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Huang ST, Loh CH, Lin CH, Hsiao FY, Chen LK. Trends in dementia incidence and mortality, and dynamic changes in comorbidity and healthcare utilization from 2004 to 2017: A Taiwan national cohort study. Arch Gerontol Geriatr 2024; 121:105330. [PMID: 38341955 DOI: 10.1016/j.archger.2024.105330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/13/2024]
Abstract
AIMS This study aims to ascertain dementia incidence from 2004 to 2017 in Taiwan, and to examine the disease course in comorbidity, treatments, healthcare usage, and mortality among older people with incident dementia preceding the diagnosis of dementia and afterwards. METHODS Taiwan National Health Insurance data on people aged ≥ 65 years with incident dementia from January 2004 to December 2017 were excerpted to estimate annual incidence rates and annualized percentage changes(APCs). For people diagnosed before 2013, annual mortality rates and causes of death during 5-years' follow-up were determined. Changes in 22 diseases/conditions, hospital visits and admissions, and psychotropic medication prescriptions commonly associated with dementia, were examined from 3 years preceding the index diagnosis until 5 years afterwards. RESULTS From 2004 to 2017, the annual incidence of dementia in Taiwan increased from 30,606 to 50,651, and by > 90 % in women; age-standardized annual incidence increased significantly, with an APC of 0.4 %(p = 0.02). For 372,203 incident cases from 2004 to 2013, annual mortality was∼12 % during 5-years' follow-up. The prevalence of most comorbidities increased by 65-150 % after being diagnosed with dementia. People with incident dementia had increased healthcare usage 1 year before diagnosis, which peaked 1 year afterwards. Psychotropic medication prescriptions increased gradually over 3 years before diagnosis, peaked 3 months afterwards, gradually declined during the next 2 years, then remained stable. CONCLUSION The incidence of dementia in Taiwan has increased gradually over time, with an annual mortality risk of∼12 %. Older people with dementia had more healthcare needs and comorbid conditions after dementia diagnosis, highlighting the exigency of person-centered dementia care.
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Affiliation(s)
- Shih-Tsung Huang
- Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Hui Loh
- Center for Healthy Longevity, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chi-Hung Lin
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fei-Yuan Hsiao
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
| | - Liang-Kung Chen
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan; Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.
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Jacobson M, Ferido P, Zissimopoulos J. Health care utilization before and after a dementia diagnosis in Medicare Advantage versus traditional Medicare. J Am Geriatr Soc 2024; 72:1856-1866. [PMID: 37668467 PMCID: PMC10912367 DOI: 10.1111/jgs.18570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/12/2023] [Accepted: 08/03/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Half of all Medicare beneficiaries are enrolled in Medicare Advantage (MA). Many studies document lower care utilization and mortality in MA than traditional Medicare (TM), but evidence for persons with Alzheimer's disease and related dementias (ADRD) is limited. METHODS We conducted a retrospective cohort study of 2015-2018 Medicare claims and encounter data for community-dwelling beneficiaries aged 65 and over in TM and MA with an incident ADRD diagnosis in 2017. We compared monthly hospitalization rates and outpatient visits 12 months before and after diagnosis and mortality 1 year from diagnosis. Models adjusted for sociodemographic characteristics and comorbidities. Sensitivity analyses addressed residual confounding using a control group with incident arthritis/glaucoma or excluding MA Special Needs Plans, and potential underreporting by restricting to MA plans with high data completeness. RESULTS Among 454,508 beneficiaries diagnosed with ADRD in 2017, 250,837 (55%) were in TM and 203,671 (45%) in MA. Four to 12 months before diagnosis, monthly hospitalizations and outpatient visits were similar in TM and MA. In the diagnosis month, 36.5% of beneficiaries in TM had a hospitalization compared with 25.4% in MA, an adjusted difference of 10.7 percentage points [95% CI: 10.3, 11.1]. Beneficiaries in TM averaged 10.5 outpatient visits in the diagnosis month compared with 8.4 in MA, an adjusted difference of 1.59 visits [95% CI: 1.47-1.70]. Utilization differences narrowed but remained higher in TM for many months. One-year mortality was 27.9% in TM and 22.2% in MA; an adjusted odds ratio of 1.152 [95% CI: 1.135-1.169] for those in TM compared with MA. Controlling for hospitalization in the diagnosis month substantially reduced the mortality difference. CONCLUSION Hospitalization rates and outpatient visits increased more after an ADRD diagnosis in TM than MA. One-year post-diagnosis, mortality was not higher in MA than TM but comparisons of quality of life and caregiver burden are needed.
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Affiliation(s)
- Mireille Jacobson
- Andrus School of Gerontology & Schaeffer Center, University of Southern California
| | - Patricia Ferido
- Price School of Public Policy & Schaeffer Center, University of Southern California
| | - Julie Zissimopoulos
- Price School of Public Policy & Schaeffer Center, University of Southern California
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Xu H, Bayless TM, Østbye T, Dupre ME. Care sequences leading to the diagnosis of Alzheimer's disease and related dementias: An analysis of electronic health records. Alzheimers Dement 2024; 20:2155-2164. [PMID: 38270269 PMCID: PMC10984433 DOI: 10.1002/alz.13669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/24/2023] [Accepted: 12/03/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND We examined the sequences of clinical care leading to diagnoses of Alzheimer's disease and related dementias (ADRD) using electronic health records from a large academic medical center. METHODS We included patients aged 65+ with their first ADRD diagnoses from January 1, 2014 to December 31, 2019. Using state sequence analysis, care sequences were defined by the ordering of healthcare utilizations occurred in the 2 years before ADRD diagnosis. RESULTS Of 3621 patients (median age 80), nearly half followed a care sequence of having one primary care visit close to their ADRD diagnosis. Additional care sequences included periodic (n = 322, 8.9%) and multiple (n = 416, 11.5%) outpatient visits to primary care and having one (n = 395, 10.9%), multiple (n = 469, 13.0%), or highly frequent (n = 357, 10.7%) outpatient visits to other specialties. Patients' sociodemographic traits contributed to the variability in care sequences. CONCLUSIONS Several distinct patterns of care leading to ADRD diagnoses were identified. Integrated care models are needed to promote early identification of ADRD. HIGHLIGHTS Dementia patients followed distinct care pathways prior to their dementia diagnoses. Key sociodemographic traits contributed to the variation in the sequences of care. Racial differences in the sequencing of care were also found, but only in women.
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Affiliation(s)
- Hanzhang Xu
- Department of Family Medicine and Community HealthDuke UniversityDurhamNorth CarolinaUSA
- Duke University School of NursingDuke UniversityDurhamNorth CarolinaUSA
- Center for the Study of Aging and Human DevelopmentDuke UniversityDurhamNorth CarolinaUSA
| | - Teah M. Bayless
- Department of Family Medicine and Community HealthDuke UniversityDurhamNorth CarolinaUSA
| | - Truls Østbye
- Department of Family Medicine and Community HealthDuke UniversityDurhamNorth CarolinaUSA
- Duke University School of NursingDuke UniversityDurhamNorth CarolinaUSA
- Center for the Study of Aging and Human DevelopmentDuke UniversityDurhamNorth CarolinaUSA
| | - Matthew E. Dupre
- Center for the Study of Aging and Human DevelopmentDuke UniversityDurhamNorth CarolinaUSA
- Department of Population Health SciencesDuke UniversityDurhamNorth CarolinaUSA
- Duke Clinical Research InstituteDuke UniversityDurhamNorth CarolinaUSA
- Department of SociologyDuke UniversityDurhamNorth CarolinaUSA
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Couret A, Lapeyre-Mestre M, Gombault-Datzenko E, Renoux A, Villars H, Gardette V. Which factors preceding dementia identification impact future healthcare use trajectories: multilevel analyses in administrative data. BMC Geriatr 2024; 24:89. [PMID: 38263052 PMCID: PMC10807194 DOI: 10.1186/s12877-023-04643-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Healthcare use patterns preceding a diagnosis of Alzheimer's Disease and Related Diseases (ADRD) may be associated with the quality of healthcare use trajectories (HUTs) after diagnosis. We aimed to identify determinants of future favorable HUTs, notably healthcare use preceding ADRD identification. METHODS This nationwide retrospective observational study was conducted on subjects with incident ADRD identified in 2012 in the French health insurance database. We studied the 12-month healthcare use ranging between 18 and 6 months preceding ADRD identification. The five-year HUTs after ADRD identification were qualified by experts as favorable or not. In order to take into account geographical differences in healthcare supply, we performed mixed random effects multilevel multivariable logistic regression model to identify determinants of future favorable HUTs. Analyses were stratified by age group (65-74, 75-84, ≥ 85). RESULTS Being a woman, and preventive and specialist care preceding ADRD identification increased the probability of future favorable HUT, whereas institutionalization, comorbidities, medical transportation and no reimbursed drug during [-18;-6] months decreased it. Besides, some specificities appeared according to age groups. Among the 65-74 years subjects, anxiolytic dispensing preceding ADRD identification decreased the probability of future favorable HUT. In the 75-84 years group, unplanned hospitalization and emergency room visit preceding ADRD identification decreased this probability. Among subjects aged 85 and older, short hospitalization preceding ADRD identification increased the probability of future favorable HUTs. CONCLUSION Regular healthcare use with preventive and specialist care preceding ADRD identification increased the probability of future favorable HUTs whereas dependency decreased it.
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Affiliation(s)
- Anaïs Couret
- Agence Régionale de Santé Occitanie, Toulouse, France.
- Maintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France.
- Faculté de médecine, 37 allées Jules Guesde, Toulouse, 31000, France.
| | - Maryse Lapeyre-Mestre
- Department of Pharmacology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Centre d'Investigation Clinique 1436, Team PEPSS "Pharmacologie En Population cohorteS et biobanqueS", Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France
| | - Eugénie Gombault-Datzenko
- Department of Medical Information (DIM), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Axel Renoux
- Maintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Hélène Villars
- Geriatric Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Virginie Gardette
- Maintain Aging Research team, CERPOP, Université de Toulouse, Université Paul Sabatier, Inserm, Toulouse, France
- Department of Epidemiology and Public Health, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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Chandler JM, Ye W, Mi X, Doty EG, Johnston JA. Potential Impact of Slowing Disease Progression in Early Symptomatic Alzheimer's Disease on Patient Quality of Life, Caregiver Time, and Total Societal Costs: Estimates Based on Findings from GERAS-US Study. J Alzheimers Dis 2024; 100:563-578. [PMID: 38875031 PMCID: PMC11307086 DOI: 10.3233/jad-231166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/16/2024]
Abstract
Background Impact of Alzheimer's disease (AD) progression on patient health-related quality of life (HRQoL), caregiver time, and societal costs is not well characterized in early AD. Objective To assess the association of change in cognition with HRQoL, caregiver time, and societal costs over 36 months, and estimate the impact of slowing disease progression on these outcomes. Methods This post-hoc analysis included patients with amyloid-positive mild cognitive impairment (MCI) and mild AD dementia (MILD AD) from the 36-month GERAS-US study. Disease progression was assessed using the Mini-Mental State Examination score. Change in outcomes associated with slowing AD progression was estimated using coefficients from generalized linear models. Results At baseline, 300 patients had MCI and 317 had MILD AD. Observed natural progression over 36 months was associated with: 5.1 point decline in the Bath Assessment of Subjective Quality of Life in Dementia (BASQID) score (for HRQoL), increase in 1,050 hours of total caregiver time, and $8,504 total societal costs for MCI; 6.6 point decline in the BASQID score, increase in 1,929 hours of total caregiver time, and $12,795 total societal costs for MILD AD per person. Slowing AD progression by 30% could result in per person savings in HRQoL decline, total caregiver time, and total societal costs: for MCI: 1.5 points, 315 hours, and $2,638; for MILD AD: 2.0 points, 579 hours, and $3,974. Conclusions Slowing AD progression over 36 months could slow decline in HRQoL and save caregiver time and societal cost in patients with MCI and MILD AD.
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Affiliation(s)
| | - Wenyu Ye
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Xiaojuan Mi
- TechData Services Company, King of Prussia, PA, USA
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Wu W, Holkeboer KJ, Kolawole TO, Carbone L, Mahmoudi E. Natural language processing to identify social determinants of health in Alzheimer's disease and related dementia from electronic health records. Health Serv Res 2023; 58:1292-1302. [PMID: 37534741 PMCID: PMC10622277 DOI: 10.1111/1475-6773.14210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVE To develop a natural language processing (NLP) algorithm that identifies social determinants of health (SDoH), including housing, transportation, food, and medication insecurities, social isolation, abuse, neglect, or exploitation, and financial difficulties for patients with Alzheimer's disease and related dementias (ADRD) from unstructured electronic health records (EHRs). DATA SOURCES AND STUDY SETTING We leveraged 1000 medical notes randomly selected from 7401 emergency department and inpatient social worker notes generated between 2015 and 2019 for 231 unique patients diagnosed with ADRD at Michigan Medicine. STUDY DESIGN We developed a rule-based NLP algorithm for the identification of seven domains of SDoH noted above. We also compared the rule-based algorithm with deep learning and regularized logistic regression approaches. These models were compared using accuracy, sensitivity, specificity, F1 score, and the area under the receiver operating characteristic curve (AUC). All notes were split into 700 notes for training NLP algorithms, and 300 notes for validation. DATA COLLECTION/EXTRACTION METHODS Social worker notes used in this study were extracted from the Michigan Medicine EHR database. PRINCIPAL FINDINGS Of the 700 notes for training, F1 and AUC for the rule-based algorithm were at least 0.94 and 0.95, respectively, for all SDoH categories. Of the 300 notes for validation, F1 and AUC were at least 0.80 and 0.97, respectively, for all SDoH except housing and medication insecurities. The deep learning and regularized logistic regression algorithms had unsatisfactory performance. CONCLUSIONS The rule-based algorithm can accurately extract SDoH information in all seven domains of SDoH except housing and medication insecurities. Findings from the algorithm can be used by clinicians and social workers to proactively address social needs of patients with ADRD and other vulnerable patient populations.
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Affiliation(s)
- Wenbo Wu
- Departments of Population Health and Medicine, Grossman School of MedicineNew York UniversityNew York CityNew YorkUSA
- Center for Data ScienceNew York UniversityNew York CityNew YorkUSA
- Department of Family MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Kaes J. Holkeboer
- Department of Family MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- College of Literature, Science, and the ArtsUniversity of MichiganAnn ArborMichiganUSA
| | - Temidun O. Kolawole
- Krieger School of Arts and SciencesJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Lorrie Carbone
- Department of Family MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Elham Mahmoudi
- Department of Family MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborMichiganUSA
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Damsgaard L, Janbek J, Laursen TM, Waldemar G, Jensen-Dahm C. Healthcare utilization prior to a diagnosis of young-onset Alzheimer's disease: a nationwide nested case-control study. J Neurol 2023; 270:6093-6102. [PMID: 37668703 PMCID: PMC10632232 DOI: 10.1007/s00415-023-11974-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE Our aim was to identify changes in healthcare utilization prior to a young-onset Alzheimer's disease diagnosis. METHODS In a retrospective incidence density matched nested case-control study using national health registers, we examined healthcare utilization for those diagnosed with young-onset Alzheimer's disease in Danish memory clinics during 2016-2018 compared with age- and sex-matched controls. Negative binomial regression analysis produced contact rate ratios. RESULTS The study included 1082 young-onset Alzheimer's disease patients and 3246 controls. In the year preceding diagnosis, we found increased contact rate ratios for all types of contacts except physiotherapy. Contact rate ratios for contacts with a general practitioner were significantly increased also > 1-5 and > 5-10 years before diagnosis. The highest contact rate ratios were for psychiatric emergency contacts (8.69, 95% CI 4.29-17.62) ≤ 1 year before diagnosis. INTERPRETATION Results demonstrate that young-onset Alzheimer's disease patients have increased healthcare utilization from 5 to 10 years prior to diagnosis. Awareness of specific alterations in health-seeking behaviour may help healthcare professionals provide timely diagnoses.
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Affiliation(s)
- Line Damsgaard
- Department of Neurology, Danish Dementia Research Centre, Section 8008, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Janet Janbek
- Department of Neurology, Danish Dementia Research Centre, Section 8008, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Thomas Munk Laursen
- Department of Economics and Business Economics, National Centre for Register-based Research, Aarhus BSS, Aarhus University, Fuglesangs Allé 26-Building R, 8210, Aarhus V, Denmark
| | - Gunhild Waldemar
- Department of Neurology, Danish Dementia Research Centre, Section 8008, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Christina Jensen-Dahm
- Department of Neurology, Danish Dementia Research Centre, Section 8008, Copenhagen University Hospital-Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Lin Z, Chen X. The Long-Term Impacts of Dementia on Preventive Care Utilization and Health Behaviors. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.24.23297477. [PMID: 37961188 PMCID: PMC10635193 DOI: 10.1101/2023.10.24.23297477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Dementia has large impact on individuals' decision making, independent living, and wellbeing. Identifying early signals of dementia risk may offer people more time to prepare for the future, helping to delay the onset or slow the progression of dementia. Using the 1995-2018 waves of Health and Retirement Study, we offer novel evidence on the impacts of dementia on a rich set of preventive care utilization and health behaviors. Leveraging both within- and between-individual variations in an event study design, we characterize long-term dynamic changes in preventive care and health behaviors relative to the incidence of dementia and find early behavioral indicators of the disorder. We show that relative to the group of people who never develop dementia during the study periods, people with dementia have consistent and escalating declines in the use of cholesterol test, dental visit, prostate test and mammogram around the incidence of dementia. Significant declines are also found in physical activities and social engagement. Importantly, we demonstrate that the behavioral changes can occur up to 6 years before the incidence of dementia; and these patterns are absent in other chronic or acute conditions. The results are robust to sample selection, model specification, and the further control of aging and cohort effects. Overall, our findings highlight the salient impact of dementia risk on preventive care utilization and health behaviors, which may increase individuals' vulnerability to health shocks. Detecting early signals of dementia and facilitating targeted interventions are thus called for to prevent individuals from adverse behavioral and health consequences.
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Affiliation(s)
- Zhuoer Lin
- Department of Health Policy and Management, Yale School of Public Health
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health
- Department of Economics, Yale University
- Alzheimer's Disease Research Center, Yale University
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Dinesh D, Shao Q, Palnati M, McDannold S, Zhang Q, Monfared AAT, Jasuja GK, Davila H, Xia W, Moo LR, Miller DR, Palacios N. The epidemiology of mild cognitive impairment, Alzheimer's disease and related dementia in U.S. veterans. Alzheimers Dement 2023; 19:3977-3984. [PMID: 37114952 DOI: 10.1002/alz.13071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/25/2022] [Accepted: 11/10/2022] [Indexed: 04/29/2023]
Abstract
INTRODUCTION US veterans have a unique dementia risk profile that may be evolving over time. METHODS Age-standardized incidence and prevalence of Alzheimer's disease (AD), AD and related dementias (ADRD), and mild cognitive impairment (MCI) was estimated from electronic health records (EHR) data for all veterans aged 50 years and older receiving Veterans Health Administration (VHA) care from 2000 to 2019. RESULTS The annual prevalence and incidence of AD declined, as did ADRD incidence. ADRD prevalence increased from 1.07% in 2000 to 1.50% in 2019, primarily due to an increase in the prevalence of dementia not otherwise specified. The prevalence and incidence of MCI increased sharply, especially after 2010. The prevalence and incidence of AD, ADRD, and MCI were highest in the oldest veterans, in female veterans, and in African American and Hispanic veterans. DISCUSSION We observed 20-year trends of declining prevalence and incidence of AD, increasing prevalence of ADRD, and sharply increasing prevalence and incidence of MCI.
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Affiliation(s)
- Deepika Dinesh
- Department of Public Health, University of Massachusetts at Lowell, Zuckerberg College of Health Sciences, Lowell, Massachusetts, USA
- Center for Population Health, Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell, Massachusetts, USA
| | - Qing Shao
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
| | - Madhuri Palnati
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
| | - Sarah McDannold
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
| | - Quanwu Zhang
- Easai Inc., Neurology Business Group, Woodcliff Lake, New Jersey, USA
| | - Amir Abbas Tahami Monfared
- Easai Inc., Neurology Business Group, Woodcliff Lake, New Jersey, USA
- McGill University, Epidemiology, Biostatistics, and Occupational Health, Montreal, Quebec, Canada
| | - Guneet K Jasuja
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Heather Davila
- Center for Access & Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa, USA
- General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Weiming Xia
- Bedford VA Healthcare System, Geriatric Research and Education Clinical Center, Bedford, Massachusetts, USA
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lauren R Moo
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
- Bedford VA Healthcare System, Geriatric Research and Education Clinical Center, Bedford, Massachusetts, USA
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Donald R Miller
- Center for Population Health, Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell, Massachusetts, USA
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
| | - Natalia Palacios
- Department of Public Health, University of Massachusetts at Lowell, Zuckerberg College of Health Sciences, Lowell, Massachusetts, USA
- Center for Population Health, Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell, Massachusetts, USA
- Bedford VA Healthcare System, Geriatric Research and Education Clinical Center, Bedford, Massachusetts, USA
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Ruiz-Adame M, Ibañez A, Mollayeva T, Trépel D. Association Between Neuroticism and Dementia on Healthcare Use: A Multi-Level Analysis Across 27 Countries from The Survey of Health, Ageing and Retirement in Europe (SHARE). J Alzheimers Dis 2023; 95:181-193. [PMID: 37482998 PMCID: PMC11194739 DOI: 10.3233/jad-230265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND People with high levels of neuroticism are greater users of health services. Similarly, people with dementia have a higher risk of hospitalization and medical visits. As a result, dementia and a high level of neuroticism increase healthcare use (HCU). However, how these joint factors impact the HCU at the population level is unknown. Similarly, no previous study has assessed the degree of generalization of such impacts, considering relevant variables including age, gender, socioeconomic, and country-level variability. OBJECTIVE To examine how neuroticism and dementia interact in the HCU. METHODS A cross-sectional study was performed on a sample of 76,561 people (2.4% with dementia) from 27 European countries and Israel. Data were analyzed with six steps multilevel non-binomial regression modeling, a statistical method that accounts for correlation in the data taken within the same participant. RESULTS Both dementia (Incidence Rate Ratio (IRR): 1.537; α= 0.000) and neuroticism (IRR: 1.122; α= 0.000) increased the HCU. The effect of having dementia and the level of neuroticism increased the HCU: around 53.67% for the case of having dementia, and 12.05% for each increment in the level of neuroticism. Conversely, high levels of neuroticism in dementia decreased HCU (IRR: 0.962; α= 0.073). These results remained robust when controlling for age, gender, socioeconomic, and country-levels effects. CONCLUSION Contrary to previous findings, neuroticism trait in people with dementia decreases the HCU across sociodemographic, socioeconomic, and country heterogeneity. These results, which take into account this personality trait among people with dementia, are relevant for the planning of health and social services.
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Affiliation(s)
- Manuel Ruiz-Adame
- Applied Economic Department, University of Granada, Campus of Melilla, Melilla, Spain
- Trépel Laboratory, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Agustín Ibañez
- Latin American Brain Health Institute, Universidad Adolfo Ibanez, Santiago, Chile
- Cognitive Neuroscience Center & CONICET, Universidad de San Andres, Buenos Aires, Argentina
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
- Predictive Brain Health Modelling, Trinity College Dublin, Dublin, Ireland
| | - Tatyana Mollayeva
- Dalla Lana School of Public Health, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- KITE Research Institute, Toronto Rehab, University Health Network, Toronto, Canada
- Global Brain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland
| | - Dominic Trépel
- Trépel Laboratory, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
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Lutski M, Shahar R, Vered S, Novick D, Zucker I, Weinstein G. Hospitalizations in older-adults newly diagnosed with dementia: A population-based longitudinal study in Israel. Int J Geriatr Psychiatry 2023; 38:e5871. [PMID: 36683135 PMCID: PMC10108175 DOI: 10.1002/gps.5871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To compare inpatient burden (i.e. likelihood of hospitalization, number of admissions and length of stay) in persons with newly diagnosed dementia to the general population without dementia. Additionally, to evaluate whether inpatient burden is increased during the years prior to and post dementia diagnosis, and to identify factors associated with increased inpatient burden. METHOD The Israeli National Dementia Dataset (2016) was cross-linked with the National Hospital Discharge Database of the Israeli Ministry of Health (2014-2018). Dementia definition was based on documented dementia diagnoses and/or the purchase of medications during 2016. Mixed-effects models were applied to identify demographic and health characteristics associated with inpatient burden in the one and 2 years prior to and after dementia diagnosis. RESULTS The dataset included 11,625 individuals aged ≥65 years, identified as incident dementia cases. Compared to the general population of older-adults without dementia, those with newly diagnosed dementia had a higher age-standardized proportion of hospitalizations (26.4% vs. 40%). The odds for hospitalization were highest during the year preceding dementia diagnosis (OR = 3.19, 95% CI 2.51-4.06) compared to 2 years prior to diagnosis, and remained high (although slightly decreased) after dementia diagnosis. Older age was associated with inpatient burden after, but not prior to dementia diagnosis. CONCLUSIONS Older persons with dementia are a vulnerable population group with increased utilization of inpatient burden compared to those without dementia, particularly in the years surrounding dementia diagnosis. Sociodemographic risk factors may differ with respect to the time surrounding dementia diagnosis.
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Affiliation(s)
- Miri Lutski
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel.,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Rotem Shahar
- School of Public Health, University of Haifa, Haifa, Israel
| | - Shiraz Vered
- School of Public Health, University of Haifa, Haifa, Israel
| | - Deborah Novick
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Inbar Zucker
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel.,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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12
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Couret A, Lapeyre-Mestre M, Gombault-Datzenko E, Renoux A, Villars H, Gardette V. Healthcare use patterns before Alzheimer's disease and related diseases identification and future healthcare trajectory. Int J Geriatr Psychiatry 2023; 38:e5849. [PMID: 36457190 DOI: 10.1002/gps.5849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES A frequent late Alzheimer's Disease and Related Diseases (ADRD) identification is described and may induce erratic health resource use. We aimed to describe healthcare use patterns preceding ADRD identification. METHODS We studied persons aged 65 or older, identified with incident ADRD in 2012 in the French health insurance database. Healthcare use covering a wide range of care in ambulatory and hospital settings during the period ranging from 18 to six months before ADRD identification was studied. The main dimensions of healthcare use patterns before ADRD identification were investigated in three age groups (65-74, 75-84, ≥85) through a multiple correspondence analysis. These dimensions were secondarily interpreted according to the 5-year healthcare trajectory following ADRD identification, qualified as favorable (or not) by experts in the field. RESULTS This research studied 36,990 subjects. Four dimensions raised in each age group. Two dimensions' interpretations were retrieved in all age groups: intensity of healthcare use, functional dependency. However, their rank differed along with the qualification of the future healthcare trajectory. Some specificities appeared in some age group. In the 65-74 and 75-84 years groups, there were dimensions reflecting healthcare use related to psychiatric or psycho-behavioral disorders. In the ≥85 group, two dimensions reflected dependency related to other comorbidities, and organised medical follow-up. CONCLUSION Several dimensions emerged in line with erratic trajectories before ADRD identification. They underlined the need for actions towards ADRD identification.
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Affiliation(s)
- Anaïs Couret
- Agence Régionale de Santé Occitanie, Toulouse, France.,Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Maryse Lapeyre-Mestre
- Department of Pharmacology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Centre D'Investigation Clinique 1436, Team PEPSS "Pharmacologie En Population CohorteS et BiobanqueS", Centre Hospitalier Universitaire de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Eugénie Gombault-Datzenko
- Department of Medical Information (DIM), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Axel Renoux
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Hélène Villars
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France.,Geriatric Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Virginie Gardette
- Maintain Aging Research Team, CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France.,Department of Epidemiology and Public Health, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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13
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Chao YH, Huang WY, Tang CH, Pan YA, Chiou JY, Ku LJE, Wei JCC. Effects of continuity of care on hospitalizations and healthcare costs in older adults with dementia. BMC Geriatr 2022; 22:724. [PMID: 36056303 PMCID: PMC9438333 DOI: 10.1186/s12877-022-03407-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/25/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION People with dementia have high rates of hospitalization, and a share of these hospitalizations might be avoidable with appropriate ambulatory care, also known as potentially preventable hospitalization (PAH). This study investigates the associations between continuity of care and healthcare outcomes in the following year, including all-cause hospitalization, PAHs, and healthcare costs in patients with dementia. METHODS This is a longitudinal retrospective cohort study of 69,658 patients with dementia obtained from the Taiwan National Health Insurance Research Database. The Continuity of Care Index (COCI) was calculated to measure the continuity of dementia-related visits across physicians. The PAHs were classified into five types as defined by the Medicare Ambulatory Care Indicators for the Elderly (MACIEs). Logistic regression models were used to examine the effect of COCI on all-cause hospitalizations and PAHs, while generalized linear models were used to analyze the effect of COCI on outpatient, hospitalization, and total healthcare costs. RESULTS The high COCI group was significantly associated with a lower likelihood of all-cause hospitalization than the low COCI group (OR = 0.848, 95%CI: 0.821-0.875). The COCI had no significant effect on PAHs but was associated with lower outpatient costs (exp(β) = 0.960, 95%CI: 0.941 ~ 0.979), hospitalization costs (exp(β) = 0.663, 95%CI: 0.614 ~ 0.717), total healthcare costs (exp(β) = 0.962, 95%CI: 0.945-0.980). CONCLUSION Improving continuity of care for dementia-related outpatient visits is recommended to reduce hospitalization and healthcare costs, although there was no statistically significant effect of continuity of care found on PAHs.
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Affiliation(s)
- Yung-Hsiang Chao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Wen-Yen Huang
- Department of Public Health, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan
| | - Chia-Hong Tang
- Department of Public Health, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan
- Department of Psychiatric, Tainan Hospital, Ministry of Health and Welfare, Tainan City, Taiwan
| | - Yu-An Pan
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jeng-Yuan Chiou
- School of Health Policy and Management, Chung Shan Medical University, Taichung, Taiwan
| | - Li-Jung Elizabeth Ku
- Department of Public Health, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- Department of Allergy, Immunology & Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
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14
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Buta B, Friedman AB, Chung SE, Sheehan OC, Blinka MD, Gearhart SL, Xue QL. The combined effects of physical frailty and cognitive impairment on emergency department- versus direct-admission hospitalizations. BMC Geriatr 2022; 22:718. [PMID: 36042414 PMCID: PMC9429704 DOI: 10.1186/s12877-022-03397-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We aimed to study whether physical frailty and cognitive impairment (CI) increase the risk of recurrent hospitalizations in older adults, independent of comorbidity, and disability. METHODS Two thousand five hundred forty-nine community-dwelling participants from the National Health and Aging Trends Study (NHATS) with 3 + years of continuous Medicare coverage from linked claims data were included. We used the marginal means/rates recurrent events model to investigate the association of baseline CI (mild CI or dementia) and physical frailty, separately and synergistically, with the number of all-source vs. Emergency Department (ED)-admission vs. direct admission hospitalizations over 2 years. RESULTS 17.8% of participants had at least one ED-admission hospitalization; 12.7% had at least one direct admission hospitalization. Frailty and CI, modeled separately, were both significantly associated with risk of recurrent all-source (Rate Ratio (RR) = 1.24 for frailty, 1.21 for CI; p < .05) and ED-admission (RR = 1.49 for frailty, 1.41 for CI; p < .05) hospitalizations but not direct admission, adjusting for socio-demographics, obesity, comorbidity and disability. When CI and frailty were examined together, 64.3% had neither (Unimpaired); 28.1% CI only; 3.5% Frailty only; 4.1% CI + Frailty. Compared to those Unimpaired, CI alone and CI + Frailty were predictive of all-source (RR = 1.20, 1.48, p < .05) and ED-admission (RR = 1.36, 2.14, p < .05) hospitalizations, but not direct admission, in our adjusted model. CONCLUSIONS Older adults with both CI and frailty experienced the highest risk for recurrent ED-admission hospitalizations. Timely recognition of older adults with CI and frailty is needed, paying special attention to managing cognitive impairment to mitigate preventable causes of ED admissions and potentiate alternatives to hospitalization.
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Affiliation(s)
- Brian Buta
- Department of Medicine Division of Geriatric Medicine and Gerontology, Center On Aging and Health, Johns Hopkins University, 2024 E. Monument Street, Suite 2-700, Baltimore, MD, 21205, USA
| | - Ari B Friedman
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, PA, Philadelphia, USA
| | - Shang-En Chung
- Department of Medicine Division of Geriatric Medicine and Gerontology, Center On Aging and Health, Johns Hopkins University, 2024 E. Monument Street, Suite 2-700, Baltimore, MD, 21205, USA
| | - Orla C Sheehan
- Department of Medicine Division of Geriatric Medicine and Gerontology, Center On Aging and Health, Johns Hopkins University, 2024 E. Monument Street, Suite 2-700, Baltimore, MD, 21205, USA
- Connolly Hospital Blanchardstown, Dublin, Ireland
| | - Marcela D Blinka
- Department of Medicine Division of Geriatric Medicine and Gerontology, Center On Aging and Health, Johns Hopkins University, 2024 E. Monument Street, Suite 2-700, Baltimore, MD, 21205, USA
| | - Susan L Gearhart
- Department of Medicine Division of Geriatric Medicine and Gerontology, Center On Aging and Health, Johns Hopkins University, 2024 E. Monument Street, Suite 2-700, Baltimore, MD, 21205, USA
| | - Qian-Li Xue
- Department of Medicine Division of Geriatric Medicine and Gerontology, Center On Aging and Health, Johns Hopkins University, 2024 E. Monument Street, Suite 2-700, Baltimore, MD, 21205, USA.
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15
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Desai U, Chandler J, Kirson N, Georgieva M, Cheung HC, Westermeyer B, Lane H, Biglan K. Epidemiology and economic burden of Lewy body dementia in the United States. Curr Med Res Opin 2022; 38:1177-1188. [PMID: 35442134 DOI: 10.1080/03007995.2022.2059978] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the trends in epidemiology, healthcare resource use (HCRU), and costs associated with Lewy body dementia (LBD), dementia with Lewy bodies (DLB), and Parkinson's disease dementia (PDD) in the United States. METHODS This retrospective study used administrative claims data for Medicare fee-for-service (2010-2018) and commercially-insured beneficiaries (2010-2017). The annual prevalence and incidence were calculated among the Medicare beneficiaries by dividing the number of prevalent or incident LBD, DLB, and PDD patients by the total eligible population of that calendar year. Baseline patient characteristics, HCRU, and costs over time were described for Medicare and commercially insured patients with continuous health plan enrollment for ≥12 months before and ≥24 months after first cognitive impairment (CI) diagnosis. RESULTS From 2010 to 2016, the incidence and prevalence rates of LBD among Medicare beneficiaries ranged from 0.21%-0.18% and 0.90%-0.83%, respectively. Of 9019 Medicare patients with LBD who met other inclusion criteria, 4796 (53.2%) had DLB and 4223 (46.8%) had PDD. The mean age was 78 years and the mean Charlson Comorbidity Index score was 1.6. On average, patients with LBD incurred $18,309 in medical costs during the 1-year pre-diagnosis and $29,174 and $22,814 at years 1 and 5 after diagnosis, respectively. The main cost drivers were inpatient and outpatient visits. Similar trends were observed for DLB and PDD as well as for commercially-insured patients. CONCLUSIONS Our findings highlight the substantial epidemiological and economic burden across the LBD spectrum and underscore a high unmet need for effective treatments to improve patient outcomes.
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Affiliation(s)
- Urvi Desai
- Analysis Group, Inc, Boston, Massachusetts, USA
| | | | - Noam Kirson
- Analysis Group, Inc, Boston, Massachusetts, USA
| | | | | | | | - Henry Lane
- Analysis Group, Inc, Boston, Massachusetts, USA
| | - Kevin Biglan
- Eli Lilly and Company, Indianapolis, Indiana, USA
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16
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Sensing Alzheimer’s Disease Utilizing Au Electrode by Controlling Nanorestructuring. CHEMOSENSORS 2022. [DOI: 10.3390/chemosensors10030094] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This paper reports the development of Alzheimer’s disease (AD) sensor through early detection of amyloid-beta (Aβ) (1–42) using simple nanorestructuring of Au sheet plate by oxidation-reduction cycle (ORC) via the electrochemical system. The topology of Au substrates was enhanced through the roughening and Au grains grown by a simple ORC technique in aqueous solutions containing 0.1 mol/L KCl electrolytes. The roughened substrate was then functionalized with the highly specific antibody β-amyloid Aβ (1–28) through HS-PEG-NHS modification, which enabled effective and direct detection of Aβ (1–42) peptide. The efficacy of the ORC method had been exhibited in the polished Au surface by approximately 15% larger electro-active sites compared to the polished Au without ORC. The ORC polished structure demonstrated a rapid, accurate, precise, reproducible, and highly sensitive detection of Aβ (1–42) peptide with a low detection limit of 10.4 fg/mL and a wide linear range of 10−2 to 106 pg/mL. The proposed structure had been proven to have potential as an early-stage Alzheimer’s disease (AD) detection platform with low-cost fabrication and ease of operation.
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17
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Tahami Monfared AA, Byrnes MJ, White LA, Zhang Q. The Humanistic and Economic Burden of Alzheimer's Disease. Neurol Ther 2022; 11:525-551. [PMID: 35192176 PMCID: PMC9095804 DOI: 10.1007/s40120-022-00335-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/03/2022] [Indexed: 02/07/2023] Open
Abstract
Alzheimer's disease (AD) is the leading cause of cognitive impairment and dementia in older individuals (aged ≥ 65 years) throughout the world. As a result of these progressive deficits in cognitive, emotional, and physical function, AD dementia can cause functional disability and loss of independence. To gain a deeper understanding of the recent literature on the burden of AD, including that of mild cognitive impairment (MCI) due to AD, we conducted a comprehensive targeted review of the PubMed-indexed literature (2014 to 2021) to examine the humanistic and economic burden of AD (including MCI) in North America, Europe, and Asia. Our literature review identified a range of factors associated with quality of life (QoL): some factors were positively associated with QoL, including caregiver relationship, religiosity, social engagement, and ability to engage in activities of daily living (ADL), whereas other factors such as neuropsychiatric symptoms were associated with poorer QoL. While patient- and proxy-rated QoL are highly correlated in patients with early AD dementia, proxy-rated QoL declines more substantially as severity worsens. The maintenance of self-reported QoL in patients with more severe AD dementia may be due to lack of awareness or to adaptation to circumstances. Compared to persons with normal cognition, MCI is associated with a greater cost burden, and individuals with MCI exhibit worse QoL. Key drivers of the societal economic burden of AD include disease severity, dependence level, institutionalization, and comorbidity burden. Evaluation of the impact of a hypothetical disease-modifying treatment delaying the progression from MCI to AD has suggested that such a treatment may result in cost savings.
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Affiliation(s)
- Amir Abbas Tahami Monfared
- Eisai, 200 Metro Blvd, Nutley, NJ, 07110, USA. .,McGill University, Epidemiology, Biostatistics and Occupational Health, Montreal, QC, Canada.
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18
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Disparities in diabetes-related avoidable hospitalization among diabetes patients with disability using a nationwide cohort study. Sci Rep 2022; 12:1794. [PMID: 35110602 PMCID: PMC8810810 DOI: 10.1038/s41598-022-05557-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/11/2022] [Indexed: 12/20/2022] Open
Abstract
Diabetes is an ambulatory care sensitive condition that quality of care can prevent complications development and hospitalization needs. However, diabetes patients with disability face greater challenges with receiving quality diabetes care than those without disabilities. This study examined diabetes-related avoidable hospitalizations (DRAH) focusing on the association with disability. We used nationally representative health insurance cohort data from 2002 to 2013. The study population is people who were newly diagnosed with type 2 diabetes. We measured the cumulated number of DRAH using the Prevention Quality Indicators (PQIs). The variables of interest were disability severity and type. We performed a recurrent events analysis using Cox proportional hazard regression model. Among 49,410 type 2 diabetes patients, 12,231 (24.8%) experienced DRAHs at least once during the follow-up period. Among the total population, 5924 (12.0%) diabetes patients were registered as disabled. The findings report that disability severity was significantly associated with higher risks for DRAH, where severely disabled diabetes patients showed the highest hazard ratio of 2.24 (95% CI 1.80-2.79). Among three DRAH indicators, severely disabled diabetes patients showed increased risks for long-term (AHR 2.21, 95% CI 1.89-2.60) and uncontrolled (AHR 2.28, 95% CI 1.80-2.88) DRAH. In addition, intellectual (AHR 5.52, 95% CI 3.78-8.05) and mental (AHR 3.97, 95% CI 2.29-6.89) disability showed higher risks than other types of disability. In conclusion, diabetes patients with disability are at higher risk for DRAH compared to those without disabilities, and those with intellectual and mental disabilities were more likely to experience DRAH compared to those with physical or other types of disability. These findings call for action to find the more appropriate interventions to improve targeted diabetes primary care for patients with disability. Further research is needed to better understand determinants of increasing risks of DRAH.
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19
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Amjad H, Samus QM, Huang J, Gundavarpu S, Bynum JPW, Wolff J, Roth DL. Acute care utilization risk among older adults living undiagnosed or unaware of dementia. J Am Geriatr Soc 2022; 70:470-480. [PMID: 34773706 PMCID: PMC8821204 DOI: 10.1111/jgs.17550] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/07/2021] [Accepted: 10/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Dementia is associated with increased risk of hospitalization and emergency department (ED) visits. Many persons with dementia are undiagnosed or unaware of their diagnosis, however. Our objective was to determine whether undiagnosed dementia or unawareness affects risk of hospitalization or ED visits. METHODS Retrospective longitudinal cohort study of 3537 community-living adults age ≥65 enrolled in the 2011-2017 National Health and Aging Trends Study with linked fee-for-service Medicare claims. Using self or proxy reported diagnosis, proxy dementia screening questionnaire, cognitive testing, and Medicare claims diagnosis, participants were classified as having (1) no dementia or dementia, for which they were classified as (2) undiagnosed, (3) diagnosed but unaware, or (4) diagnosed and aware. Proportional hazards models evaluated all-cause and potentially preventable hospitalization and ED visit risk by time-varying dementia status, adjusting for older adult characteristics. RESULTS Most participants (n = 2879) had no dementia at baseline. Among participants with dementia at baseline (n = 658), 187 were undiagnosed, 300 diagnosed but unaware, and 171 diagnosed and aware. In multivariable adjusted proportional hazards models, persons with undiagnosed dementia had lower risk of hospitalization and ED visits compared to persons diagnosed and aware (all-cause hospitalization aHR 0.59 [0.44, 0.79] and ED visit aHR 0.63 [0.47, 0.85]) and similar risks of these outcomes compared to persons without dementia. Individuals diagnosed but unaware had greater risk compared to those without dementia: aHR 1.37 (1.18, 1.59) for all-cause hospitalization and 1.48 (1.28, 1.71) for ED visits; they experienced risk comparable to individuals diagnosed and aware. CONCLUSION Older adults with undiagnosed dementia are not at increased risk of acute care utilization after accounting for differences in other characteristics. Individuals unaware of diagnosed dementia demonstrate risk similar to individuals aware of the diagnosis. Increasing diagnosis alone may not affect acute care utilization. The role of awareness warrants further investigation.
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Affiliation(s)
- Halima Amjad
- Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology, Baltimore, MD,Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | - Quincy M. Samus
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD
| | - Jin Huang
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | | | - Julie PW Bynum
- University of Michigan Medical School, Division of Geriatric & Palliative Medicine, Ann Arbor, MI
| | - Jennifer Wolff
- Johns Hopkins University Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD
| | - David L. Roth
- Johns Hopkins University School of Medicine, Division of Geriatric Medicine and Gerontology, Baltimore, MD,Center on Aging and Health, Johns Hopkins University, Baltimore, MD
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20
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Chandler JM, Nair R, Biglan K, Ferries EA, Munsie LM, Changamire T, Patel N. Characteristics of Parkinson's Disease in Patients with and without Cognitive Impairment. JOURNAL OF PARKINSONS DISEASE 2021; 11:1381-1392. [PMID: 33720850 PMCID: PMC8461668 DOI: 10.3233/jpd-202190] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Characterizing patients with Parkinson’s disease (PD) and cognitive impairment is important toward understanding their natural history. Objective: Understand clinical, treatment, and cost characteristics of patients with PD pre- and post-cognitive impairment (memory loss/mild cognitive impairment/dementia or dementia treatment) recognition. Methods: 2,711 patients with PD newly diagnosed with cognitive impairment (index) were identified using administrative claims data. They were matched (1:1) on age and gender to patients with PD and no cognitive impairment (controls). These two cohorts were compared on patient characteristics, healthcare resource utilization, and total median costs for 3 years pre- and post-index using Chi-square tests, t-tests, and Wilcoxon rank-sum tests. Logistic regression was used to identify factors predicting cognitive impairment. Results: Comorbidity indices for patients with cognitive impairment increased during the 6-year study period, especially after the index. Enrollment in Medicare Advantage Prescription Drug plans vs. commercial (OR = 1.60), dual Medicare/Medicaid eligibility (OR = 1.36), cerebrovascular disease (OR = 1.24), and PD medication use (OR = 1.46) were associated with a new cognitive impairment diagnosis (all p < 0.05). A greater proportion of patients with cognitive impairment had hospitalizations and emergency department visits and higher median total healthcare costs than controls for each year pre- and post-index. Conclusion: In patients with PD newly diagnosed with cognitive impairment, comorbidity burden, hospitalizations, emergency department visits, and total costs peaked 1-year pre- and post-identification. These data coupled with recommendations for annual screening for cognitive impairment in PD support the early diagnosis and management of cognitive impairment in order to optimize care for patients and their caregivers.
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Affiliation(s)
| | - Radhika Nair
- Humana Healthcare Research, Inc., Louisville, KY, USA
| | | | | | | | | | - Nick Patel
- Humana Healthcare Research, Inc., Louisville, KY, USA
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21
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Chen J, Benjenk I, Barath D, Anderson AC, Reynolds CF. Disparities in Preventable Hospitalization Among Patients With Alzheimer Diseases. Am J Prev Med 2021; 60:595-604. [PMID: 33832801 PMCID: PMC8068589 DOI: 10.1016/j.amepre.2020.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/11/2020] [Accepted: 12/08/2020] [Indexed: 11/21/2022]
Abstract
INTRODUCTION System-level care coordination strategies can be the most effective to promote continuity of care among people with Alzheimer's disease; however, the evidence is lacking. The objective of this study is to determine whether accountable care organizations are associated with lower rates of potentially preventable hospitalizations for people with Alzheimer's disease and whether hospital accountable care organization affiliation is associated with reduced racial and ethnic disparities in preventable hospitalizations among patients with Alzheimer's disease. METHODS This study employed a cross-sectional study design and used 2015 Healthcare Cost and Utilization Project inpatient claims data from 11 states and the 2015 American Hospital Association Annual Survey. Logistic regression and the Blinder-Oaxaca decomposition method were used. RESULTS African American patients with Alzheimer's disease were less likely to be hospitalized at accountable care organization‒affiliated hospitals than White patients. Among patients with Alzheimer's disease who were hospitalized, hospital accountable care organization affiliation was associated with lower odds of potentially preventable hospitalizations (OR=0.86, p=0.02; OR=0.66, p<0.001 with propensity score matching) after controlling for patient characteristics, hospital characteristics, and state indicators. Hospital accountable care organization affiliation explained 3.01% (p<0.01) of the disparity in potentially preventable hospitalizations between White and African American patients but could not explain disparities between White and Latinx patients. CONCLUSIONS Evidence suggests that accountable care organizations may be able to improve care coordination for people with Alzheimer's disease and to reduce disparities between Whites and African Americans. Further research is needed to determine whether this benefit can be attributed to accountable care organization formation or whether providers that participate in accountable care organizations tend to provide higher-quality care.
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Affiliation(s)
- Jie Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland; Hospital And Public health interdisciPlinarY research (HAPPY) Lab, School of Public Health, University of Maryland, College Park, Maryland.
| | - Ivy Benjenk
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland; Hospital And Public health interdisciPlinarY research (HAPPY) Lab, School of Public Health, University of Maryland, College Park, Maryland
| | - Deanna Barath
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland; Hospital And Public health interdisciPlinarY research (HAPPY) Lab, School of Public Health, University of Maryland, College Park, Maryland
| | - Andrew C Anderson
- Department of Health Policy & Management, Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Charles F Reynolds
- Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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22
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Abstract
OBJECTIVE. This article aimed to assess changing use of brain imaging tests among patients with Alzheimer disease and vascular dementia who visited U.S. emergency departments (EDs) between 2006 and 2014. MATERIALS AND METHODS. Using the largest publicly available all-payer ED database, the Nationwide Emergency Department Sample, we identified a weighted cohort of 427,705 individuals with Alzheimer disease and 33,743 individuals with vascular dementia who visited U.S. EDs between 2006 and 2014. Logistic regression analyses were performed to identify factors associated with use. RESULTS. Between 2006 and 2014, ED visits among patients with Alzheimer disease and vascular dementia declined by 24.7% and 20.3%, respectively. However, there was a significant increase in utilization rates of head CT (from 4.4% to 11.1% in patients with Alzheimer disease and from 1.5% to 2.9% in patients with vascular dementia) and brain MRI (from 0.04% to 0.5% in patients with Alzheimer disease and 0.0% to 0.1% in those with vascular dementia) in the same time period. Among patients with Alzheimer disease, age, median income in patient ZIP code, day of the week of the ED visit, hospital teaching status, and hospital geographic region were significant predictors of imaging use. Among patients with vascular dementia, insurance type and hospital classification (urban vs rural) were significant predictors of imaging use. CONCLUSION. Despite declining ED visits, ED brain imaging in patients with Alzheimer disease and vascular dementia has increased. Various patient-specific and hospital-specific factors contribute to differential utilization rates.
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Downer B, Al Snih S, Chou LN, Kuo YF, Raji M, Markides KS, Ottenbacher KJ. Changes in Health Care Use by Mexican American Medicare Beneficiaries Before and After a Diagnosis of Dementia. J Gerontol A Biol Sci Med Sci 2021; 76:534-542. [PMID: 32944734 PMCID: PMC7907487 DOI: 10.1093/gerona/glaa236] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Evidence from predominantly non-Hispanic White cohorts indicates health care utilization increases before Alzheimer's disease and related dementias (ADRD) is diagnosed. We investigated trends in health care utilization by Mexican American Medicare beneficiaries before and after an incident diagnosis of ADRD. METHODS Data came from the Hispanic Established Populations for the Epidemiological Study of the Elderly that has been linked with Medicare claims files from 1999 to 2016 (n = 558 matched cases and controls). Piecewise regression and generalized linear mixed models were used to compare the quarterly trends in any (ie, one or more) hospitalizations, emergency room (ER) admissions, and physician visits for 1 year before and 1 year after ADRD diagnosis. RESULTS The piecewise regression models showed that the per-quarter odds for any hospitalizations (odds ratio [OR] = 1.62, 95% CI = 1.43-1.84) and any ER admissions (OR = 1.40, 95% CI = 1.27-1.54) increased before ADRD was diagnosed. Compared to participants without ADRD, the percentage of participants with ADRD who experienced any hospitalizations (27.2% vs 14.0%) and any ER admissions (19.0% vs 11.7%) was significantly higher at 1 quarter and 3 quarters before ADRD diagnosis, respectively. The per-quarter odds for any hospitalizations (OR = 0.88, 95% CI = 0.80-0.97) and any ER admissions (OR = 0.89, 95% CI = 0.82-0.97) decreased after ADRD was diagnosed. Trends for any physician visits before or after ADRD diagnosis were not statistically significant. CONCLUSIONS Older Mexican Americans show an increase in hospitalizations and ER admissions before ADRD is diagnosed, which is followed by a decrease after ADRD diagnosis. These findings support the importance of a timely diagnosis of ADRD for older Mexican Americans.
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Affiliation(s)
- Brian Downer
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston
- Sealy Center on Aging, University of Texas Medical Branch, Galveston
| | - Soham Al Snih
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston
- Sealy Center on Aging, University of Texas Medical Branch, Galveston
| | - Lin-Na Chou
- Office of Biostatistics, University of Texas Medical Branch, Galveston
| | - Yong-Fang Kuo
- Sealy Center on Aging, University of Texas Medical Branch, Galveston
- Office of Biostatistics, University of Texas Medical Branch, Galveston
| | - Mukaila Raji
- Sealy Center on Aging, University of Texas Medical Branch, Galveston
- Internal Medicine – Geriatrics & Palliative Medicine, University of Texas Medical Branch, Galveston
| | - Kyriakos S Markides
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston
- Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston
- Sealy Center on Aging, University of Texas Medical Branch, Galveston
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Feter N, Leite JS, Cardoso RK, Rombaldi AJ. Economic burden of physical inactivity in hospitalizations due to dementia: a Brazilian nationwide study. CAD SAUDE PUBLICA 2021; 37:e00046520. [PMID: 33566988 DOI: 10.1590/0102-311x00046520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/24/2020] [Indexed: 11/21/2022] Open
Abstract
Our study aimed at determining the economic burden of leisure-time physical inactivity in hospitalizations due to dementia in Brazil. In this national-wide descriptive study, we used secondary data from the Brazilian Health Informatics Department and from the latest Brazilian National Health Survey (2013). Rate of hospitalization and economic cost were extracted from 2013. Leisure-time physical inactivity prevalence was used to estimate its population attributable fraction for dementia. Outcomes were stratified into sex (man/woman), age groups (< 50, 50-59, 60-69, 70-79, 80+), ethnicity (white, black, mixed race, other), and region (South, Southeast, North, Northeast, and Central). In 2013, 3,724 people were hospitalized due to dementia in Brazil resulting in a total cost of BRL 17,971,833.85 (USD 7,673,973.05). More than half of cost among men was spent with individuals younger than 59 years, white and mixed-race, and from Southeast region. Proportion of cost was higher in women older than 60 years and white. In 2013, 37% of all hospitalization from dementia in Brazil were attributable to physical inactivity, with values reaching 42.9% and 43.8% for men and women aged 80 or older, respectively. Physical inactivity cost BRL 6,994,254.75 (USD 2,986,546.78) in 2013 on hospitalizations due to dementia in Brazil. Higher attributable-cost was found for patients younger than 50 years and women older than 80. Strategies to preserve the quality of life of these patients are needed to reduce the burden for the patients, their family, and on the healthcare system.
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Affiliation(s)
- Natan Feter
- Universidade Federal de Pelotas, Pelotas, Brasil.,The University of Queensland, St. Lucia, Australia
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Gilmore-Bykovskyi A, Cotton Q, Morgan J, Block L. Diverse perspectives on hospitalisation events among people with dementia: protocol for a multisite qualitative study. BMJ Open 2021; 11:e043016. [PMID: 33550256 PMCID: PMC7925923 DOI: 10.1136/bmjopen-2020-043016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION People living with dementia (PLWD) are more likely to experience hospitalisation events (hospitalisation, rehospitalisation) than those without dementia. Many hospitalisation events, particularly rehospitalisation within 30 days of discharge, are thought to be avoidable. Yet our understanding of dementia-specific risk and protective factors surrounding avoidable hospitalisation is limited to specific intersetting transitions and predominantly clinician perspectives. Broader insights are needed to design accessible and effective solutions for reducing avoidable hospitalisations. We have designed the Stakeholders Understanding of Prevention Protection and Opportunities to Reduce HospiTalizations (SUPPORT) Study to address these gaps. The objectives of the SUPPORT Study are to elicit and examine family caregiver, community and hospital providers' perspectives on avoidable hospitalisation events among PLWD, and to identify opportunities for effective prevention. METHODS AND ANALYSIS We will conduct a multisite, descriptive qualitative study to interview around 100 family caregivers, community and hospital providers. We will identify and sample from regions and communities with higher socio-contextual disadvantage and hospital utilisation, and will aim to recruit individuals representing diverse racial/ethnic backgrounds. Interviews will follow a descriptive qualitative design in conjunction with constant comparison techniques to sample divergent situations and events. We will employ a range of analytical approaches to address specific research questions including thematic (inductive and deductive), comparative and dimensional analysis. Interviews will be conducted individually or in focus groups and follow a semistructured interview guide. ETHICS AND DISSEMINATION The study is approved by the University of Wisconsin-Madison Institutional Review Board. Informed consent procedures will incorporate steps to evaluate capacity to provide informed consent in the event that participants express concerns with thinking or memory or demonstrate challenges recalling study details during the consent process to ensure capacity to consent to participation. A series of publicly available reports, seminars and symposia will be undertaken in collaboration with collaborating organisation partners.
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Affiliation(s)
- Andrea Gilmore-Bykovskyi
- Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Division of Geriatrics, Department of Medicine, University of Wisconsin-Madison School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Quinton Cotton
- Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jennifer Morgan
- Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Laura Block
- Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Park S, Chen J. Racial and ethnic patterns and differences in health care expenditures among Medicare beneficiaries with and without cognitive deficits or Alzheimer's disease and related dementias. BMC Geriatr 2020; 20:482. [PMID: 33208121 PMCID: PMC7672830 DOI: 10.1186/s12877-020-01888-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 11/10/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Numerous studies have documented racial and ethnic differences in the prevalence and incidence of Alzheimer's disease and related dementias (ADRD). Less is known, however, about racial and ethnic differences in health care expenditures among older adults at risk for ADRD (cognitive deficits without ADRD) or with ADRD. In particular, there is limited evidence that racial and ethnic differences in health care expenditures change over the trajectory of ADRD or differ by types of service. METHODS We examined racial and ethnic patterns and differences in health care expenditures (total health care expenditures, out-of-pocket expenditures, and six service-specific expenditures) among Medicare beneficiaries without cognitive deficits, those with cognitive deficits without ADRD, and those with ADRD. Using the 1996-2017 Medical Expenditure Panel Survey, we performed multivariable regression models to estimate expenditure differences among racial and ethnic groups without cognitive deficits, those with cognitive deficits without ADRD, and those with ADRD. Models accounted for survey weights and adjusted for various demographic, socioeconomic, and health characteristics. RESULTS Black, Asians, and Latinos without cognitive deficits had lower total health care expenditures than whites without cognitive deficits ($10,236, $9497, $9597, and $11,541, respectively). There were no racial and ethnic differences in total health care expenditures among those with cognitive deficits without ADRD and those with ADRD. Across all three groups, however, Blacks, Asians, and Latinos consistently had lower out-of-pocket expenditures than whites (except for Asians with cognitive deficits without ADRD). Furthermore, service-specific health care expenditures varied by racial and ethnic groups. CONCLUSIONS Our study did not find significant racial and ethnic differences in total health care expenditures among Medicare beneficiaries with cognitive deficits and/or ADRD. However, we documented significant differences in out-of-pocket expenditures and service-specific expenditures. We speculated that the differences may be attributable to racial and ethnic differences in access to care and/or preferences based on family structure and cultural/economic factors. Particularly, heterogeneous patterns of service-specific expenditures by racial and ethnic groups underscore the importance of future research in identifying determinants leading to variations in service-specific expenditures among racial and ethnic groups.
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Affiliation(s)
- Sungchul Park
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, USA.
| | - Jie Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD, USA
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Jain S, Rosenbaum PR, Reiter JG, Hoffman G, Small DS, Ha J, Hill AS, Wolk DA, Gaulton T, Neuman MD, Eckenhoff RG, Fleisher LA, Silber JH. Using Medicare claims in identifying Alzheimer's disease and related dementias. Alzheimers Dement 2020; 17:10.1002/alz.12199. [PMID: 33090695 PMCID: PMC8296851 DOI: 10.1002/alz.12199] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/25/2020] [Accepted: 08/29/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION This study develops a measure of Alzheimer's disease and related dementias (ADRD) using Medicare claims. METHODS Validation resembles the approach of the American Psychological Association, including (1) content validity, (2) construct validity, and (3) predictive validity. RESULTS We found that four items-a Medicare claim recording ADRD 1 year ago, 2 years ago, 3 years ago, and a total stay of 6 months in a nursing home-exhibit a pattern of association consistent with a single underlying ADRD construct, and presence of any two of these four items predict a direct measure of cognitive function and also future claims for ADRD. DISCUSSION Our four items are internally consistent with the measurement of a single quantity. The presence of any two items do a better job than a single claim when predicting both a direct measure of cognitive function and future ADRD claims.
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Affiliation(s)
- Siddharth Jain
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
| | - Paul R. Rosenbaum
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
- Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA
| | - Joseph G. Reiter
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Geoffrey Hoffman
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA
- University of Michigan’s Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Dylan S. Small
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
- Department of Statistics, The Wharton School, The University of Pennsylvania, Philadelphia, PA
| | - JinKyung Ha
- Division of Geriatrics/Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA
| | - Alexander S. Hill
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - David A. Wolk
- Department of Neurology, The Perelman School of Medicine, The University of Pennsylvania
| | - Timothy Gaulton
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
- Center for Perioperative Outcomes Research and Transformation, The University of Pennsylvania, Philadelphia, PA
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Mark D. Neuman
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
- Center for Perioperative Outcomes Research and Transformation, The University of Pennsylvania, Philadelphia, PA
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Roderic G. Eckenhoff
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Lee A. Fleisher
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
- Center for Perioperative Outcomes Research and Transformation, The University of Pennsylvania, Philadelphia, PA
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Jeffrey H. Silber
- Center for Outcomes Research, Children’s Hospital of Philadelphia, Philadelphia, PA
- The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, PA
- Department of Anesthesiology and Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- The Departments of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Health Care Management, The Wharton School, The University of Pennsylvania, Philadelphia, PA
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Desai U, Kirson NY, Lu Y, Bruemmer V, Andrews JS. Disease severity at the time of initial cognitive assessment is related to prior health-care resource use burden. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12093. [PMID: 32793800 PMCID: PMC7418892 DOI: 10.1002/dad2.12093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/16/2020] [Accepted: 07/22/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Research has shown increased health-care resource use (HRU) among patients with Alzheimer's disease and related disorders (ADRD) well before diagnosis, but the degree to which HRU is correlated with disease severity at the time of initial assessment is not well documented. METHODS Retrospective analysis of linked medical records and claims data for three cohorts: mild ADRD (first [index] Mini-Mental State Examination [MMSE] ≥20), moderate/severe ADRD (index MMSE < 20), controls without cognitive impairment. HRU during the pre-index year was compared using multivariate regressions. RESULTS ADRD cohorts had significantly (P < .01) higher HRU than controls. Compared to mild ADRD patients, moderate/severe ADRD patients had higher rates of hospitalizations (relative risk [RR]: 1.57), emergency department visits (RR: 1.36), potentially avoidable hospitalizations (RR: 1.72), and accidental falls (RR: 1.58). DISCUSSION HRU before initial assessment increases with disease severity at the time of assessment, highlighting the need for timely evaluation and improved management in the earliest stages of ADRD.
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Affiliation(s)
- Urvi Desai
- Analysis Group, Inc.BostonMassachusettsUSA
| | | | - Yao Lu
- Analysis Group, Inc.WashingtonDistrict of ColumbiaUSA
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Gungabissoon U, Perera G, Galwey NW, Stewart R. The association between dementia severity and hospitalisation profile in a newly assessed clinical cohort: the South London and Maudsley case register. BMJ Open 2020; 10:e035779. [PMID: 32284392 PMCID: PMC7200045 DOI: 10.1136/bmjopen-2019-035779] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 02/07/2020] [Accepted: 03/20/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the risk and common causes of hospitalisation in patients with newly diagnosed dementia and variation by severity of cognitive impairment. SETTING We used data from a large London mental healthcare case register linked to a national hospitalisation database. PARTICIPANTS Individuals aged ≥65 years with newly diagnosed dementia with recorded cognitive function and the catchment population within the same geography. OUTCOME MEASURES We evaluated the risk and duration of hospitalisation in the year following a dementia diagnosis. In addition we identified the most common causes of hospitalisation and calculated age-standardised and gender-standardised admission ratios by dementia severity (mild/moderate/severe) relative to the catchment population. RESULTS Of the 5218 patients with dementia, 2596 (49.8%) were hospitalised in the year following diagnosis. The proportion of individuals with mild, moderate and severe dementia who had a hospital admission was 47.9%, 50.8% and 51.7%, respectively (p= 0.097). Duration of hospital stay increased with dementia severity (median 2 days in mild to 4 days in severe dementia, p 0.0001). After excluding readmissions for the same cause, the most common primary hospitalisation discharge diagnoses among patients with dementia were urinary system disorders, pneumonia and fracture of femur, accounting for 15%, 10% and 6% of admissions, respectively. Overall, patients with dementia were hospitalised 30% more than the catchment population, and this trend was observed for most of the discharge diagnoses evaluated. Standardised admission ratios for urinary and respiratory disorders were higher in those with more severe dementia at diagnosis. CONCLUSIONS Individuals with a dementia diagnosis were more likely to be hospitalised than individuals in the catchment population. The length of hospital stay increased with dementia severity. Most of the common causes of hospitalisation were more common than expected relative to the catchment population, but standardised admission ratios only varied by dementia stage for certain groups of conditions.
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Affiliation(s)
- Usha Gungabissoon
- Epidemiology (Value Evidence and Outcomes), GSK, Brentford, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Gayan Perera
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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Healthcare utilization of Mexican-American Medicare beneficiaries with and without Alzheimer's disease and related dementias. PLoS One 2020; 15:e0227681. [PMID: 31940401 PMCID: PMC6961888 DOI: 10.1371/journal.pone.0227681] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 12/26/2019] [Indexed: 01/26/2023] Open
Abstract
Background Older adults with Alzheimer’s disease and related dementias (ADRD) are high-risk to experience hospitalizations and emergency room (ER) admissions. Mexican-Americans have a high prevalence of ADRD, but there is limited information on the healthcare use of older Mexican-Americans with ADRD. We used data from a cohort of older Mexican-Americans that has been linked with Medicare files to investigate differences in hospitalizations, ER admissions, and physician visits according to ADRD diagnosis. We also identify sociodemographic, health, and functional characteristics that may contribute to differences in healthcare utilization between Mexican-American Medicare beneficiaries with and without an ADRD diagnosis. Methods and findings Data came from the Hispanic Established Populations for the Epidemiological Study of the Elderly that has been linked with Medicare Master Beneficiary Summary Files, Medicare Provider Analysis and Review files, Outpatient Standard Analytic files, and Carrier files. The final analytic sample included 1048 participants. Participants were followed for two years (eight quarters) after their survey interview. Generalized estimating equations were used to estimate the probability for one or more hospitalizations, ER admissions, and physician visits at each quarter. ADRD was associated with higher odds for hospitalizations (OR = 1.65, 95%CI = 1.29–2.11) and ER admissions (OR = 1.57, 95%CI = 1.23–1.94) but not physician visits (OR = 1.23, 95%CI = 0.91–1.67). The odds for hospitalizations (OR = 1.24, 95%CI = 0.97–1.60) and ER admissions (OR = 1.27, 95%CI = 1.01–1.59) were reduced after controlling for limitations in activities of daily living and comorbidities. Conclusions Mexican-American Medicare beneficiaries with ADRD had significantly higher odds for one or more hospitalizations and ER admissions but similar physician visits compared to beneficiaries without ADRD. Functional limitations and comorbidities contributed to the higher hospitalizations and ER admissions for older Mexican-Americans with ADRD.
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