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J Am Geriatr Soc. 2017 Oct;65(10):2182-2189. doi: 10.1111/jgs.15007. Epub 2017 Aug 9.

Apathy: Risk Factor for Mortality in Nursing Home Patients.

Author information

1
Archipel Landrijt, Knowledge Center for Specialized Care, Eindhoven, the Netherlands.
2
Department of Primary and Community Care, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, the Netherlands.
3
Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, the Netherlands.
4
Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, the Netherlands.
5
Joachim en Anna, Center for Specialized Geriatric Care, Nijmegen, the Netherlands.

Abstract

OBJECTIVES:

To determine the prognostic value of apathy for mortality in patients of somatic (SC) and dementia special care (DSC) nursing home (NH) units.

DESIGN:

Longitudinal design, secondary analyses of a 2-year, cluster-randomized trial with six measurements, approximately 4 months in between.

SETTING:

SC and DSC-units of Dutch NHs.

PARTICIPANTS:

NH-patients of seventeen SC-units (n = 342) and sixteen DCS-units (n = 371).

MEASUREMENTS:

Data were available for 713 NH-patients, 266 of whom died during the study. Apathy was assessed using the 10-item Apathy Evaluation Scale (AES-10) and applied as categorical variable using known cut-off scores as well as dimensional variable. Additionally, depressive symptoms were assessed using the Cornell Scale for Depression in Dementia.

RESULTS:

Mixed effects cox models using the coxme package in R revealed a higher risk of mortality between two measurements, if apathy was present (hazard ratio (HR) = 1.77; 95% confidence interval (CI] = 1.35-2.31, P < .001). Results remained significant (HR = 1.64; 95% CI = 1.23-2.19, P < .001) when controlled for depressive symptoms. DSC-units and SC-units did not differ (P > .05) in the effect of apathy on mortality. Male gender (HR = 1.67; 95% CI = 1.23-2.27, P < .001), and higher age in years (HR = 1.06; 95% CI = 1.04-1.08, P < .001) were also predictors of mortality. Regarding apathy as a dimensional construct, one standard deviation increase of AES-10 scores was associated with a 62% increase of mortality risk (HR = 1.62, 95% CI = 1.40-1.88, P < .001).

CONCLUSIONS:

Apathy was associated with mortality over a 4-month period in NH patients, even when controlling for depression. These data suggest that screening and treatment strategies for apathy should be developed for this patient population.

KEYWORDS:

apathy; dementia care; depression; mortality; nursing home; risk factor; somatic

PMID:
28791690
DOI:
10.1111/jgs.15007
[Indexed for MEDLINE]

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