Prevalence of Epilepsy and Seizures as a Comorbidity of Neurologic Disorders in Nursing Homes

AK Birnbaum, IE Leppik, K Svendsen, L Eberly. Neurology, 2017; 88: 751-757.

Purpose

There are 30,000 seniors (65 and over) with epilepsy in the United States. It’s hard to identify and treat seizures in older persons because symptoms of seizures may be subtle or mistaken for other problems like lost time, confusion, or other cognitive or neurological problems.

About 1 in 7 Americans are considered seniors and that number will continue to rise.¹ While the majority of seniors live in a non-institutionalized setting, 1.2 million seniors lived in nursing homes in 2015.¹

To help define care needs for seniors, researchers examined the prevalence (how many people affected) of epilepsy, seizures, and other associated problems of seniors in nursing homes. The study also looked at the activity or cognitive status of seniors in nursing homes who live with epilepsy.

Description of the study

• Researchers analyzed a database that included information about residents in Medicare/Medicaid-certified nursing homes in the United States from 2003-2007. Over 91,000 residents with epilepsy/seizures were compared to over 1 million without epilepsy.
• Epilepsy and seizures were identified by a standardized assessment form (called MDS or Minimim Data Set) that is done on all nursing home residents.
• Epilepsy and seizure prevalence was compared to other neurological problems of interest. Comorbidities or other problems examined included stroke, head injury, skull fracture, brain tumor, Alzheimer's disease, dementia, hypertension, diabetes, Parkinson's disease, and multiple sclerosis.

Summary of study findings

• The overall prevalence of epilepsy and seizures in nursing homes was estimated to be 7.8% in this 5-year period. This number is higher than the number of people with epilepsy and seizures living in the community.
• Epilepsy and seizures were 1.5 times higher for men than women (65.5% vs 34.5%).
• Prevalence was 4 times higher in the 65-74-year-old group compared to the 85 and older population. This means that people aged 65 to 74 had higher rates of epilepsy than people age 85 and older.
• Epilepsy/seizures was found more often in black residents of nursing homes than in people of other races.
• Seniors with seizures had slightly lower rates of falls or fractures in the past 180 days and slightly worse measures of function and cognition. They also had a higher number of other medical problems and recent use of other medications.
• Brain tumors had the highest association with epilepsy and seizures, followed by weakness on one side of the body (hemiplegia), and head injury.
• Nursing home residents with stroke have double the odds of developing epilepsy and seizures compared to those without stroke. Individuals with dementia, Alzheimer's disease, Parkinson’s disease, diabetes, hypertension, head injury, skull fracture, and hemiplegia all had higher prevalence of epilepsy compared to individuals without those conditions in the same group.

What does this mean?

• Seniors who have other neurological problems (or the conditions listed in this article) should talk to their health care team about their risks for seizures.
• People who do have seizures should also pay attention to other health problems and make sure these are treated properly. Seizures alone and when other health problems are present can affect one’s function and quality of life in many ways.
• Seniors and their caregivers should learn about types of seizures and contact an epileptologist (a neurologist who specializes in epilepsy) if they believe seizures may be occurring.