Deficit accumulation in relation to dementia and survival outcomes in residential care older adults
Bibliographic record
Abstract
Abstract Background As people age, they are more likely to accumulate health deficits leading to an increased risk of adverse outcomes, including dementia. In community‐dwelling older adults, even combining only the deficits traditionally unrelated to dementia predicts dementia. Previously, we reported an association between deficit accumulation and dementia in residential care. Here, our objectives are to 1) understand the profiles of deficit accumulation and the relationships between traditional and non‐traditional dementia risk factors in older residents with or without dementia and 2) investigate the impact of deficit accumulation on dementia and survival outcomes in residential‐care older adults. Method We analyzed the first full‐assessment data of older adults in InterRAI Residential Care (RAI‐RC MDS2.0) who enrolled in facilities under the care of Fraser Health Canada between 2010 and 2019 (female = 63.8%, mean age = 84.6±8.0 years). Dementia diagnoses (n = 18169), including pure Alzheimer’s disease (AD), mixed AD, other dementia, and no dementia (n = 11,589), were recorded at annual assessments. Two indices were constructed as the mean of the coded deficits between 0 (absent) and 1 (present), employing the same descriptive levels as in the original assessment. One index contained 20 traditional dementia risk factors (e.g., cognition, hypertension, and heart disease); the other contained 20 non‐traditional ones (e.g., vision, hearing, arthritis, and continence). Participants were followed until 2021. Relationships between the indices and their impact on survival were tested. Incidental dementia outcome was examined for the non‐demented sub‐sample. Result Over 92% of residents had at least one daily‐living dependency. The two indices were highly correlated (R = 0.59, p<.001), and each positively related to mortality, regardless of dementia diagnoses. People with dementia accumulated more deficits and had a higher mean traditional risk index than those without dementia (F = 334.72, p<.001), while the latter group accumulated more non‐traditional risk factors on average (F = 135.39, p<.001). A higher level of the indices showed variable risks of incidental dementia at follow‐ups (p’s<.05). Conclusion Older residents without dementia are dominated by dependent living with a distinct deficit accumulation profile than those with dementia. Deficit accumulation has negative impact on both dementia and survival outcomes in residential care.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".