DAILY LIFE INDEPENDENCE LEVELS WITH DEMENTIA IS ASSOCIATED WITH THE ONSET OF DEEP VEIN THROMBOSIS IN THE FRAIL ELDERLY

K. Nakanishi¹, T. Kanda², M. Mori¹, Y. Kasamaki³

Background: Deep vein thrombosis (DVT) is the serious complication happens with rehabilitation often. DVT have recently risen rapidly with an increase of the people who need nursing care with dementia in Japan. However, the relevance between DVT and daily life independence levels with dementia remain unknown. Also, no efficient tool to assess the risk of DVT among the elderly has been established.

Purpose: This study aimed to create the risk assessment score for DVT by clarifying the risk factors include daily life independence levels and cognitive impairment in the elderly.

Methods: We recruited 252 patients aged over 65 years (mean: 80.9±7.8 years) who underwent a medical examination at our institution because of suspected DVT. Risk factors for DVT, laboratory data, conventional risk assessment scores (Wells score), and daily life independence levels with dementia (grade 0, no cognitive impairment; grade I, independence at home and community with slight cognitive impairment; grade II, independence by support with some hindrances such as difficulty in communication or problematic behaviors; grade III: nurse-care requirement with difficulty in communicating or problem behaviors; grade IV: regular nursing care required; and grade V: specialized medical care required because of serious mental or physical problem behaviors) were collected from medical records retrospectively. These data ware analyzed to calculate the odds ratios (OR) for the onset of DVT with logistic regressions. We created the new risk assessment score (Himi score) by adjusting the respective OR of factors significantly related to DVT. The discrimination accuracy of Himi score was compared to those of Wells score based on the area under the receiver operating characteristic curve (AUC). A two-sided P-value < 0.05 was considered to indicate statistical significance.

Results: Severe independence levels (grade ≥ II) (OR 10.78), cancer (OR 7.13), D-dimer > 3.0 μg/mL (OR 6.05), paralysis or recent immobilization of leg (OR 5.74), lower limb symptoms of fever and /or pain (OR 2.34) and anticoagulant prescriptions (OR 0.26) were significantly associated with the onset of DVT with multivariate logistic analysis. The Himi score (range: -1 to 9 points) was determined by allocating two points to the independence levels, D-dimer level, active cancer, and paresis or recent immobilization; one point to lower limb symptoms, and -1 point to anticoagulant prescriptions. The ROC curve analysis was documented such that the AUC of Himi score was significantly higher than those of Wells score (AUC: 0.854 vs 0.680; P < 0.01).

Conclusion(s): Daily life independence levels with dementia is the most associated with the onset of DVT in the elderly. The new score include daily life independence levels could be used to assess the risk of DVT efficiently. We need to examine internal and external validation for our findings with subjects from multiple centers and different regions in future studies.

Implications: Our findings could support to prevent and early detect of DVT efficiently and easily, since Himi score show high diagnostic accuracy with a few evaluation items. We expect that improve survival rate, reduce medical expense, and help patients need rehabilitation recover more quickly with spend less time in the hospital.

Funding, acknowledgements: This work was unfunded. We sincerely thank the patients in this study for providing the various medical information. 

Keywords: Deep Vein Thrombosis, Activity of Daily Living, Cognitive Aging

Topic: Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? Yes

Institution: Kanazawa Medical University Himi Municipal Hospital

Committee: Ethics Committee of Kanazawa Medical University Hospital

Ethics number: 59