk of dying (one standard deviation increase of AES-10 scores was associated with a 62% increase of mortality risk [HR=1.62, 95% CI=1.40 to 1.88, p><0.001]). Dementia special care-units and Somatic Care-units did not differ (p>0.05) in the effect of apathy on mortality. Male gender (HR=1.67; 95% CI=1.23 to 2.27, p<0.001), and higher age in years (HR=1.06; 95% CI=1.04 to 1.08, p><0.001) were also predictors of mortality.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Apathy was associated with mortality over a four month period in nursing home patients, even when controlling for depression. No effective treatment for apathy has yet been established. Further research is needed on effective screening and treatment for apathy and enhancing professional caregivers’ awareness of apathy as a poor prognostic sign. The presence of apathy in nursing home patients should become a point of particular concern in daily care and should initiate establishing goals of care to improve quality of life and advanced care planning in the context of decreased life expectancy.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: These data suggest that screening and treatment strategies for apathy should be developed for this patient population.
Further research is also needed on increasing awareness and identification because apathy is still rarely identified as a problem in NHs. Effective screening and treatment strategies should be developed and analyzed for their effects on reducing apathy in patients and improving quality of life (QoL).
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Nijsten, J. M. H., Leontjevas, R., Pat-El, R., Smalbrugge, M., Koopmans, R. T. C. M. and Gerritsen, D. L. (2017), Apathy: Risk Factor for Mortality in Nursing Home Patients. J Am Geriatr Soc. doi:10.1111/jgs.15007
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