Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Dementia identified as a risk factor for infection-related hospital contacts in a national, population-based and longitudinal matched-cohort study

Nature Aging volume 1, pages 226–233 (2021)Cite this article

Subjects

Abstract

The aim of this study was to investigate the association between incident dementia and rates of infection-related hospital contacts. We conducted a registry- and population-based matched-cohort study of all Danish residents who were born in or before 1950, included from 1 January 2000 or their 65th birthday (whichever came later), who were alive and resided in Denmark at the start of the study, excluding those who had received a dementia diagnosis before 1 January 2000 or their 65th birthday (n = 1,712,100). A total of 129,660 people (403,744 person years) with incident dementia were matched with 297,476 people (1,918,784 person years) without dementia. Incidence rate ratios (IRRs) of infection-related hospital contacts were calculated using Poisson regression, by infection type, sex and age. The IRR for any infection-related contact in dementia was 1.5, was highest for nervous and urinary system infections and sepsis, decreased with increasing age and was higher in men. More people with than without dementia had contacts five years before the index date. Our findings show that dementia is a risk factor for infection-related hospital contacts and infections might be an early sign of dementia.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Cohort population flow chart.
Fig. 2: IRRs of infection-related hospital contacts, by infection site category, in people with dementia.
Fig. 3: IRRs by sex and age group in people with dementia.
Fig. 4: Infection-related hospital contacts during the 5 years before the index date.

Similar content being viewed by others

Data availability

All of the data used in this study are derived from the Danish National and Public Health registries. These data are collected and stored by the relevant authorities and cannot be made public or accessed by unauthorized parties. Access to such data is given via standard rules and regulations of data access outlined by the Danish Data Protection Agency and Danish Health Data Authority.

Code availability

SAS software version 9.4 was used for analysis and coding relating to all of the methods used in this study. We used the procedure PROC GENMOD.

References

  1. Rao, A., Suliman, A., Vuik, S., Aylin, P. & Darzi, A. Outcomes of dementia: systematic review and meta-analysis of hospital administrative database studies. Arch. Gerontol. Geriatr. 66, 198–204 (2016).

    Article  PubMed  Google Scholar 

  2. Phelan, E. A., Borson, S., Grothaus, L., Balch, S. & Larson, E. B. Association of incident dementia with hospitalizations. J. Am. Med. Assoc. 307, 165–172 (2012).

    Article  CAS  Google Scholar 

  3. Natalwala, A., Potluri, R., Uppal, H. & Heun, R. Reasons for hospital admissions in dementia patients in Birmingham, UK, during 2002–2007. Dement. Geriatr. Cogn. Disord. 26, 499–505 (2008).

    Article  PubMed  Google Scholar 

  4. Mitchell, S. L. Care of patients with advanced dementia. UpToDate https://www.uptodate.com/contents/care-of-patients-with-advanced-dementia (2019).

  5. Naumova, E. N. et al. Pneumonia and influenza hospitalizations in elderly people with dementia. J. Am. Geriatr. Soc. 57, 2192–2199 (2009).

    Article  PubMed  Google Scholar 

  6. Alpay, Y., Aykin, N., Korkmaz, P., Gulduren, H. M. & Caglan, F. C.Urinary tract infections in the geriatric patients. Pakistan J. Med. Sci. 34, 67–72 (2018).

    Google Scholar 

  7. Clegg, A., Young, J., Iliffe, S., Rikkert, M. O. & Rockwood, K. Frailty in elderly people. Lancet 381, 752–762 (2013).

    Article  PubMed  Google Scholar 

  8. Parsons, C. & van der Steen, J. T. Antimicrobial use in patients with dementia: current concerns and future recommendations. CNS Drugs 31, 433–438 (2017).

    Article  CAS  PubMed  Google Scholar 

  9. Mouton, C. P., Bazaldua, O. V., Pierce, B. & Espino, D. V. Common infections in older adults. Am. Fam. Physician 63, 257–268 (2001).

    CAS  PubMed  Google Scholar 

  10. Nace, D. A., Drinka, P. J. & Crnich, C. J. Clinical uncertainties in the approach to long term care residents with possible urinary tract infection. J. Am. Med. Dir. Assoc. 15, 133–139 (2014).

    Article  PubMed  Google Scholar 

  11. Kline, K. A. & Bowdish, D. M. E. Infection in an aging population. Curr. Opin. Microbiol. 29, 63–67 (2016).

    Article  PubMed  Google Scholar 

  12. Tolppanen, A.-M. et al. Hospital admissions, outpatient visits and healthcare costs of community-dwellers with Alzheimer’s disease. Alzheimers Dement. 11, 955–963 (2015).

    Article  PubMed  Google Scholar 

  13. Albert, S. M. et al. Hospitalization and Alzheimer’s disease: results from a community-based study. J. Gerontol. A Biol. Sci. Med. Sci. 54, M267–M271 (1999).

    Article  CAS  PubMed  Google Scholar 

  14. Bernardes, C., Massano, J. & Freitas, A. Hospital admissions 2000–2014: a retrospective analysis of 288 096 events in patients with dementia. Arch. Gerontol. Geriatr. 77, 150–157 (2018).

    Article  PubMed  Google Scholar 

  15. Guijarro, R. et al. Impact of dementia on hospitalization. Neuroepidemiology 35, 101–108 (2010).

    Article  PubMed  Google Scholar 

  16. Zuliani, G. et al. Discharge diagnosis and comorbidity profile in hospitalized older patients with dementia. Int. J. Geriatr. Psychiatry 27, 313–320 (2012).

    Article  PubMed  Google Scholar 

  17. Daiello, L. A., Gardner, R., Epstein-Lubow, G., Butterfield, K. & Gravenstein, S. Association of dementia with early rehospitalization among Medicare beneficiaries. Arch. Gerontol. Geriatr. 59, 162–168 (2014).

    Article  PubMed  Google Scholar 

  18. Sampson, E. L., Blanchard, M. R., Jones, L., Tookman, A. & King, M. Dementia in the acute hospital: prospective cohort study of prevalence and mortality. Br. J. Psychiatry 195, 61–66 (2009).

    Article  PubMed  Google Scholar 

  19. Shen, H.-N., Lu, C.-L. & Li, C.-Y. Dementia increases the risks of acute organ dysfunction, severe sepsis and mortality in hospitalized older patients: a national population-based study. PLoS ONE 7, e42751 (2012).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Zhao, Y., Kuo, T.-C., Weir, S., Kramer, M. S. & Ash, A. S. Healthcare costs and utilization for Medicare beneficiaries with Alzheimer’s. BMC Health Serv. Res. 8, 108 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  21. Draper, B., Karmel, R., Gibson, D., Peut, A. & Anderson, P. The Hospital Dementia Services Project: age differences in hospital stays for older people with and without dementia. Int. Psychogeriatrics 23, 1649–1658 (2011).

    Article  Google Scholar 

  22. Harris, D. P., Chodosh, J., Vassar, S. D., Vickrey, B. G. & Shapiro, M. F. Primary care providers’ views of challenges and rewards of dementia care relative to other conditions. J. Am. Geriatr. Soc. 57, 2209–2216 (2009).

    Article  PubMed  Google Scholar 

  23. Hendriks, S. A. et al. End-of-life treatment decisions in nursing home residents dying with dementia in the Netherlands. Int. J. Geriatr. Psychiatry 32, e43–e49 (2017).

    Article  PubMed  Google Scholar 

  24. Allers, K. & Hoffmann, F. Mortality and hospitalization at the end of life in newly admitted nursing home residents with and without dementia. Soc. Psychiatry Psychiatr. Epidemiol. 53, 833–839 (2018).

    Article  PubMed  Google Scholar 

  25. Kitazawa, M., Oddo, S., Yamasaki, T. R., Green, K. N. & LaFerla, F. M. Lipopolysaccharide-induced inflammation exacerbates tau pathology by a cyclin-dependent kinase 5-mediated pathway in a transgenic model of Alzheimer’s disease. J. Neurosci. 25, 8843–8853 (2005).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Dunn, N., Mullee, M., Perry, V. H. & Holmes, C.Association between dementia and infectious disease: evidence from a case-control study.Alzheimer Dis. Assoc. Disord. 19, 91–94 (2005).

    Article  PubMed  Google Scholar 

  27. Balin, B. J. & Hudson, A. P. Herpes viruses and Alzheimer’s disease: new evidence in the debate. Lancet Neurol. 17, 839–841 (2018).

    Article  PubMed  Google Scholar 

  28. Holmes, C. Review: systemic inflammation and Alzheimer’s disease. Neuropathol. Appl. Neurobiol. 39, 51–68 (2013).

    Article  CAS  PubMed  Google Scholar 

  29. Maheshwari, P. & Eslick, G. D. Bacterial infection and Alzheimer’s disease: a meta-analysis. J. Alzheimers Dis. 43, 957–966 (2015).

    Article  PubMed  Google Scholar 

  30. Shindler-Itskovitch, T., Ravona-Springer, R., Leibovitz, A. & Muhsen, K. A systematic review and meta-analysis of the association between Helicobacter pylori infection and dementia. J. Alzheimers Dis. 52, 1431–1442 (2016).

    Article  PubMed  Google Scholar 

  31. Phung, T. K. T. et al. Validity of dementia diagnoses in the Danish hospital registers. Dement. Geriatr. Cogn. Disord. 24, 220–228 (2007).

    Article  PubMed  Google Scholar 

  32. Zakarias, J. K. et al. Geographical variation in the diagnostic rate and quality of dementia diagnoses.J. Alzheimers Dis. 69, 513–520 (2019).

    Article  PubMed  Google Scholar 

  33. Bauer, K., Schwarzkopf, L., Graessel, E. & Holle, R. A claims data-based comparison of comorbidity in individuals with and without dementia. BMC Geriatr. 14, 10 (2014).

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Taudorf, L. et al. Declining incidence of dementia: a national registry-based study over 20 years. Alzheimers Dement. 15, 1383–1391 (2019).

    Article  PubMed  Google Scholar 

  35. National Research Strategy on Dementia 2025 (Danish Health Authority, 2018); https://www.sst.dk/-/media/Udgivelser/2018/National-Research-Strategy-on-Dementia-2025_Final.ashx

  36. Bebe, A. et al. Exploring the concurrent validity of the nationwide assessment of permanent nursing home residence in Denmark—a cross-sectional data analysis using two administrative registries. BMC Health Serv. Res. 17, 607 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  37. Boisen, A. B., Dalager-Pedersen, M., Søgaard, M., Mortensen, R. & Thomsen, R. W. Relationship between death and infections among patients hospitalized in internal medicine departments: a prevalence and validation study. Am. J. Infect. Control 42, 506–510 (2014).

    Article  PubMed  Google Scholar 

  38. Erlangsen, A. & Fedyszyn, I. Danish nationwide registers for public health and health-related research. Scand. J. Public Health 43, 333–339 (2015).

    Article  PubMed  Google Scholar 

  39. Thygesen, L. C., Daasnes, C., Thaulow, I. & Brønnum-Hansen, H. Introduction to Danish (nationwide) registers on health and social issues: structure, access, legislation, and archiving. Scand. J. Public Health 39, 12–16 (2011).

    Article  PubMed  Google Scholar 

  40. Schmidt, M. et al. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin. Epidemiol. 7, 449–490 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  41. Mors, O., Perto, G. P. & Mortensen, P. B. The Danish Psychiatric Central Research Register. Scand. J. Public Health 39, 54–57 (2011).

    Article  PubMed  Google Scholar 

  42. Wallach Kildemoes, H., Toft Sørensen, H. & Hallas, J. The Danish National Prescription Registry. Scand. J. Public Health 39, 38–41 (2011).

    Article  Google Scholar 

  43. Brusselaers, N. & Lagergren, J. The Charlson comorbidity index in registry-based research. Methods Inf. Med. 56, 401–406 (2017).

    Article  PubMed  Google Scholar 

  44. Ribe, A. R. et al. Thirty-day mortality after infection among persons with severe mental illness: a population-based cohort study in Denmark. Am. J. Psychiatry 172, 776–783 (2015).

    Article  PubMed  Google Scholar 

  45. Nielsen, P. R., Benros, M. E. & Mortensen, P. B. Hospital contacts with infection and risk of schizophrenia: a population-based cohort study with linkage of Danish national registers. Schizophr. Bull. 40, 1526–1532 (2014).

    Article  PubMed  Google Scholar 

  46. Data for research. Statistics Denmark https://www.dst.dk/en/TilSalg/Forskningsservice (2020).

Download references

Acknowledgements

The Danish Dementia Research Centre is supported by the Danish Ministry of Health, which was not involved in any phase of this study (design or conduct; collection, management, analysis or interpretation of the data; preparation, review or approval of the manuscript; or decision to submit the manuscript for publication).

Author information

Authors and Affiliations

  1. Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Janet Janbek

  2. Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark

    Niels Frimodt-Møller

  3. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Niels Frimodt-Møller

  4. National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Aarhus, Denmark

    Thomas Munk Laursen

  5. Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Gunhild Waldemar

  6. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark

    Gunhild Waldemar

Authors
  1. Janet Janbek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Niels Frimodt-Møller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Munk Laursen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gunhild Waldemar
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

J.J., G.W. and N.F.-M. conceived of the study concept and performed the literature review. All authors designed the study. J.J. and N.F.-M. prepared and defined the data related to the infection codes. J.J. and T.M.L. performed the statistical analyses. J.J. wrote the manuscript as outlined by J.J. and G.W. All authors contributed equally to data interpretation and critical review of the manuscript.

Corresponding author

Correspondence to Janet Janbek.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Peer review information Nature Aging thanks Louise Allan and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Supplementary Information

Supplementary Methods and Tables 1–10.

Reporting Summary

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Janbek, J., Frimodt-Møller, N., Laursen, T.M. et al. Dementia identified as a risk factor for infection-related hospital contacts in a national, population-based and longitudinal matched-cohort study. Nat Aging 1, 226–233 (2021). https://doi.org/10.1038/s43587-020-00024-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s43587-020-00024-0

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing