Abstract
Objective
The point prevalence of epilepsy is high in nursing homes (NH), but the incidence
of epilepsy after admission is unknown. This study was done to determine the incidence
of epilepsy/seizure (epi/sz) comorbid with other conditions in older adult NH residents.
Design
Retrospective evaluation of Minimum Data Set records to identify new onset epi/sz
in NH residents.
Setting and Participants
Five cross-sectional cohorts of all residents in any Medicare/Medicaid certified NH
in the United States on July 15 of each year 2003-2007.
Measures
Epi/sz was identified by International Classification of Diseases, Ninth Revision codes (345.xx or 780.39) or check box on the Minimum Data Set. Those with no such
code on admission and with 1 to 3 plus years of follow-up (n = 3,609,422) were followed
through 2007 or end of stay.
Results
Overall incidence of epi/sz was 16.42/1000 patient years (PY). Incidence was highest
in the first year after admission and declined thereafter. There were more women (n =
2,523,951) than men (n = 1,089,631), but men had a higher incidence (21.17/1000PY)
compared with women (14.81/1000PY). Although the 65‒74 years of age cohort included
fewer residents (n = 594,722) compared with the age 85 years + cohort (n = 1,520,167),
the younger residents had the highest incidence (28.53/1000 PY) compared with the
oldest, 10.22/1000 PY for the age 85+ years cohort. The highest incidences were among
those with brain tumor (122.55/1000PY), followed by head injury (45.66/1000PY). Overall,
714,340 had a diagnosis of stroke, and incidence was 27.52/1000PY. Those with none
of selected risk factors had an overall incidence of 12.45/1000PY.
Conclusions and Implications
The incidence of epi/sz in older individuals after admission to a NH is high. There
is a need to develop practice approaches to best manage this large cohort. There does
not appear to be a uniform approach to managing new onset epilepsy in NHs at this
time. Studies to develop evidence for practice guidelines are needed.
Keywords
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Article info
Publication history
Published online: June 29, 2022
Footnotes
This project was supported by grant number ASPH/CDC #S-382 (LEE, IEL, KS) and the National Institutes of Health 5R01AG026390 (AKB, LEE, IEL) from the National Institute on Aging (NIA). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control, the NIA, or the National Institutes of Health.
Research efforts by Drs. Birnbaum, Eberly, and Leppik were funded in part by NIH/NIA 5R01AG026390; Dr. Eberly, Dr. Leppik, and Mr. Svensden were also funded in part by ASPH/CDC #S-3822. Dr. Leppik has received honoraria for consulting from Sunovion and for speaking from Eisai.
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© 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
ScienceDirect
Access this article on ScienceDirectRelated Podcast
September 28, 2022
September 2022: Person-Centered Care, Trauma Informed Care, New Onset Seizures, and Transitions to Home Care
Host: Karl Steinberg MD, HMDC, CMD; Guests: Philip Sloane MD, MPH; Mallory Brown, MD
Topics: Person-Centered Care, Trauma Informed Care, New Onset Seizures, and Transitions to Home Care
https://mcdn.podbean.com/mf/download/4mjx78/JOTG-2022-09-28_mixdown.mp3
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