Abstracts

Rationale: The incidence of epilepsy is highest among older adults; the burden of epilepsy is especially great among frail nursing home (NH) elderly. With an annual US NH census of millions, epidemiological studies are crucial to design care and outcomes interventions. Methods: Using national Minimum Data Set (MDS) data from Centers for Medicare/Medicaid Services (CMS) on ~2.3 million NH residents aged ≥65 years during 2002, we compared the demographics and health characteristics of 143,518 residents with epilepsy to 2,135,066 residents without. Epilepsy was defined by MDS indication of epilepsy/seizure disorder, stratified by indication of a predisposing condition (PDC; stroke, dementia, MS, brain injury/tumor, diabetes, hemiplegia, or hypertension). Results: 130,202 (5.7%) of 2,278,584 NH residents had epilepsy indication with PDC; 13,316 (0.6%) had epilepsy indication with no PDC. Prevalence of epilepsy with PDC was significantly higher for men (6.9%) compared to women (5.3%); for blacks (10.0%), Hispanics (7.6%), and Native Americans (7.9%) compared to whites (5.2%); and for residents ages 65-74 (9.8%) compared to 75-84 (6.2%) and ≥85 (3.7%) years. Similar trends across groups were seen for prevalence of epilepsy without PDC. Activities of daily living (ADL) composite scores (bed mobility, transfer, locomotion, dressing, eating, toileting, and hygiene, scale 0-28; higher scores for worse function) were worse for those with epilepsy and PDC (mean 18.3, SD 8.2), followed by those with PDC but no epilepsy (mean 15.7, SD 8.0), than those with epilepsy but no PDC (mean 14.4, SD 8.3), with best scores seen among those with neither epilepsy nor PDC (mean 13.4, SD 7.4). Similar significant results were seen for cognition, social engagement, and depressive symptom scores. For all four groups (with/without epilepsy by with/without PDC), physical and psychosocial functional scores were generally worse for older residents. For example, among those with PDC but no epilepsy, mean ADL scores were 14.4 (SD 8.1) for those 65-74, 15.4 (SD 7.9) for those 75-84, and 16.4 (SD 7.9) for those aged ≥85 years. These latter scores, averaging 16.4 among the oldest, were better than average ADL scores among the youngest of those with epilepsy and PDC: 17.3 (SD 8.6) for those 65-74, 18.5 (SD 8.1) for those 75-84, and 19.0 (SD 7.8) for those ≥85 years. Conclusions: Physical, cognitive, and psychosocial functional measures were consistently worse for those with epilepsy compared to those without, indicating significant co-morbid burden of epilepsy among NH elderly. Higher prevalences among some racial/ethnic groups may be driven by the correlation of race/ethnicity with several of the epilepsy PDCs (e.g., stroke), or by differential health status trends, or reasons for NH admission, across races/ethnicities. Future work will examine incident epilepsy, after admission and in long-stay residents, and subsequent outcomes during 2003-2007. All authors except DT supported by CDC/ASPH Grant S3822. Findings and conclusions are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.