Adverse events among nursing home residents with Alzheimer's disease and psychosis

Purpose The objective of this study was to quantify rates of adverse events in a high-risk multi-morbid population of institutionalized patients with Alzheimer's disease (AD). Methods We conducted a retrospective cohort study among nursing home residents diagnosed with AD and psychosis during January 1998 to October 1999. Using the Medicare Minimum Data Set (MDS) and Medicare inpatient claims (ICD-9 codes), 7728 nursing home residents aged 55-95 years with AD and psychosis were identified for study. Potential adverse events of interest were identified from the MDS and Medicare inpatient claims (ICD-9 codes). We estimated the incidence rate (IR) and 95% confidence interval (Cl) for each adverse event during a 2-year follow-up period. Results Of the 7728 residents studied, nearly 30% were considered 'dependent' by the activities of daily living (ADL) score and approximately 15% exhibited severe cognitive impairment at baseline. At least 90% had comorbid psychiatric disorders. The most common adverse event was accidental injury, occurring at a rate of 97.7 per 100 person-years (95%CI=94.7-100.7). Other common adverse events were death (IR=44.6/100 person-years; 95%CI=42.9-46.4), infection (IR=41.8/100 person-years; 95%CI=39.7-43.8), pain (IR=43.5/100 person-years; 95%CI=41.2-45.9), anorexia (41.3/100 person-years; 95%CI=39.1-43.6), and weight change (IR=40.2/100 person-years; 95%CI=38.7-41.7). Conclusions This information on the occurrence of adverse outcomes among nursing home patients with AD and psychosis provides useful context for any safety event observed among patients treated for psychosis. Copyright (c) 2006 John Wiley & Sons, Ltd.