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Xie Y, Sinclair C, Hamilton M, Peisah C, Temple J, Anstey KJ. Barriers Experienced by Community-Dwelling Older Adults Navigating Formal Care: Evidence From an Australian Population-Based National Survey. J Aging Health 2024:8982643241263132. [PMID: 38914050 DOI: 10.1177/08982643241263132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
OBJECTIVES This study aims to identify the relationship between psychosocial factors and unmet needs among community-dwelling older adults who have received or who expect to receive formal home-based aged care services. METHODS A subsample of the national Survey of Disability, Ageing and Carers was used to examine the prevalence of having any unmet needs among older adults navigating care. We also examined associations between older adults' psychosocial factors and their unmet needs using logistic regression. RESULTS Regression analyses highlighted that perceived social isolation (OR = 1.62, 95% CI: 1.30-2.01), high/very high psychological distress (OR = 2.11, 95% CI: 1.52-2.93), and occasional assistance from informal support (OR = 1.92, 95% CI: 1.22-3.05) were associated with increased odds of having unmet needs, after adjusting for other covariates. DISCUSSION Our study suggests that older adults facing psychosocial difficulties or lacking informal support are more likely to encounter barriers in accessing formal care. Future policy should address the psychosocial needs and support networks of older adults.
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Affiliation(s)
- Yuchen Xie
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - Craig Sinclair
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
| | - Myra Hamilton
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - Carmelle Peisah
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
- Discipline of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Jeromey Temple
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Kaarin J Anstey
- Ageing Futures Institute, University of New South Wales, Sydney, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia, Sydney, NSW, Australia
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Swearinger H, Lapham JL, Martinson ML, Berridge C. Older Adults' Unmet Needs at the End of Life: A Cross-Country Comparison of the United States and England. J Aging Health 2024:8982643241245249. [PMID: 38613317 DOI: 10.1177/08982643241245249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Objectives: This study aimed to compare the end-of-life (EOL) experiences in concentration with place of death, for older adults in the U.S. and England. Methods: Weighted comparative analysis was conducted using harmonized Health and Retirement Study and English Longitudinal Study of Ageing datasets covering the period of 2006-2012. Results: At the EOL, more older adults in the U.S. (64.14%) than in England (54.09%) had unmet needs (I/ADLs). Home was the main place of death in the U.S. (47.34%), while it was the hospital in England (58.01%). Gender, marital status, income, place of death, previous hospitalization, memory-related diseases, self-rated health, and chronic diseases were linked to unmet needs in both countries. Discussion: These findings challenge the existing assumptions about EOL experiences and place of death outcomes, emphasizing the significance of developing integrated care models to bolster support for essential daily activities of older adults at the EOL.
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Affiliation(s)
- Hazal Swearinger
- Department of Social Work, Cankiri Karatekin University, Çankırı, Turkey
| | | | | | - Clara Berridge
- Department of Social Work, University of Washington, Seattle, WA, USA
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Wang S, Temkin-Greener H, Simning A, Konetzka RT, Cai S. Outcomes After Community Discharge From Skilled Nursing Facilities: The Role of Medicaid Home and Community-Based Services. J Appl Gerontol 2024:7334648241242942. [PMID: 38581163 DOI: 10.1177/07334648241242942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024] Open
Abstract
This study investigated the association between Medicaid Home and Community-Based Services (HCBS) generosity and post-discharge outcomes among dual-eligible beneficiaries discharged from skilled nursing facilities (SNFs). We linked multiple national datasets for duals discharged from SNFs between 2010 and 2013. Accounting for SNF fixed effects, we estimated the effect of HCBS generosity, measured by its breadth and intensity, on the likelihood of remaining in the community, risks of death, nursing home (NH) admission, and hospitalizations within 30 and 180 days after SNF discharge. We found that higher HCBS generosity was associated with an increased likelihood of remaining in the community. HCBS breadth and intensity were both significantly associated with reduced risks of NH admission, while higher HCBS intensity was related to a reduced risk of acute hospitalizations within 30 days after discharge. Our findings suggest that more generous HCBS programs may facilitate smoother transitions and sustainable community living following SNF discharge.
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Affiliation(s)
- Sijiu Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | | | - Adam Simning
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | | | - Shubing Cai
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
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Jopson AD, Fabius CD, Shen K, Ornstein KA, Wolff JL. Profile of Older Dual-Enrollees Living in Areas with Managed Long-Term Services and Supports. J Am Med Dir Assoc 2024; 25:722-728. [PMID: 38103571 PMCID: PMC10990790 DOI: 10.1016/j.jamda.2023.11.004] [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: 08/28/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Nearly half of all state Medicaid agencies in the United States have implemented managed long-term services and supports (MLTSS). Data gaps have inhibited our understanding of MLTSS experiences to date. We draw on a national survey with novel data linkages to develop a profile of older dual-enrollees with significant LTSS needs by MLTSS program presence. DESIGN Cross-sectional observational study using the 2015 round of the National Health and Aging Trends Study (NHATS), a longitudinal study of a nationally representative sample of Medicare beneficiaries aged 65 years and older. SETTING AND PARTICIPANTS The sample comprised 275 participants who self-reported Medicaid enrollment and met our definition of significant LTSS need as defined by receiving help with 2 or more self-care or mobility activities (eating, bathing, toileting, dressing, bed transfer, indoor mobility). METHODS Bivariate analyses were used to comparatively examine differences in demographic, health, and care circumstances by MLTSS, as defined by living in a county with MLTSS program presence. RESULTS Among approximately 1 million (weighted sample) older dual-enrollees with significant LTSS needs, 56.2% (weighted percentage) lived in counties with MLTSS and 43.7% lived in counties with mandatory MLTSS enrollment in 2015. Those living in areas with MLTSS were much more likely to be of Hispanic or other race and ethnicity (50.5% vs 15.1%, P < .001) yet less likely to live in a rural location (8.7% vs 31.4%, P < .05) or in a residential care facility or nursing home (18.4% vs 34.7%, P < .05). The majority (78.5%) received assistance from 2 or more helpers and received more than 70 hours of care per week. CONCLUSIONS AND IMPLICATIONS Our findings reinforce the growing reach of MLTSS programs and importance of filling evidence gaps about who these programs are serving.
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Affiliation(s)
- Andrew D Jopson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Chanee D Fabius
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen Shen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Katherine A Ornstein
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Lin Z, Liu H. Race/Ethnicity, Nativity, and Gender Disparities in Unmet Care Needs Among Older Adults in the United States. THE GERONTOLOGIST 2024; 64:gnad094. [PMID: 37434547 PMCID: PMC10943507 DOI: 10.1093/geront/gnad094] [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: 02/22/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Although disparities in disability and the unequal distribution of care resources are widely discussed in the literature, there has been less research on disparities in experiencing unmet care needs among older adults. This study aims to investigate how unmet care needs are unevenly distributed across social groups with various intersecting identities, such as race/ethnicity, nativity, and gender, although considering their care needs and care networks, drawing on the conceptual framework of the pathway to unmet needs. RESEARCH DESIGN AND METHODS The data for this study came from the National Health and Aging Trends Study (2011-2018), and the study sample consisted of 7,061 Medicare beneficiaries who needed assistance with daily activities. Questions about unmet care needs were in the form of consequences related to difficulty or lack of help with daily activities. Mixed-effects negative binomial regression models were used to predict rates of unmet needs. RESULTS Older adults of color, especially women, experienced higher rates of unmet care needs compared with their White and male counterparts. Although Black-White and gender differences in unmet needs were mostly explained by unequal exposures to care needs and differential care networks, Hispanic women and foreign-born Hispanic men were still at a disadvantage even after adjusting for these covariates. DISCUSSION AND IMPLICATIONS These results emphasize the importance of adopting an intersectional approach to enhance the quality of long-term services and support for older adults facing social disadvantages.
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Affiliation(s)
- Zhiyong Lin
- Department of Sociology, The University of Texas at San Antonio, San Antonio, Texas, USA
- Population Research Center, The University of Texas at Austin, Austin, Texas, USA
| | - Hui Liu
- Center on Aging and the Life Course and Department of Sociology, Purdue University, West Lafayette, Indiana, USA
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Huang J, Qian X, Choi EPH, Chau PH. The Consequences of Unmet Needs for Assistance With Daily Life Activities Among Older Adults: A Systematic Review. Med Care Res Rev 2024:10775587241233798. [PMID: 38450440 DOI: 10.1177/10775587241233798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Many older adults are experiencing unmet needs for assistance with the activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Such unmet needs might threaten their physical and psychosocial well-being. We conducted a systematic review to provide a comprehensive picture of the health consequences of unmet ADL/IADL needs among older adults. Twenty-eight published articles were included for qualitative synthesis. We found that unmet ADL/IADL needs were consistently associated with higher health care utilization (e.g., hospitalization, medical spending) and adverse psychosocial consequences (e.g., anxiety, depression), while the findings of falls and mortality remain inconsistent. More studies are needed to draw firm conclusions and to allow for quantitative synthesis. This review advocates for more coordinated and comprehensive long-term care services for older adults. Future studies should explore how the adverse health outcomes identified in this review can be prevented or improved by adequately meeting older adults' needs for assistance.
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Affiliation(s)
- Jing Huang
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Xingxing Qian
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Pui Hing Chau
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
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Wang H, Liu H, Wu B, Hai L. The Association Between Trajectories of Perceived Unmet Needs for Home and Community-Based Services and Life Satisfaction Among Chinese Older Adults: The Moderating Effect of Psychological Resilience. Res Aging 2024; 46:139-152. [PMID: 37768843 DOI: 10.1177/01640275231203608] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
This study examined whether trajectories of perceived unmet needs for Home and Community-Based Services (HCBS) were associated with life satisfaction among Chinese older adults and whether the association was moderated by psychological resilience. Data came from five waves (2005-2018) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Latent class growth analysis revealed three distinct trajectories of perceived unmet HCBS needs: "increasing" (n = 977, 36.24%), "persistent" (n = 570, 21.14%), and "decreasing" (n = 1149, 42.62%). Multiple regression estimates showed that the increasing group was associated with lower life satisfaction, and the association was moderated by psychological resilience, especially for older adults who were male, living in rural, and oldest-old. Results indicate that inequalities in cumulative exposure to perceived unmet HCBS needs may further lead to increasing inequalities in life satisfaction. Interventions focused on minimizing the provision-need gap of HCBS and enhancing personal resilience should be considered to improve the life satisfaction of older adults.
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Affiliation(s)
- Hui Wang
- Institute for Population and Development Studies, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Huijun Liu
- Institute for Population and Development Studies, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Lun Hai
- Institute for Population and Development Studies, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
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Mattke S, Jun H, Chu S, Hanson M. Disparities in Access to Diagnostic Evaluation for Alzheimer's Disease in Individuals Dually Eligible for Medicare and Medicaid: A Modeling Study. J Alzheimers Dis 2024; 98:1403-1414. [PMID: 38517787 DOI: 10.3233/jad-231134] [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] [Indexed: 03/24/2024]
Abstract
Background Individuals dually eligible for Medicare and Medicaid (duals) may face greater obstacles to access to disease-modifying Alzheimer's treatments in spite of their higher disease burden, because of clinicians' reluctance to accept Medicaid and the so-called "lesser of" policy, under which Medicaid may pay providers lower rates. Objective To project differential wait times for duals compared to Medicare-only beneficiaries by state. Methods We used State Medicaid payment policy and Medicare enrollment data and a Markov model to predict differential wait times for duals and non-duals from 2023 to 2050. We estimated available diagnostic appointments by state for both groups based on reluctance of clinicians to accept Medicaid and the "lesser of" policy for each year. Results We estimate overall average wait times of almost two years (22.9 months) but almost three times as long for duals (59.8 months) than non-duals (20.7 months) because of higher disease burden. The effects of Medicaid payment policy would increase average wait times for duals to 89 months with 20 states having wait times of 99 months or more, which would effectively deprive duals of access. Conclusions The added average wait times in many states would effectively deprive duals from access to treatment and translate into avoidable disease progression and mortality. Policy interventions to reduce financial and nonfinancial obstacles are dearly needed to avoid deepening disparities. Examples are coverage arrangements that integrate Medicare and Medicaid coverage, covering the co-payment for physician services in full, and stricter network adequacy requirements for Medicaid Managed Care plans.
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Affiliation(s)
- Soeren Mattke
- The USC Brain Health Observatory, University of Southern California, Los Angeles, CA, USA
| | - Hankyung Jun
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | | | - Mark Hanson
- The USC Brain Health Observatory, University of Southern California, Los Angeles, CA, USA
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FABIUS CHANEED, OKOYE SAFIYYAHM, WU MINGCHEMJ, JOPSON ANDREWD, CHYR LINDAC, BURGDORF JULIAG, BALLREICH JEROMIE, SCERPELLA DANNY, WOLFF JENNIFERL. The Role of Place in Person- and Family-Oriented Long-Term Services and Supports. Milbank Q 2023; 101:1076-1138. [PMID: 37503792 PMCID: PMC10726875 DOI: 10.1111/1468-0009.12664] [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: 12/22/2022] [Revised: 06/13/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023] Open
Abstract
Policy Points Little attention to date has been directed at examining how the long-term services and supports (LTSS) environmental context affects the health and well-being of older adults with disabilities. We develop a conceptual framework identifying environmental domains that contribute to LTSS use, care quality, and care experiences. We find the LTSS environment is highly associated with person-reported care experiences, but the direction of the relationship varies by domain; increased neighborhood social and economic deprivation are highly associated with experiencing adverse consequences due to unmet need, whereas availability and generosity of the health care and social services delivery environment are inversely associated with participation restrictions in valued activities. Policies targeting local and state-level LTSS-relevant environmental characteristics stand to improve the health and well-being of older adults with disabilities, particularly as it relates to adverse consequences due to unmet need and participation restrictions. CONTEXT Long-term services and supports (LTSS) in the United States are characterized by their patchwork and unequal nature. The lack of generalizable person-reported information on LTSS care experiences connected to place of community residence has obscured our understanding of inequities and factors that may attenuate them. METHODS We advance a conceptual framework of LTSS-relevant environmental domains, drawing on newly available data linkages from the 2015 National Health and Aging Trends Study to connect person-reported care experiences with public use spatial data. We assess relationships between LTSS-relevant environmental characteristic domains and person-reported care adverse consequences due to unmet need, participation restrictions, and subjective well-being for 2,411 older adults with disabilities and for key population subgroups by race, dementia, and Medicaid enrollment status. FINDINGS We find the LTSS environment is highly associated with person-reported care experiences, but the direction of the relationship varies by domain. Measures of neighborhood social and economic deprivation (e.g., poverty, public assistance, social cohesion) are highly associated with experiencing adverse consequences due to unmet care needs. Measures of the health care and social services delivery environment (e.g., Medicaid Home and Community-Based Service Generosity, managed LTSS [MLTSS] presence, average direct care worker wage, availability of paid family leave) are inversely associated with experiencing participation restrictions in valued activities. Select measures of the built and natural environment (e.g., housing affordability) are associated with participation restrictions and lower subjective well-being. Observed relationships between measures of LTSS-relevant environmental characteristics and care experiences were generally held in directionality but were attenuated for key subpopulations. CONCLUSIONS We present a framework and analyses describing the variable relationships between LTSS-relevant environmental factors and person-reported care experiences. LTSS-relevant environmental characteristics are differentially relevant to the care experiences of older adults with disabilities. Greater attention should be devoted to strengthening state- and community-based policies and practices that support aging in place.
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Roberts ET, Xue L, Lovelace J, Kypriotis C, Connor KL, Liang Q, Grabowski DC. Changes in Care Associated With Integrating Medicare and Medicaid for Dual-Eligible Individuals. JAMA HEALTH FORUM 2023; 4:e234583. [PMID: 38127588 PMCID: PMC10739174 DOI: 10.1001/jamahealthforum.2023.4583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/23/2023] [Indexed: 12/23/2023] Open
Abstract
Importance There is growing interest in expanding integrated models, in which 1 insurer manages Medicare and Medicaid spending for dually eligible individuals. Fully integrated dual-eligible special needs plans (FIDE-SNPs) are one of the largest integrated models, but evidence about their performance is limited. Objective To evaluate changes in care associated with integrating Medicare and Medicaid coverage in a FIDE-SNP in Pennsylvania. Design, Setting, and Participants This cohort study using a difference-in-differences analysis compared changes in care between 2 cohorts of dual-eligible individuals: (1) an integration cohort composed of Medicare Dual Eligible Special Needs Plan enrollees who joined a companion Medicaid plan following a 2018 state reform mandating Medicaid managed care (leading to integration), and (2) a comparison cohort with nonintegrated coverage before and after the start of Medicaid managed care. Analyses were conducted between February 2022 and June 2023. Main Outcomes and Measures Analyses examined outcomes in 4 domains: use of home- and community-based services (HCBS), care management and coordination, hospital stays and postacute care, and long-term nursing home stays. Results The study included 7967 individuals in the integration cohort and 3832 individuals in the comparison cohort. In the integration cohort, the mean (SD) age at baseline was 63.3 (14.7) years, and 5268 individuals (66.1%) were female and 2699 (33.9%) were male. In the comparison cohort, the mean (SD) age at baseline was 64.8 (18.6) years, and 2341 individuals (61.1%) were female and 1491 (38.9%) were male. At baseline, integration cohort members received a mean (SD) of 2.83 (8.70) days of HCBS per month and 3.34 (3.56) medications for chronic conditions per month, and the proportion with a follow-up outpatient visit after a hospital stay was 0.47. From baseline through 3 years after integration, HCBS use increased differentially in the integration vs comparison cohorts by 0.61 days/person-month (95% CI, 0.28-0.94; P < .001). However, integration was not associated with changes in care management and coordination, including medication use for chronic conditions (-0.02 fills/person-month; 95% CI, -0.10 to 0.06; P = .65) or follow-up outpatient care after a hospital stay (-0.01 visits/hospital stay; 95% CI, -0.04 to 0.03; P = .61). Hospital stays did not change differentially between the cohorts. Unmeasured factors contributing to differential mortality limited the ability to identify changes in long-term nursing home stays associated with integration. Conclusions and Relevance In this cohort study with a difference-in-differences analysis of 2 cohorts of individuals dually eligible for Medicare and Medicaid, integration was associated with greater HCBS use but not with other changes in care patterns. The findings highlight opportunities to strengthen how integrated programs manage care and a need to further evaluate their performance.
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Affiliation(s)
- Eric T. Roberts
- Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Lingshu Xue
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - John Lovelace
- UPMC Insurance Services Division, Pittsburgh, Pennsylvania
| | - Chris Kypriotis
- Center for High-Value Health Care, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Qingfeng Liang
- Center for High-Value Health Care, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David C. Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Reckrey JM, Kleijwegt H, Morrison RS, Nothelle S, Kelley AS, Ornstein KA. Paid Care for People with Functional Impairment and Serious Illness: Results from the Health and Retirement Study. J Gen Intern Med 2023; 38:3355-3361. [PMID: 37349637 PMCID: PMC10681964 DOI: 10.1007/s11606-023-08262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Paid caregivers (e.g., home health aides) care for individuals living at home with functional impairment and serious illnesses (health conditions with high risk of mortality that impact function and quality of life). OBJECTIVE To characterize those who receive paid care and identify factors associated with receipt of paid care in the context of serious illness and socioeconomic status. DESIGN Retrospective cohort study. PARTICIPANTS Community-dwelling participants ≥ 65 years enrolled in the Health and Retirement Study (HRS) between 1998 and 2018 with new-onset functional impairment (e.g., bathing, dressing) and linked fee-for-service Medicare claims (n = 2521). MAIN MEASURES Dementia was identified using HRS responses and non-dementia serious illness (e.g., advanced cancer, end-stage renal disease) was identified using Medicare claims. Paid care support was identified using HRS survey report of paid help with functional tasks. KEY RESULTS While about 27% of the sample received paid care, those with both dementia and non-dementia serious illnesses in addition to functional impairment received the most paid care (41.7% received ≥ 40 h of paid care per week). In multivariable models, those with Medicaid were more likely to receive any paid care (p < 0.001), but those in the highest income quartile received more hours of paid care (p = 0.05) when paid care was present. Those with non-dementia serious illness were more likely to receive any paid care (p < 0.001), but those with dementia received more hours of care (p < 0.001) when paid care was present. CONCLUSIONS Paid caregivers play a significant role in meeting the care needs of those with functional impairment and serious illness and high paid care hours are common among those with dementia in particular. Future work should explore how paid caregivers can collaborate with families and healthcare teams to improve the health and well-being of the seriously ill throughout the income spectrum.
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Affiliation(s)
| | | | | | | | - Amy S Kelley
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine A Ornstein
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center for Equity in Aging, Johns Hopkins University School of Nursing, Baltimore, MD, USA
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Kong D, Li X, Solomon P, Dong X. Social Support and Unmet Needs for Personal Assistance Among Community-Dwelling U.S. Chinese Older Adults: Does the Source of Support Matter? JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:874-887. [PMID: 36919914 DOI: 10.1080/01634372.2023.2191124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/02/2023] [Accepted: 03/11/2023] [Indexed: 06/18/2023]
Abstract
This study examines the relationship between social support sources and unmet needs among U.S. Chinese older adults. Data were from the Population Study of Chinese Elderly in Chicago. Unmet needs were assessed by indexes of activities of daily living (ADL) and instrumental activities of daily living (IADL). Three specific sources of social support (spouse, family members, and friends) were included. Multivariable logistic regression models were conducted. Approximately 17% of the 3,157 respondents reported having unmet ADL/IADL needs. U.S. Chinese older adults with less overall social support were more likely to have unmet ADL needs (odds ratio [OR]=0.91, 95% CI=0.83-0.99) and IADL needs (OR=0.84, 95% CI=0.81-0.88). Family and friend support were associated with a lower likelihood of having unmet ADL needs. Support from spouse, family, and friends was associated with a lower likelihood of having unmet IADL needs. The findings highlight the importance of informal social support in addressing unmet needs .
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Affiliation(s)
- Dexia Kong
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China
| | - Xuhong Li
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China
| | - Phyllis Solomon
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Xinqi Dong
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA
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Cao Y, Feng Z, Mor V, Du P. Unmet Needs and Associated Factors among Community-living Older People with Disability in China: 2005-2014. J Aging Soc Policy 2023; 35:648-666. [PMID: 35950837 DOI: 10.1080/08959420.2022.2110806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 01/21/2021] [Indexed: 10/15/2022]
Abstract
Based on the Chinese Longitudinal Healthy Longevity Survey from 2005 to 2014, this study estimated the prevalence and examined risk factors of under-met needs and completely unmet needs for assistance in activities of daily living (ADLs) among community-living older people with disability in China. As of 2014, over 50% of community-living Chinese elders with disability experienced under-met needs, and nearly 5% had completely unmet needs. From 2005 to 2014, the proportion with completely unmet needs doubled for all disabled elders. Significant risk factors of under-met needs included lower per capita annual household income, more ADL limitations, living alone, and fewer living children, and those of completely unmet needs included less ADL limitations and living alone. More policy attention should be paid to address the gap between long-term care services for older persons with severe disability and supportive services for those who are relatively healthy, toward ultimately establishing a care continuum for the elderly at all stages of their life course. In addition, family care for elders with severe functional impairments should be supplemented by professional long-term care services to best meet their needs.
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Affiliation(s)
- Yang Cao
- School of Public Administration, Sichuan University, Chengdu, Sichuan, China
| | - Zhanlian Feng
- Department of Labor and Social Security, RTI International, Waltham, Massachusetts, USA
| | - Vincent Mor
- Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island, USA
| | - Peng Du
- Institute of Gerontology, Renmin University, Beijing, P.R. China
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14
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Erçin Swearinger H, Lapham J. Patterns of Unmet Needs With Assistance for Self-Care Activities at the End of Life by Place of Death Among Older Adults. Am J Hosp Palliat Care 2023; 40:805-811. [PMID: 36399397 DOI: 10.1177/10499091221127427] [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] [Indexed: 07/20/2023] Open
Abstract
Older Americans experience adverse consequences linked to inadequate assistance with self-care activities. These unmet care needs increase risk of hospitalization, institutionalization, and morbidity. While a growing body of research has focused on disparities in unmet care needs and place of death outcomes among older adults separately, less is known about the intersection between the two: place of death and unmet care needs at the end of life. Therefore, this study utilized data from the National Health & Aging Trends Study (NHATS) to examine patterns of place of death and unmet care needs outcomes among older adults to identify disparities in care and inform policies and programs. We conducted weighted bivariate analyses and multivariate logistic regression models using appropriate survey weights. Findings suggest more than half of older adults experienced an unmet need at the end of their lives and increasing rates of unmet needs are experienced by older adults who died in hospitals. Older adults receiving hospice care were also found to have less unmet needs at the end of their lives. Given the well-documented consequences of unmet needs with self-care activities, ongoing research is needed to better inform policies and programs that provide assistance and support to older adults with their self-care activities during their end of lives.
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Affiliation(s)
| | - Jessica Lapham
- School of Social Work, University of Washington, Seattle, WA, USA
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15
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Garcia-Davis S, Palacio A, Bast E, Penney LS, Finley E, Kinosian B, Intrator O, Dang S. Peer-to-Patient-Aligned Care Team (Peer-to-PACT; P2P), a Peer-Led Home Visit Intervention Program for Targeting and Improving Long-term Care Services and Support for Veterans With High Needs and High Risk: Protocol for a Mixed Methods Feasibility Study. JMIR Res Protoc 2023; 12:e46156. [PMID: 37307055 DOI: 10.2196/46156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Keeping older veterans with high needs and high risk (HNHR) who are at risk of long-term institutional care safely in their homes for as long as possible is a Department of Veterans Affairs priority. Older veterans with HNHR face disproportionate barriers and disparities to engaging in their care, including accessing care and services. Veterans with HNHR often have poor ability to maintain health owing to complicated unmet health and social needs. The use of peer support specialists (peers) is a promising approach to improving patient engagement and addressing unmet needs. The Peer-to-Patient-Aligned Care Team (Peer-to-PACT; P2P) intervention is a multicomponential home visit intervention designed to support older veterans with HNHR to age in place. Participants receive a peer-led home visit to identify unmet needs and home safety risks aligned with the age-friendly health system model; care coordination, health care system navigation, and linking to needed services and resources in collaboration with their PACT; and patient empowerment and coaching using Department of Veterans Affairs whole health principles. OBJECTIVE The primary aim of this study is to evaluate the preliminary effect of the P2P intervention on patient health care engagement. The second aim is to identify the number and types of needs and unmet needs as well as needs addressed using the P2P needs identification tool. The third aim is to evaluate the feasibility and acceptability of the P2P intervention delivered over 6 months. METHODS We will use a quantitative-qualitative convergent mixed methods approach to evaluate the P2P intervention outcomes. For our primary outcome, we will conduct an independent, 2-tailed, 2-sample t test to compare the means of the 6-month pre-post differences in the number of outpatient PACT encounters between the intervention and matched comparison groups. Qualitative data analysis will follow a structured rapid approach using deductive coding as well as the Consolidated Framework for Implementation Research. RESULTS Study enrollment began in July 2020 and was completed in March 2022. Our sample size consists of 114 veterans: 38 (33.3%) P2P intervention participants and 76 (66.7%) matched comparison group participants. Study findings are expected to be published in late 2023. CONCLUSIONS Peers may help bridge the gap between PACT providers and veterans with HNHR by evaluating veterans' needs outside of the clinic, summarizing identified unmet needs, and developing team-based solutions in partnership with the PACT. The home visit component of the intervention provides eyes in the home and may be a promising and innovative tool to improve patient engagement. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46156.
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Affiliation(s)
- Sandra Garcia-Davis
- Department of Public Health Sciences, University of Miami, Coral Gables, FL, United States
| | - Ana Palacio
- Geriatric Research, Education, and Clinical Center (GRECC), Bruce W Carter Department of Veterans Affairs Medical Center, Miami, FL, United States
- Leonard M Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Elizabeth Bast
- Geriatric Research, Education, and Clinical Center (GRECC), Bruce W Carter Department of Veterans Affairs Medical Center, Miami, FL, United States
| | - Lauren S Penney
- South Texas Veterans Health Care System, San Antonio, TX, United States
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Washington, DC, United States
| | - Erin Finley
- Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, United States
| | - Bruce Kinosian
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Orna Intrator
- Geriatrics and Extended Care Data Analysis Center (GECDAC), Canandaigua Veterans Affairs Medical Center, Canandaigua, NY, United States
| | - Stuti Dang
- Geriatric Research, Education, and Clinical Center (GRECC), Bruce W Carter Department of Veterans Affairs Medical Center, Miami, FL, United States
- Leonard M Miller School of Medicine, University of Miami, Miami, FL, United States
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, Washington, DC, United States
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16
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Kreider AR, Werner RM. The Home Care Workforce Has Not Kept Pace With Growth In Home And Community-Based Services. Health Aff (Millwood) 2023; 42:650-657. [PMID: 37075251 PMCID: PMC10278236 DOI: 10.1377/hlthaff.2022.01351] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Home and community-based services (HCBS) are the predominant approach to delivering long-term services and supports in the US, but there are growing numbers of reports of worker shortages in this industry. Medicaid, the primary payer for long-term services and supports, has expanded HCBS coverage, resulting in a shift in the services' provision out of institutions and into homes. Yet it is unknown whether home care workforce growth has kept up with the increased use of these services. Using data from the American Community Survey and the Henry J. Kaiser Family Foundation, we compared trends in the size of the home care workforce with data on Medicaid HCBS participation between 2008 and 2020. The home care workforce grew from approximately 840,000 to 1.22 million workers between 2008 and 2013. After 2013, growth slowed, ultimately reaching 1.42 million workers in 2019. In contrast, the number of Medicaid HCBS participants grew continuously from 2008 to 2020, with accelerated growth between 2013 and 2020. As a consequence, the number of home care workers per 100 HCBS participants declined by 11.6 percent between 2013 and 2019, with preliminary estimates suggesting that further declines occurred in 2020. Improving access to HCBS will require not just expanded insurance coverage but also new workforce investments.
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Affiliation(s)
- Amanda R Kreider
- Amanda R. Kreider , University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel M Werner
- Rachel M. Werner, University of Pennsylvania and Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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17
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Tong JKC, Mascuilli T, Wirtalla C, Aarons CB, Saur NM, Mahmoud NN, Kelz RR. Exploring ethnic differences in post-discharge patterns of surgical care for older adults admitted with diverticulitis. Colorectal Dis 2023; 25:1006-1013. [PMID: 36655392 PMCID: PMC10257996 DOI: 10.1111/codi.16484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/11/2022] [Accepted: 01/05/2023] [Indexed: 01/20/2023]
Abstract
AIM We aimed to evaluate ethnic differences in patterns of care following an index nonoperative admission for acute diverticulitis amongst a universally insured patient cohort. METHODS We identified nationwide Medicare beneficiaries aged 65.5 years or older hospitalized between 1 July 2015 and 1 November 2017 for nonoperative management of an index admission for diverticulitis. Patients were followed for 1 year to examine patterns of care. Primary categorical outcomes included receipt of an elective operation, emergency operation, nonoperative readmission or no further hospitalizations for diverticulitis. Multinomial regression was performed to determine the association between ethnicity and receipt of each primary outcome category whilst adjusting for potential confounders. We examined the use of percutaneous drainage during the index admission to better understand its association with subsequent care patterns. RESULTS Amongst 22 630 study patients, subsequent operative treatment was less common for Black, Hispanic, Asian and American Indian patients relative to White patients. Multinomial logistic regression noted that Black (relative risk 0.40; 95% CI 0.32-0.50) and Asian (relative risk 0.37; 95% CI 0.15-0.91) patients were associated with the lowest relative risk of undergoing an elective interval operation compared to White patients. Black patients were also associated with a 1.43 (95% CI 1.19-1.73) increased risk of requiring subsequent nonoperative readmissions for disease recurrence compared to White patients. The use of percutaneous drainage was higher amongst White patients relative to Black patients (6.9% vs. 4.0%, P value < 0.001). CONCLUSION We have identified ongoing inequities in the consumption of medical resources, with White patients being more likely to undergo elective colectomy and percutaneous drainage. Differences in care are not fully alleviated by equal access to insurance.
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Affiliation(s)
- Jason K C Tong
- Department of Surgery, Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- National Clinicians Scholars Veterans Affairs Fellow, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tory Mascuilli
- Department of Surgery, Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher Wirtalla
- Department of Surgery, Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cary B Aarons
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicole M Saur
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Najjia N Mahmoud
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Surgery, Division of Colon and Rectal Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel R Kelz
- Department of Surgery, Center for Surgery and Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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18
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Calderón-Jaramillo M, Zueras P. Cared and uncared populations: understanding unmet care needs of older adults (65+) across different social care systems in Europe. Eur J Ageing 2023; 20:11. [PMID: 37119379 PMCID: PMC10148628 DOI: 10.1007/s10433-023-00760-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/01/2023] Open
Abstract
Population care needs are dynamic. They change throughout individuals' life courses and are related to the population structure. These needs are particularly demanding during population ageing and may vary depending on how societies cope with them. In this study, we explored the unmet social care needs of individuals in twelve European countries with different social care systems. We used data from the seventh wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) to conduct a cross-sectional study of individuals aged 65 and over with care needs (n = 7136). Unmet care needs were measured from an absolute approach. We fitted binomial regression models to explain the relative importance of individuals' characteristics, health status and different social care systems on unmet needs. The absolute measure shows that 53.02% of the analytical sample faced unmet care needs as they reported limitations and did not receive help. The prevalence of unmet care needs is higher for men than women and for younger than older individuals. Furthermore, we found that individuals living in Mediterranean social care systems have the highest prevalence of these unmet needs. This analysis contributes to the ongoing debate about the challenges posed by ageing populations and their relationship with care.
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Affiliation(s)
- Mariana Calderón-Jaramillo
- Universitat Autònoma de Barcelona, Barcelona, Catalunya, Spain.
- Centre d'Estudis Demogràfics (CED-CERCA) - Cerdanyola del Valles, Barcelona, Catalunya, Spain.
| | - Pilar Zueras
- Centre d'Estudis Demogràfics (CED-CERCA) - Cerdanyola del Valles, Barcelona, Catalunya, Spain
- Institute for Social and Economic Research, University of Essex, Colchester, UK
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19
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Di Novi C, Martini G, Sturaro C. The impact of informal and formal care disruption on older adults' psychological distress during the COVID-19 pandemic in UK. ECONOMICS AND HUMAN BIOLOGY 2023; 49:101242. [PMID: 37058982 PMCID: PMC10079322 DOI: 10.1016/j.ehb.2023.101242] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 05/08/2023]
Abstract
This paper investigates how formal and informal caregiving disruptions-due to the U.K. government's non-pharmaceutical interventions (NPIs) aimed at reducing transmission of the SARS-CoV-2 virus-may have affected the likelihood of psychological distress among older individuals. We model the association between disruption of formal and informal care and mental health of the elderly during the first wave of the COVID-19 pandemic using a recursive simultaneous - equation model for binary variables. Our findings reveal that public interventions, which are most essential for reducing the pandemic spread, influenced the provision of formal and informal care. The lack of adequate long-term care following the COVID-19 outbreak has also had negative repercussions on the psychological well-being of these adults.
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Affiliation(s)
- Cinzia Di Novi
- European Commission, Joint Research Centre (JRC), Ispra, Italy.
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20
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Sokas CM, Bollens-Lund E, Husain M, Ornstein KA, Kelly MT, Sheu C, Kerr E, Jarman M, Salim A, Kelley AS, Cooper Z. The Trauma Dyad: The Role of Informal Caregivers for Older Adults After Traumatic Injury. Ann Surg 2023; 277:e907-e913. [PMID: 36892516 PMCID: PMC9999045 DOI: 10.1097/sla.0000000000005200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the association between higher injury severity and increased informal caregiving received by injured older adults. SUMMARY OF BACKGROUND DATA Injured older adults experience high rates of functional decline and disability after hospitalization. Little is known about the scope of caregiving received post-discharge, particularly from informal caregivers such as family. METHODS We used the National Health and Aging Trends Study 2011 to 2018 linked to Medicare claims to identify adults ≥65 with hospital admission for traumatic injury and a National Health and Aging Trends Study interview within 12 months pre- and post-trauma. Injury severity was assessed using the injury severity score (ISS, low 0-9; moderate 10-15; severe 16-75). Patients reported the types and hours of formal and informal help received and any unmet care needs. Multi variable logistic regression models examined the association between ISS and increase in informal caregiving hours after discharge. RESULTS We identified 430 trauma patients. Most were female (67.7%), non-Hispanic White (83.4%) and half were frail. The most common mechanism of injury was fall (80.8%) and median injury severity was low (ISS = 9). Those reporting receiving help with any activity increased post-trauma (49.0% to 72.4%, P < 0.01), and unmet needs nearly doubled (22.8% to 43.0%, P < 0.01). Patients had a median of 2 caregivers and most (75.6%) were informal, often family members. Median weekly hours of care received pre- versus post-injury increased from 8 to 14 (P < 0.01). ISS did not independently predict increase in caregiving hours; pre-trauma frailty predicted an increase in hours ≥8 per week. CONCLUSIONS Injured older adults reported high baseline care needs which increased significantly after hospital discharge and were mostly met by informal caregivers. Injury was associated with increased need for assistance and unmet needs regardless of injury severity. These results can help set expectations for caregivers and facilitate post-acute care transitions.
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Affiliation(s)
- Claire M. Sokas
- Brigham and Woman’s Hospital, Center for Surgery and Public Health, Boston, MA USA
| | - Evan Bollens-Lund
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mohammed Husain
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Katherine A. Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Masami T. Kelly
- Brigham and Woman’s Hospital, Center for Surgery and Public Health, Boston, MA USA
| | - Christina Sheu
- Brigham and Woman’s Hospital, Center for Surgery and Public Health, Boston, MA USA
| | - Emma Kerr
- Brigham and Woman’s Hospital, Center for Surgery and Public Health, Boston, MA USA
| | - Molly Jarman
- Brigham and Woman’s Hospital, Center for Surgery and Public Health, Boston, MA USA
| | - Ali Salim
- Brigham and Woman’s Hospital, Center for Surgery and Public Health, Boston, MA USA
- Brigham and Woman’s Hospital, Department of Surgery, Boston, MA USA
| | - Amy S. Kelley
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Zara Cooper
- Brigham and Woman’s Hospital, Center for Surgery and Public Health, Boston, MA USA
- Brigham and Woman’s Hospital, Department of Surgery, Boston, MA USA
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21
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Chen S, Zhang H, Underwood BR, Wang D, Chen X, Cardinal RN. Trends in Gender and Racial/Ethnic Disparities in Physical Disability and Social Support Among U.S. Older Adults With Cognitive Impairment Living Alone, 2000-2018. Innov Aging 2023; 7:igad028. [PMID: 37223006 PMCID: PMC10202553 DOI: 10.1093/geroni/igad028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Indexed: 05/25/2023] Open
Abstract
Background and Objectives Informal care is the primary source of support for older adults with cognitive impairment, yet is less available to those who live alone. We examined trends in the prevalence of physical disability and social support among older adults with cognitive impairment living alone in the United States. Research Design and Methods We analyzed 10 waves of data from the U.S. Health and Retirement Survey spanning 2000-2018. Eligible people were those aged ≥65, having cognitive impairment, and living alone. Physical disability and social support were measured via basic and instrumental activities of daily living (BADLs, IADLs). We estimated linear temporal trends for binary/integer outcomes via logistic/Poisson regression, respectively. Results A total of 20 070 participants were included. Among those reporting BADL/IADL disability, the proportion unsupported for BADLs decreased significantly over time (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.97-0.99), and the proportion unsupported for IADLs increased (OR = 1.02, CI 1.01-1.04). Among those receiving IADL support, the number of unmet IADL support needs increased significantly over time (relative risk [RR] 1.04, CI 1.03-1.05). No gender disparities were found for these trends. Over time, Black respondents had a relatively increasing trend of being BADL-unsupported (OR = 1.03, CI 1.0-1.05) and Hispanic and Black respondents had a relatively increasing trend in the number of unmet BADL needs (RR = 1.02, CI 1.00-1.03; RR = 1.01, CI 1.00-1.02, respectively), compared to the corresponding trends in White respondents. Discussion and Implications Among lone-dwelling U.S. older adults with cognitive impairment, fewer people received IADL support over time, and the extent of unmet IADL support needs increased. Racial/ethnic disparities were seen both in the prevalence of reported BADL/IADL disability and unmet BADL/IADL support needs; some but not all were compatible with a reduction in disparity over time. This evidence could prompt interventions to reduce disparities and unmet support needs.
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Affiliation(s)
- Shanquan Chen
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Huanyu Zhang
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Benjamin R Underwood
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn, Cambridge, UK
| | - Dan Wang
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Centre for Disability Prevention and Rehabilitation, Ontario Tech University, Oshawa, Ontario, Canada
| | - Xi Chen
- School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Rudolf N Cardinal
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn, Cambridge, UK
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22
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Affiliation(s)
- Adrian Diaz
- Department of Surgery, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Timothy M Pawlik
- Department of Surgery, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH.
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23
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Fabius CD, Okoye SM, Mulcahy J, Burgdorf JG, Wolff JL. Associations Between Use of Paid Help and Care Experiences Among Medicare-Medicaid Enrolled Older Adults With and Without Dementia. J Gerontol B Psychol Sci Soc Sci 2022; 77:e216-e225. [PMID: 35554530 PMCID: PMC9799184 DOI: 10.1093/geronb/gbac072] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Community-living older Medicare and Medicaid enrollees ("dual-enrollees") have high care needs and commonly receive paid and unpaid long-term services and supports (LTSS) to help with routine activities. Little is known about whether receiving paid help or individuals' state and neighborhood environmental context ("LTSS environment") relates to dual-enrollees' care experiences. METHODS We examine a sample of n = 979 community-dwelling dual-enrollees with disabilities from 2011 to 2015 National Health and Aging Trends Study, linked to measures of neighborhood disadvantage and state Medicaid home and community-based services (HCBS) generosity. Logistic regression models stratified by dementia status assess associations between paid help and: (a) adverse consequences due to unmet care needs, and (b) participation restrictions in valued activities, among dual-enrollees with and without dementia, adjusting for individual and LTSS environmental characteristics. RESULTS Use of paid help was greater for those with (versus without) dementia (46.9% vs. 37.8%). Neighborhood disadvantage was associated with greater use of paid help among dual-enrollees living with dementia. High state Medicaid HCBS generosity was associated with the use of paid help, regardless of dementia status. Dual-enrollees with dementia receiving paid help had higher odds of experiencing adverse consequences due to unmet need (adjusted odds ratio = 2.05; 95% confidence interval 1.16-3.61; p = .02)-no significant associations were observed for participation restrictions. Use of paid help and LTSS environment were not significantly associated with care experiences for dual-enrollees without dementia. DISCUSSION Findings highlight the complexities of caring for dual-enrollees, particularly those with dementia, and emphasize the need to strengthen the delivery of paid care with considerations for the LTSS environment.
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Affiliation(s)
- Chanee D Fabius
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - John Mulcahy
- University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Julia G Burgdorf
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Visting Nurse Service of New York, New York, New York, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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24
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Functional disability and utilisation of long-term care in the older population in England: a dual trajectory analysis. Eur J Ageing 2022; 19:1363-1373. [PMID: 36692765 PMCID: PMC9729679 DOI: 10.1007/s10433-022-00723-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 01/26/2023] Open
Abstract
This study investigates the developmental trajectories of long-term care needs and utilisation in older people aged 65 years and over in England. The data came from the English Longitudinal Survey of Ageing (ELSA, waves 6-9, 2012-2018, N = 13,425). We conducted dual trajectory analyses to cluster people's trajectories of care needs (measured by functional disability) and utilisation into distinct groups. We conducted logistic regression analyses to identify the factors associated with trajectory memberships. We identified three trajectories of long-term needs (low, medium, and high) and three trajectories of care utilisation (low, medium, and high). Both care needs and care hours increased with age, but the speed of increase varied by trajectory. Females, minority ethnic groups, people with low wealth, and those experiencing housing problems were more likely to follow the joint trajectories characterised by higher care needs and higher care intensity. People with low or medium care needs stayed in the same trajectories of care utilisation. In contrast, people in the high-needs trajectory followed divergent trajectories of care utilisation: 63% of them followed the trajectory of high care intensity and the rest (37%) followed the trajectory of medium care intensity. Lack of spouse care was the leading predictor of trajectory divergence (OR = 3.57, p < 0.001). Trajectories of care needs and utilisation are highly heterogeneous in later life, which indicates persistent inequalities over time. Single people with multiple functional limitations face an acute and enduring risk of inadequate care and unmet needs. The amount of support is as important as the availability of support. Supplementary Information The online version contains supplementary material available at 10.1007/s10433-022-00723-0.
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25
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Socioeconomic inequality of long-term care for older people with and without dementia in England. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Ensuring distributive fairness in the long-term care sector is vitally important in the context of global population ageing and rising care needs. This study, part of the DETERMIND (DETERMinants of quality of life, care and costs, and consequences of INequalities in people with Dementia and their carers) programme, investigates socioeconomic inequality and inequity in the utilisation of long-term care for older people with and without dementia in England. The data come from three waves of the English Longitudinal Study of Ageing (ELSA, Waves 6–8, N = 16,458). We find that older people with dementia have higher levels of care needs and a lower socioeconomic status than those without dementia. The distribution of formal and informal care is strongly pro-poor. When care needs are controlled for, there is no significant inequality of formal or informal care among people with dementia, nor of informal care among people without dementia, but there is a significant pro-rich distribution of formal care among people without dementia. Unmet care needs are significantly concentrated among poorer people, both with and without dementia. We argue that the long-term care system in England plays a constructive role in promoting socioeconomic equality of long-term care for people with dementia, but support for older people with lower financial means and substantial care needs remains insufficient. Increased government support for older people is needed to break the circle between care inequality and health inequality.
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Dynamics of unmet need for social care in England. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Meeting individuals' social care needs is a core element of UK social policy. However, the conceptualisation and operationalisation of ‘unmet need’ remain a challenge. This paper advances our understanding by incorporating a temporal dimension into the conceptual framework on unmet need to investigate the dynamics of met and unmet need for social care over time. Using data from Waves 8 and 9 of the English Longitudinal Study of Ageing, this paper examines five possible trajectories among individuals with a social care need for bathing or dressing at baseline: (a) no longer having such a need; (b) having continued needs met; (c) delayed needs met; (d) newly arisen unmet needs; and (e) repeated unmet needs. The results indicate that amongst those with need at baseline, unmet need has decreased over time – indicating that some needs for social care may be fulfilled with a delay. However, a significant proportion of older people experienced repeated unmet needs, particularly those who were younger, with no spouse or civil partner, and those whose activities of daily living index scores worsened over time. Understanding the dynamics of unmet need can support policy makers in better ensuring that those facing an elevated risk of repeated unmet need over time do not fall through the social care safety net.
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Jenkins Morales M, Robert SA. Examining Consequences Related to Unmet Care Needs Across the Long-Term Care Continuum. J Gerontol B Psychol Sci Soc Sci 2022; 77:S63-S73. [PMID: 35030256 PMCID: PMC9122632 DOI: 10.1093/geronb/gbab210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To examine how different care arrangements across the long-term care continuum are associated with experiencing unmet care need consequences (UCNCs), such as skipping meals, going without clean clothes, or taking the wrong medication. METHODS We include older adults receiving assistance with at least one self-care, mobility, or household activity (for health/functioning reasons) in the 2015 National Health and Aging Trends Study (N = 2,388). We examine the likelihood of experiencing a UCNC across the long-term care continuum: those receiving unpaid community care only, paid community care, and residential care. Cross-sectional logistic and longitudinal multinomial logistic regression models examine if type of care arrangement in 2015 is associated with UCNCs in 2015 and change in UCNCs by 2017. RESULTS In adjusted cross-sectional models, paid community care recipients had roughly 2 times greater odds of experiencing a UCNC in 2015 compared to those living in residential care or receiving only unpaid care. In adjusted longitudinal models, the risk of experiencing persistent UCNCs (compared to having needs met in both years) was 4.81 times higher for those receiving paid community care compared to those in residential care and 2.17 times that of those receiving unpaid care only. DISCUSSION Older adults receiving paid care face significant and consequential gaps in care, particularly in comparison to those in other care arrangements. More attention is needed to determine how paid care arrangements can be improved and/or expanded to meet the needs of the growing number of older adults receiving paid care in the community.
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Affiliation(s)
- Meghan Jenkins Morales
- Sandra Rosenbaum School of Social Work, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Stephanie A Robert
- Sandra Rosenbaum School of Social Work, University of Wisconsin–Madison, Madison, Wisconsin, USA
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Jain S, Murphy TE, O’Leary JR, Leo-Summers L, Ferrante LE. Association Between Socioeconomic Disadvantage and Decline in Function, Cognition, and Mental Health After Critical Illness Among Older Adults : A Cohort Study. Ann Intern Med 2022; 175:644-655. [PMID: 35254879 PMCID: PMC9316386 DOI: 10.7326/m21-3086] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Older adults admitted to an intensive care unit (ICU) are at risk for developing impairments in function, cognition, and mental health. It is not known whether socioeconomically disadvantaged older persons are at greater risk for these impairments than their less vulnerable counterparts. OBJECTIVE To evaluate the association between socioeconomic disadvantage and decline in function, cognition, and mental health among older survivors of an ICU hospitalization. DESIGN Retrospective analysis of a longitudinal cohort study. SETTING Community-dwelling older adults in the National Health and Aging Trends Study (NHATS). PARTICIPANTS Participants with ICU hospitalizations between 2011 and 2017. MEASUREMENTS Socioeconomic disadvantage was assessed as dual-eligible Medicare-Medicaid status. The outcome of function was defined as the count of disabilities in 7 activities of daily living and mobility tasks, the cognitive outcome as the transition from no or possible to probable dementia, and the mental health outcome as the Patient Health Questionnaire-4 score in the NHATS interview after ICU hospitalization. The analytic sample included 641 ICU hospitalizations for function, 458 for cognition, and 519 for mental health. RESULTS After accounting for sociodemographic and clinical characteristics, dual eligibility was associated with a 28% increase in disability after ICU hospitalization (incidence rate ratio, 1.28; 95% CI, 1.00 to 1.64); and nearly 10-fold greater odds of transitioning to probable dementia (odds ratio, 9.79; 95% CI, 3.46 to 27.65). Dual eligibility was not associated with symptoms of depression and anxiety after ICU hospitalization (incidence rate ratio, 1.33; 95% CI, 0.99 to 1.79). LIMITATION Administrative data, variability in timing of baseline and outcome assessments, proxy selection. CONCLUSION Dual-eligible older persons are at greater risk for decline in function and cognition after an ICU hospitalization than their more advantaged counterparts. This finding highlights the need to prioritize low-income seniors in rehabilitation and recovery efforts after critical illness and warrants investigation into factors leading to this disparity. PRIMARY FUNDING SOURCE National Institute on Aging.
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Affiliation(s)
- Snigdha Jain
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Terrence E. Murphy
- Program on Aging, Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - John R. O’Leary
- Program on Aging, Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Linda Leo-Summers
- Program on Aging, Section of Geriatrics, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Lauren E. Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
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Taylor K, Diaz A, Nuliyalu U, Ibrahim A, Nathan H. Association of Dual Medicare and Medicaid Eligibility With Outcomes and Spending for Cancer Surgery in High-Quality Hospitals. JAMA Surg 2022; 157:e217586. [PMID: 35195684 PMCID: PMC8867385 DOI: 10.1001/jamasurg.2021.7586] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Although dual eligibility (DE) status for Medicare and Medicaid has been used for social risk stratification in value-based payment programs, little is known about the interplay between hospital quality and disparities in outcomes and spending by social risk. OBJECTIVE To assess whether treatment at high-quality hospitals mitigates DE-associated disparities in outcomes and spending for cancer surgery. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study from January 1, 2014, to December 31, 2018, evaluating inpatient surgery at acute care hospitals. A total of 119 757 Medicare beneficiaries aged 65 years or older who underwent colectomy, rectal resection, lung resection, or pancreatectomy were evaluated. Data were analyzed between November 1, 2020, and April 30, 2021. EXPOSURES Medicare and Medicaid DE status and hospital quality. MAIN OUTCOMES AND MEASURES Postoperative complications, readmission, and mortality by DE status and hospital quality. RESULTS Overall, 119 757 Medicare beneficiaries underwent colectomy, rectal resection, lung resection, or pancreatectomy. The mean (SD) age was 75.3 (6.7) years, 61 617 (51.5%) were women, 7677 (6.4%) were Black, 106 099 (88.6%) were White, and 5981 (5.0%) identified as another race or ethnicity; 11.3% had DE status. Dually eligible patients were more likely to be discharged to a facility (colectomy, 15.0% [95% CI, 14.7%-15.3%] vs 23.9% [95% CI, 22.9%-24.9%]; proctectomy, 18.7% [95% CI, 18.0%-19.3%] vs 26.9% [95% CI, 24.9%-28.9%]; lung resection, 11.0% [95% CI, 10.7%-11.3%] vs 17.9% [95% CI, 16.8%-18.9%]; pancreatectomy, 23.5% [95% CI, 22.5%-24.4%] vs 30.0% [95% CI, 26.5%-33.5%]). Differences in postacute care use persisted even after accounting for postoperative complications and contributed to variation in spending. Compared with the lowest-quality hospitals, DE patients had improved rates of discharge to a facility (22.7% vs 19.3%) and spending ($22 577 vs $20 100) but rates remained increased compared with Medicare patients even at the highest-quality hospitals. CONCLUSIONS AND RELEVANCE The findings of this study indicate that, even among the highest-quality hospitals, DE patients had poorer outcomes and higher spending. Dually eligible patients were more likely to be discharged to a facility and therefore incurred higher postacute care costs. Although treatment at high-quality hospitals is associated with reduced differences in outcomes, DE patients remain at high risk for adverse postoperative outcomes and increased readmissions and postacute care use.
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Affiliation(s)
- Kathryn Taylor
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor,Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor,Department of Surgery, Stanford University, Stanford, California,Department of Surgery, University of Michigan, Ann Arbor
| | - Adrian Diaz
- National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor,Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor,Department of Surgery, The Ohio State University, Columbus
| | - Usha Nuliyalu
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor
| | - Andrew Ibrahim
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor,Department of Surgery, University of Michigan, Ann Arbor
| | - Hari Nathan
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor,Department of Surgery, University of Michigan, Ann Arbor
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30
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Huang J, Choi EPH, Chau PH. The impact of unmet needs for assistance with activities of daily living on the self-rated health and life satisfaction of Chinese community-dwelling older adults. Aging Ment Health 2022; 27:803-810. [PMID: 35238264 DOI: 10.1080/13607863.2022.2045563] [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] [Indexed: 11/01/2022]
Abstract
OBJECTIVES This study examined the associations of change in unmet needs for assistance with Activities of Daily Living (ADLs) with the self-rated health and life satisfaction of community-dwelling Chinese older adults. METHODS Using national longitudinal data from the Chinese Longitudinal Healthy Longevity Study, we examined the associations of change in unmet ADL needs with self-rated health and life satisfaction from baseline (T1) to a 3-year follow-up (T2) among 1,914 ADL-limited older adults. Change in unmet ADL needs was categorized into 'Persistently Unmet,' 'Unmet at T1 Only,' 'Unmet at T2 Only,' and 'Never Unmet.' Self-rated health and life satisfaction were rated by 5-point Likert scales. Linear mixed models were performed to examine the associations, controlling for sociodemographics, health conditions, and social support. RESULTS Older adults whose ADL needs were 'Persistently Unmet,' 'Unmet at T2 Only,' or 'Never Unmet,' showed a significant decline in self-rated health, but those whose ADL needs were 'Unmet at T1 Only' exhibited a significant rise at follow-up. While life satisfaction was stable among older adults with 'Persistently Unmet' or 'Never Unmet' ADL needs, it significantly decreased among those with 'Unmet at T2 Only' ADL needs and increased among those with 'Unmet at T1 Only' ADL needs. CONCLUSION Unmet needs may play an even more significant role in negatively impacting life satisfaction than the ADL limitation itself. Unmet ADL needs' effects on self-rated health and life satisfaction appeared to be short-term rather than long-term. Thus, it is never too late to adequately meet older adults' ADL needs. UNLABELLED Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2022.2045563.
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Affiliation(s)
- Jing Huang
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong.,School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | | | - Pui Hing Chau
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong
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Magid KH, Galenbeck E, Hazelwood J, Shanbhag P, Joucovsky AL, Levy CR, Lum HD. Sharing Space to Age in Community: A Mixed-Methods Study of Homeshare Organizations. J Aging Soc Policy 2022; 34:809-837. [DOI: 10.1080/08959420.2022.2029266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kate H. Magid
- Health Science Specialist, Denver-Seattle Center of Innovation, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Emily Galenbeck
- Research Assistant, Denver-Seattle Center of Innovation, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Jackie Hazelwood
- Graduate Student, Division of Health Care Policy & Research, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Prajakta Shanbhag
- Data Analyst, Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Cari R. Levy
- Co-Director, Denver-Seattle Center of Innovation, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
- Professor and Vice Division Head, Division of Health Care Policy & Research, University of Colorado School of Medicine, Aurora, Colorad, USA
| | - Hillary D. Lum
- Research Physician, Geriatrics Research Education and Clinical Center, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
- Associate Professor of Medicine, Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Chong N, Akobirshoev I, Caldwell J, Kaye HS, Mitra M. The relationship between unmet need for home and community-based services and health and community living outcomes. Disabil Health J 2021; 15:101222. [PMID: 34657829 DOI: 10.1016/j.dhjo.2021.101222] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/24/2021] [Accepted: 10/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Few studies have examined user-reported perspectives about the quality and sufficiency of home and community-based services (HCBS) and their relationship to key health and community living outcomes. OBJECTIVE To examine the association between unmet need for HCBS and health and community living outcomes in a multi-state, multi-program sample of Medicaid HCBS users. METHODS We used data from the 2017-2018 National Core Indicators-Aging and Disability (NCI-AD) survey, collected among older adults and adults with physical disabilities who were receiving Medicaid HCBS across 13 states (N = 10,263). We conducted descriptive analysis on the demographic, functional, and health characteristics of the sample, and examined the prevalence of unmet need for HCBS across five domains: 1) assistance with daily activities, 2) assistive technology, 3) home modifications, 4) transportation, and 5) sufficiency of services for meeting user needs and goals. We used logistic regressions to estimate adjusted odds ratios for the association between unmet need for HCBS and health care utilization (ED visits, hospital/rehab stays, preventative care) and community living outcomes (active in the community, interacting with family/friends, satisfaction, control). RESULTS Across the five domains, prevalence of unmet need ranged from 21% (unmet need for assistance with self-care or other daily activities) to 54% (unmet need for assistive technology). Individuals who experienced unmet need had consistently worse health and community living outcomes than those who reported no unmet need, after adjusting for key user demographic, functional, and social characteristics (p < 0.05). CONCLUSIONS Unmet need for HCBS is consistently and significantly associated with poor health and community living outcomes among Medicaid users.
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Affiliation(s)
- Natalie Chong
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, USA.
| | - Ilhom Akobirshoev
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, USA
| | - Joseph Caldwell
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, USA
| | - H Stephen Kaye
- Institute for Health and Aging, University of California San Francisco, USA
| | - Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, USA
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Fan VS, Mahadevan R, Leung J. Effect of income inequality, community infrastructure and individual stressors on adult depression. Health Promot Int 2021; 36:46-57. [PMID: 32277828 DOI: 10.1093/heapro/daaa036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This paper considers the impact of variables at three different levels-city, community and individual-on the depression of adults aged 45 years and above in China. Evidence shows that community factors, such as infrastructure and elderly centres, are critical to reduce depression but the effect of city-level factors such as lowering income inequality and improving public health investment is different for the segments of poor and non-poor as well as the rural and urban residents. This highlights the need to consider targeted policy mix options to avoid resource misallocation. Lastly, Chinese females' depression has worsened over time with ageing, particularly those who drink alcohol or are less educated are prone to depression prompting the need for specialist women health centres.
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Affiliation(s)
- Vanessa Sha Fan
- China Institute of Innovation and Development, Beijing Normal University, Zhuhai Campus, Guangdong 519087, P.R. China
| | - Renuka Mahadevan
- School of Economics, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Janni Leung
- School of Psychology, The University of Queensland, Brisbane, Queensland 4072, Australia & National Drug and Alcohol Research Center, University of New South Wales, Sydney, New South Wales 2052, Australia
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34
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Does "one size fit all" in subjective cognitive decline? Int Psychogeriatr 2021; 33:651-653. [PMID: 34127160 DOI: 10.1017/s104161022000335x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Beauregard LK, Miller EA. A Comparative Case Study Analysis of Barriers and Facilitators to Implementing the Affordable Care Act's Balancing Incentive Program. Res Aging 2021; 44:276-285. [PMID: 34134564 DOI: 10.1177/01640275211020795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Affordable Care Act included the opportunity for states to increase spending on Medicaid home and community-based services (HCBS) for older adults and persons with disabilities through the Balancing Incentive Program (BIP). This study utilized comparative case studies to identify the factors that facilitated or impeded states' implementation of BIP. Findings indicate factors that facilitated the implementation of BIP were communication with the federal government and its contractor, merging BIP with existing HCBS programs, and enhanced federal revenue. On the other hand, the short duration of BIP, state procurement and contracting processes, and the need to incorporate feedback from non-governmental stakeholders and determining how to spend the enhanced revenue proved challenging for some states. This research suggests ways federal and state officials can implement new initiatives to achieve greater rebalancing of Medicaid long-term services and supports for older adults.
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Affiliation(s)
- Lisa Kalimon Beauregard
- Home and Community-Based Services Policy Lab, Massachusetts Executive Office of Elder Affairs, Boston, MA, USA
| | - Edward Alan Miller
- Department of Gerontology and Gerontology Institute, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, MA, USA.,Department of Health Services Policy & Practice and Center for Gerontology and Healthcare Research, School of Public Health, Brown University, Providence, RI, USA
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36
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Bergmann M, Wagner M. The Impact of COVID-19 on Informal Caregiving and Care Receiving Across Europe During the First Phase of the Pandemic. Front Public Health 2021; 9:673874. [PMID: 34222177 PMCID: PMC8242257 DOI: 10.3389/fpubh.2021.673874] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: We analyzed the effects of COVID-19 as well as its accompanying epidemiological control measures on health-related outcomes (physical and mental health) and unmet care needs of both caregivers and care recipients across Europe and Israel by taking into account country differences. Methods: We applied comparisons of adjusted predictions, controlling for a large set of relevant respondent characteristics, to investigate changes in the physical and mental health of caregivers and care recipients due to COVID-19. Furthermore, multilevel regression models were used to analyze the effect of individual and contextual indicators on the probability of reporting difficulties in receiving care. For the analyses, we used data from 26 countries with 51,983 respondents over 50 years based on the eighth wave of the Survey of Health, Aging and Retirement in Europe (SHARE), which had to be suspended in March 2020, and the SHARE Corona Survey fielded from June to August 2020. Results: During the first phase of the pandemic in spring/summer 2020, the frequency of providing personal care to parents increased in almost all European countries, while care to children, in turn, decreased. Parental caregivers who increased the frequency of providing personal care reported significantly more mental health strains, that is, feeling sad/depressed and anxious/nervous more often since the outbreak of the pandemic. With respect to receiving care, about one out of five care recipients had difficulty in obtaining adequate care from outside the household during the pandemic. The perception of unmet care needs was significantly associated with country differences regarding the duration of the stay-at-home orders. In contrast, the number of confirmed deaths did not have a significant effect on perceiving difficulties related to receiving care. Conclusions: Our findings show the extent of the burden to which caregivers and care recipients were exposed with respect to the unintended consequences of COVID-19-related epidemiological control measures. There is a great need within this population for interventions, which effectively reduce the burden as well as the symptoms of anxiety or depression for caregivers as well as care recipients. This should be recognized by (health) policymakers and social organizations.
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Affiliation(s)
- Michael Bergmann
- Munich Center for the Economics of Aging, Max Planck Institute for Social Law and Social Policy, Munich, Germany
- Technical University of Munich, Munich, Germany
| | - Melanie Wagner
- Munich Center for the Economics of Aging, Max Planck Institute for Social Law and Social Policy, Munich, Germany
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Pittman C, Nieman CL, Reed N, Swenor BK, Willink A. Sensory Impairment and the Odds of Adverse Consequences of Unmet Needs for Care Among Older Adults. J Gerontol B Psychol Sci Soc Sci 2021; 77:983-991. [PMID: 33860302 DOI: 10.1093/geronb/gbab065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Vision and hearing impairments are highly prevalent conditions among older adults, and well-established links exist between sensory impairment and household, mobility, and self-care activity limitations. However, studies examining the impact of unmet long-term services and supports (LTSS) needs have not considered the role of vision and hearing impairment on the risk of experiencing adverse consequences, including wetting or soiling oneself. METHODS Using Rounds 1 and 5 of the National Health and Aging Trends Study, a nationally-representative survey of Medicare beneficiaries aged 65 and older, we examine the association of vision and hearing impairment on the odds of experiencing an adverse consequence while accounting for other socio-demographic and health status factors. RESULTS Among a weighted population of 49,770,947 community-living older adults with limitations in household, mobility, or self-care activities, 20.1% (95% CI: 19.2-21.0) experienced an adverse consequence as a result of unmet LTSS needs. In the full-adjusted regression, individuals with vision or hearing impairment had 96% (OR:1.96; 95% CI: 1.64-2.34) and 43% increased odds (OR:1.43; 95% CI: 1.24-1.65), respectively of experiencing any adverse consequence. Hearing impairment was associated with higher odds of household or self-care adverse consequences, while vision impairment was associated with higher odds of mobility or self-care adverse consequences. DISCUSSION Sensory impairment may increase the risk for adverse consequences for older adults with unmet LTSS needs. Activities that support older adults living safely in the community should consider the role of sensory impairment and how to address the unique needs of those with hearing or vision impairment.
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Affiliation(s)
- Corinne Pittman
- Cochlear Center for Hearing & Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,Howard University College of Medicine, Washington DC
| | - Carrie L Nieman
- Cochlear Center for Hearing & Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Center for Innovative Care in Aging, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Nicholas Reed
- Cochlear Center for Hearing & Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Bonnielin K Swenor
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Amber Willink
- Cochlear Center for Hearing & Public Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.,Menzies Center for Health Policy, Sydney School of Public Health, University of Sydney, Sydney, Australia
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Xu D, Simpson VL. Subjective Well-Being, Depression, and Delays in Care Among Older Adults: Dual-Eligible Versus Medicare-Only Beneficiaries. J Appl Gerontol 2021; 41:158-166. [PMID: 33736521 DOI: 10.1177/07334648211000920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We aimed to (a) determine the role of subjective well-being and depression in care delays among Medicare beneficiaries and (b) examine whether subjective well-being and depression play a differential role among Medicare-only and dual-eligible beneficiaries. A nationally representative sample of 1,696 older adults participated in the study. Roughly, 22% of participants reported often or sometimes experiencing care delays, with more delays among dual eligibles. We found that higher levels of subjective well-being were significantly related to less frequent care delays. In contrast, higher levels of depression were significantly related to more frequent care delays. Moreover, as depression increased, the predicted probability of delays increased to a greater extent among dual eligibles than Medicare-only beneficiaries. These findings signify the importance of identifying and implementing strategies to enhance subjective well-being and reduce depression in older adults, particularly dual eligibles, to improve access to timely care.
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39
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Beauregard LK, Miller EA. Federal Incentives to Reform Long-Term Care under the Affordable Care Act: State Adoption of the Balancing Incentive Program, 2011-2014. J Gerontol B Psychol Sci Soc Sci 2021; 77:191-200. [PMID: 33631012 DOI: 10.1093/geronb/gbab031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The Balancing Incentive Program (BIP) was an optional program for states within the Patient Protection and Affordable Care Act to promote Medicaid-funded home and community-based services (HCBS) for older adults and persons with disabilities. Twenty-one states opted to participate in BIP, including several states steadfastly opposed to the health insurance provisions of the Affordable Care Act. This study focused on identifying what factors were associated with states' participation in this program. METHODS Event history analysis was used to model state adoption of BIP from 2011 to 2014. A range of potential factors were considered representing states' economic, political, and programmatic conditions. RESULTS The results indicate that states with a higher percentage of Democrats in the state legislature, fewer state employees per capita, and more nursing facility beds were more likely to adopt BIP. In addition, states with fewer home health agencies per capita, that devoted smaller proportions of Medicaid long-term care spending to HCBS, and that had more Money Follows the Person transitions were also more likely to pursue BIP. DISCUSSION Findings highlight the role of partisanship, administrative capacity, and program history in state BIP adoption decisions. The inclusion of BIP in the Affordable Care Act may have deterred some states from participating in the program due to partisan opposition to the legislation. To encourage the adoption of optional HCBS programs, federal policymakers should consider the role of financial incentives, especially for states with limited bureaucratic capacity and that have made less progress rebalancing Medicaid long-term services and supports.
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Affiliation(s)
- Lisa Kalimon Beauregard
- Home and Community-Based Services Policy Lab Massachusetts Executive Office of Elder Affairs
| | - Edward Alan Miller
- Department of Gerontology, and Fellow, Gerontology Institute, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston.,Department of Health Services Policy & Practice, and Faculty, Center for Gerontology and Healthcare Research, School of Public Health, Brown University
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Qin W, Wang Y, Cho S. Neighborhood Social Cohesion, Physical Disorder, and Daily Activity Limitations Among Community-Dwelling Older Adults. Arch Gerontol Geriatr 2020; 93:104295. [PMID: 33242733 DOI: 10.1016/j.archger.2020.104295] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/28/2020] [Accepted: 11/08/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although extensive factors have been examined for limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), it remains unclear as to the impacts of neighborhood-level factors on ADL and IADL limitations. Thus, we aim to examine whether neighborhood characteristics are predictive of limitations in ADL and IADL. METHODS A total of 7,407 participants were selected from the National Health and Aging Trend Study. We used data from round 1 (2011) to round 8 (2018). Neighborhood characteristics were measured as social cohesion and physical disorder. Daily activity limitations were counted based on the domains of ADL and IADL. Mixed-effects negative binomial regression analyses were performed to estimate the effects of neighborhood features on ADL and IADL limitations. RESULTS Better neighborhood social cohesion significantly predicted less limitations in ADL (incidence rate ratio [IRR] = 0.98, 95% confidence interval [CI] = 0.96 - 0.99) and IADL (IRR=0.96, 95% CI = 0.95 - 0.98). More physical disorder predicted more IADL limitations (IRR=1.04, 95% CI = 1.01 - 1.06), but was not associated with ADL limitations. CONCLUSION Neighborhood social cohesion is essential in enabling older adults to perform both basic self-care activities and more complex tasks, while neighborhood physical disorder is significant to older adults' capability in performing more complex sets of activities so as to age in place. The study findings underscore the importance of improving both social and physical aspects of neighborhood environment to facilitate older adults' daily activity performance.
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Affiliation(s)
- Weidi Qin
- Jack, Joseph, and Morton Mandel School of Applied Social Sciences, Case Western Reserve University.
| | - Yi Wang
- School of Social Work, University of Iowa.
| | - Seungjong Cho
- Department of Sociology, Anthropology, and Social Work, Texas Tech University.
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Johnston KJ, Joynt Maddox KE. The Role Of Social, Cognitive, And Functional Risk Factors In Medicare Spending For Dual And Nondual Enrollees. Health Aff (Millwood) 2020; 38:569-576. [PMID: 30933581 DOI: 10.1377/hlthaff.2018.05032] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Centers for Medicare and Medicaid Services is increasingly focused on value-based payment programs, which tie payment to performance on quality and cost measures. In this context, there is rising concern that such programs systematically disadvantage providers that care for vulnerable populations, such as the poor, by holding the providers accountable for factors beyond their control that influence patient outcomes and utilization. In this nationally representative study of Medicare beneficiaries, we found that dually enrolled Medicare beneficiaries (those also enrolled in Medicaid) had strikingly higher levels of medical, functional, and cognitive comorbidities, as well as social needs, compared to their non-dually enrolled counterparts. Dual enrollees also had significantly higher annual costs of care. Including functional, cognitive, and social factors in cost prediction, in addition to risk factors derived from medical claims, improved risk prediction and decreased differences between dual and nondual enrollees. Medicare could consider such adjustment to improve accuracy and fairness in value-based payment programs.
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Affiliation(s)
- Kenton J Johnston
- Kenton J. Johnston ( ) is an assistant professor of health management and policy at Saint Louis University, in Missouri
| | - Karen E Joynt Maddox
- Karen E. Joynt Maddox is an assistant professor of medicine (cardiology) at the Washington University School of Medicine, in St. Louis
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Rapp T, Sicsic J. The contribution of the immigrant population to the U.S. long-term care workforce. Soc Sci Med 2020; 263:113305. [PMID: 32861168 DOI: 10.1016/j.socscimed.2020.113305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/29/2020] [Accepted: 08/15/2020] [Indexed: 11/24/2022]
Abstract
The long-term care (LTC) sector will soon face a shortage of care workers. The consequences are potentially dramatic, urging the need to design policies aiming at reducing the turnover rate of LTC workers. Immigrant workers are an important part of the LTC workforce. Pooling data from the Annual Social and Economic (ASEC) supplement to the Current Population Survey (CPS) for years 2003-2019, we compare US-born and immigrant LTC workers' propensity to stay in the LTC workforce over one year. We distinguish two categories of LTC workers: personal care workers and nurses. We show that for both categories, naturalized citizens, legal noncitizen immigrants, and unauthorized immigrants have a higher probability of staying in the LTC workforce compared to US-born citizens. We provide two potential explanations: we show that immigrant personal care workers are more likely to report a better health, and that immigrant nurses have a lower wage variation sensitivity. Our results also suggest that wage increases are likely to be associated with higher retention rates in the profession.
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Affiliation(s)
- Thomas Rapp
- Chaire Ageinomix & LIRAES (EA 4470), Université de Paris, France.
| | - Jonathan Sicsic
- Chaire Ageinomix & LIRAES (EA 4470), Université de Paris, France
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Ankuda CK, Ornstein KA, Covinsky KE, Bollens-Lund E, Meier DE, Kelley AS. Switching Between Medicare Advantage And Traditional Medicare Before And After The Onset Of Functional Disability. Health Aff (Millwood) 2020; 39:809-818. [PMID: 32364865 PMCID: PMC7951954 DOI: 10.1377/hlthaff.2019.01070] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Medicare Advantage (MA) plans have increasing flexibility to provide nonmedical services to support older adults aging in place in the community. However, prior research has suggested that enrollees with functional disability (hereafter, "disability") were more likely than those without disability to leave MA plans. This indicates that MA plans might not meet the needs of older adults with disability. We used data for 2011-16 from the National Health and Aging Trends Study linked to Medicare claims to measure and characterize switches in either direction between Medicare Advantage and traditional Medicare in the twelve months before and after onset of disability. While the rate of switches from Medicare Advantage to traditional Medicare increased slightly after disability onset, people with greater levels of disability were more likely to switch to traditional Medicare, compared to those with lower levels: 36 percent of those who switched from Medicare Advantage to traditional Medicare needed help with two or more activities of daily living, compared to 14.3 percent of those who switched from traditional Medicare to Medicare Advantage. This indicates the potential benefit of including functional measures in MA plan risk adjustment and quality measures. Furthermore, the highest-need older adults with disability may experience lower-quality care in Medicare Advantage and thus leave before accessing the program's expanded benefits.
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Affiliation(s)
- Claire K Ankuda
- Claire K. Ankuda ( Claire. ankuda@mssm. edu ) is an assistant professor in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, in New York City
| | - Katherine A Ornstein
- Katherine A. Ornstein is an associate professor in the Department of Geriatrics and Palliative Medicine and the Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai
| | - Kenneth E Covinsky
- Kenneth E. Covinsky is a professor of medicine in the Division of Geriatrics, University of California San Francisco
| | - Evan Bollens-Lund
- Evan Bollens-Lund is a data analyst in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Diane E Meier
- Diane E. Meier is a professor in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Amy S Kelley
- Amy S. Kelley is an associate professor in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
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Freedman VA, Kasper JD. Cohort Profile: The National Health and Aging Trends Study (NHATS). Int J Epidemiol 2020; 48:1044-1045g. [PMID: 31237935 DOI: 10.1093/ije/dyz109] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Vicki A Freedman
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Judith D Kasper
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Engelberg Anderson JK, Jain P, Wade AJ, Morris AM, Slaboda JC, Norman GJ. Indicators of potential health-related social needs and the association with perceived health and well-being outcomes among community-dwelling medicare beneficiaries. Qual Life Res 2020; 29:1685-1696. [PMID: 31907869 DOI: 10.1007/s11136-019-02410-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Health-related social needs (HRSNs) can make older adults' more vulnerable and impact their health, well-being, and ability to age-in-place. The current study assessed the prevalence of potential HRSNs (pHRSNs) across several domains (e.g., transportation, social isolation) and explored the associations with health and well-being outcomes in a sample of Medicare beneficiaries. METHODS Cross-sectional analyses were conducted with a representative sample of community-dwelling Medicare beneficiaries (N = 5758) from the 2012 National Health and Aging Trends Study. Binary indicators of pHRSNs were created for five domains: medical and utility financial needs (MUFN), housing, nutrition, social isolation, and transportation. Outcomes were depression/anxiety, self-rated health, meaning/satisfaction, perceived control/adaptability. Variables were weighted, and multivariate regression models assessed associations between pHRSN variables and outcomes, controlling for sociodemographics and health conditions. RESULTS Of the estimated 32 million community-dwelling beneficiaries, approximately 13.3 million were positive for ≥ 1 pHRSN and 11.4 million for ≥ 2 pHRSNs. The prevalence by domain was 7% for housing, 8% for transportation, 12% for UMFN and nutrition, and 33% for social isolation. Each domain, except for housing, was significantly (p < .05) associated with at least two of the four outcomes, where being positive for a pHRSN was associated with greater depression/anxiety and poorer self-rated general health. CONCLUSIONS Over 40% of Medicare beneficiaries had ≥ 1 pHRSN indicators, which means they are more vulnerable and that may limit their ability to age-in-place. Given the growing aging population, better measures and methods are needed to identify, monitor, and address HRSNs. For example, leveraging existing community-based services through coordinated care may be an effective strategy to address older adults' HRSNs.
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Affiliation(s)
| | - Purva Jain
- West Health Institute, 10350 N Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Amy J Wade
- West Health Institute, 10350 N Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Andrea M Morris
- West Health Institute, 10350 N Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Jill C Slaboda
- West Health Institute, 10350 N Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Gregory J Norman
- University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
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Ornstein KA, Liu B, Schwartz RM, Smith CB, Alpert N, Taioli E. Cancer in the context of aging: Health characteristics, function and caregiving needs prior to a new cancer diagnosis in a national sample of older adults. J Geriatr Oncol 2020; 11:75-81. [PMID: 30952516 PMCID: PMC6774923 DOI: 10.1016/j.jgo.2019.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/25/2019] [Accepted: 03/25/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION As cancer trajectories change due to screening, earlier diagnoses, living longer with illnesses, and new successful treatments, cancer is increasingly a disease of older adults. While cancer diagnoses themselves are very stressful for patients and families, little is known about the health status, functional limitations, and social resources of older patients before they face a new cancer diagnosis. MATERIALS AND METHODS Using the National Health and Aging Trends Study (NHATS), a national survey of older Medicare beneficiaries linked to Medicare claims data, we examined the health characteristics, functional limitations and social and financial resources of older adults before a new diagnosis of lung, breast, prostate or colorectal cancer and how these factors vary by race/ethnicity. RESULTS We identified 274 community-dwelling older adults with incident cancer diagnoses: lung (30.6%), breast (20.3%), prostate (30.8%), and colorectal (18.3%) representing 1,202,920 older Medicare beneficiaries. The sample was 81% Non-Hispanic White, 10% Non-Hispanic Black, and 9% Hispanic/Other. Before diagnosis, patients had an average of three comorbidities and 29% of patients reported poor/fair health. Almost one-third were living alone, 13% received help with at least one activity of daily living (ADL), 11% had probable dementia and nearly one in ten already received financial help from family members. DISCUSSION Before an older adult has ever been diagnosed with a major cancer, many face significant health and financial challenges and are dependent on others for care. These needs vary based on cancer type and race/ethnicity and must be considered as clinicians develop individualized care plans for patients alongside caregivers.
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Affiliation(s)
- Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
| | - Bian Liu
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Rebecca M Schwartz
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, United States of America
| | - Cardinale B Smith
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, United States of America
| | - Naomi Alpert
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Emanuela Taioli
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Division of Hematology/Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
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Weaver RH, Roberto KA. Effects of Long-term Services and Supports on Survival of Poor, Highly Vulnerable Older Adults. THE GERONTOLOGIST 2019; 59:936-946. [PMID: 29726928 DOI: 10.1093/geront/gny040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We explore how an understudied population of older individuals addresses their ongoing care needs when ineligible for Medicaid waiver services. RESEARCH DESIGN AND METHODS Using regression techniques, we identified factors associated with service use and health outcomes among 1,008 older adults (60+) who applied for Medicaid waiver assistance. Exploratory follow-up interviews with eight waiver-ineligible rural-dwelling individuals identified strategies used for managing their care needs. RESULTS Mortality was high among study participants. Specifically, being waiver-ineligible increased the risk of mortality. Waiver-ineligible individuals were more likely to access alternative services and supports. Rural-dwelling older adults were less likely to be waiver-eligible, but twice as likely to access alternative services and supports, compared to nonrural older adults. Participants interviewed had ongoing unmet needs, relied on family and community services, and used internal and external strategies to manage care needs. DISCUSSION AND IMPLICATIONS Having unmet needs increased the risk of mortality, whereas receiving full waiver services extended the lives of recipients. More generous services extend the lives of older, highly vulnerable, community-residing older people. Less generous services also extended life, but not to the same extent. Individuals without formal assistance relied on various strategies to confront ongoing daily challenges. Assisting a broader range of older adults with unmet needs is essential in addressing care needs and maintaining functional capacity to remain at home.
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Affiliation(s)
- Raven H Weaver
- Department of Human Development, Washington State University, Pullman
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Lines LM, Cohen J, Halpern MT, Smith AW, Kent EE. Care experiences among dually enrolled older adults with cancer: SEER-CAHPS, 2005-2013. Cancer Causes Control 2019; 30:1137-1144. [PMID: 31422490 DOI: 10.1007/s10552-019-01218-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 08/09/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Given the associations between poverty and poorer outcomes among older adults with cancer, we sought to understand the effects of dual enrollment in Medicare and Medicaid-as a marker of poverty-on self-reported care experiences among seniors diagnosed with cancer. METHODS Retrospective, observational study using cancer registry, Medicare claims, and care experience survey data (Surveillance, Epidemiology, and End Results [SEER]-Consumer Assessment of Healthcare Providers and Systems [CAHPS®]) for a national sample of fee-for-service (FFS) and Medicare Advantage (MA) enrollees aged 65 or older. We included people with one incident primary, malignant cancer diagnosed between 2005 and 2011, surveyed within 2 years after diagnosis (n = 9,800; 995 dual enrollees). Medicare CAHPS measures included 5 global ratings and 3 composite scores. RESULTS After adjustment for potential confounders, people with cancer histories who were dually enrolled were significantly more likely to report better experiences than non-duals on 2 measures (Medicare/their health plan: adjusted odds ratio [aOR]: 0.68, 95% confidence interval [CI] 0.53-0.87; prescription drug plan [PDP]: aOR: 0.54, 95% CI 0.40-0.73). CONCLUSIONS Dual enrollees with cancer reported better experiences than Medicare-only enrollees in terms of their health plan (Medicare FFS or Medicare Advantage) and their PDP. Better ratings among dually enrolled beneficiaries suggest possible divergence between health outcomes and care experiences, warranting additional investigation.
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Affiliation(s)
- Lisa M Lines
- RTI International, 307 Waverley Oaks Rd, Suite 101, Waltham, MA, 02452, USA. .,University of Massachusetts Medical School, 55 Lake Ave. North, Worcester, MA, 01655, USA.
| | - Julia Cohen
- RTI International, 307 Waverley Oaks Rd, Suite 101, Waltham, MA, 02452, USA
| | - Michael T Halpern
- Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr., Room 3E4342, Bethesda, MD, 20892-9762, USA
| | - Ashley Wilder Smith
- Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr., Room 3E4342, Bethesda, MD, 20892-9762, USA
| | - Erin E Kent
- Gillings School of Public Health, University of North Carolina - Chapel Hill, 135 Dauer Dr., Chapel Hill, NC, 27559, USA
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Nee R, Yan G, Yuan CM, Agodoa LY, Norris KC. Use of Percutaneous Coronary Intervention Among Black and White Patients With End-Stage Renal Disease in the United States. J Am Heart Assoc 2019; 8:e012101. [PMID: 31331221 PMCID: PMC6761629 DOI: 10.1161/jaha.119.012101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Racial disparities in invasive cardiac procedures such as percutaneous coronary intervention (PCI) in the general population are well documented; however, national-level data on such disparities in the end-stage renal disease (ESRD) population are lacking. We assessed racial differences in PCI between black and white patients with ESRD on maintenance dialysis. Methods and Results Using the US Renal Data System database, we abstracted Medicare inpatient procedure claims for PCI in a cohort of 268 575 Medicare-primary patients who initiated treatment on maintenance dialysis from January 1, 2009, through June 1, 2013. We conducted Cox regression analyses with PCI being the event, adjusted for demographic characteristics, Hispanic ethnicity, cause of ESRD, comorbidities, and socioeconomic factors. We also assessed the probability of PCI, accounting for death or transplant in competing risk regression models. The crude incidence rate of PCI among white patients was 25.8 per 1000 patient-years versus 15.5 per 1000 patient-years among black patients. Cox regression analyses demonstrated that black patients were significantly less likely to undergo PCI compared with white patients (adjusted hazard ratio: 0.64; 95% CI, 0.62-0.67; P<0.001). In the competing risk models, the racial gap for PCI among black and white patients remained significant with death (subdistribution hazard ratio: 0.81; 95% CI, 0.76-0.85; P<0.001) or transplant as a competing event (subdistribution hazard ratio: 0.67; 95% CI, 0.64-0.70; P<0.001). Conclusions A racial gap exists in PCI use among dialysis patients despite having comprehensive coverage with Medicare. These findings persisted despite accounting for demographic, clinical, socioeconomic factors, and death or transplant as competing events.
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Affiliation(s)
- Robert Nee
- Nephrology Service Walter Reed National Military Medical Center Bethesda MD.,Uniformed Services University Bethesda MD
| | - Guofen Yan
- Department of Public Health Sciences University of Virginia School of Medicine Charlottesville VA
| | - Christina M Yuan
- Nephrology Service Walter Reed National Military Medical Center Bethesda MD.,Uniformed Services University Bethesda MD
| | | | - Keith C Norris
- Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA
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Wolff JL, Nicholas LH, Willink A, Mulcahy J, Davis K, Kasper JD. Medicare Spending and the Adequacy of Support With Daily Activities in Community-Living Older Adults With Disability: An Observational Study. Ann Intern Med 2019; 170:837-844. [PMID: 31132789 PMCID: PMC6736697 DOI: 10.7326/m18-2467] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Identifying factors that affect variation in health care spending among older adults with disability may reveal opportunities to better address their care needs while offsetting excess spending. OBJECTIVE To quantify differences in total Medicare spending among older adults with disability by whether they experience negative consequences due to inadequate support with household activities, mobility, or self-care. DESIGN Observational study of in-person interviews and linked Medicare claims. SETTING United States, 2015. PARTICIPANTS 3716 community-living older adults who participated in the 2015 NHATS (National Health and Aging Trends Study) and survived for 12 months. MEASUREMENTS Total Medicare spending by spending quartile in multivariable regression models that adjusted for individual characteristics. RESULTS Negative consequences were experienced by 18.3% of participants with disability in household activities, 25.6% with mobility disability, and 20.0% with self-care disability. Median Medicare spending was higher for those who experienced negative consequences due to household ($4866 vs. $4095), mobility ($7266 vs. $4115), and self-care ($10 935 vs. $4436) disability versus those who did not. In regression-adjusted analyses, median spending did not differ appreciably for participants who experienced negative consequences in household activities ($338 [95% CI, -$768 to $1444]), but was higher for those with mobility ($2309 [CI, $208 to $4409]) and self-care ($3187 [CI, $432 to $5942]) disability. In the bottom-spending quartile, differences were observed for self-care only ($1460 [CI, $358 to $2561]). No differences were observed in the top quartile. LIMITATION This observational study could not establish causality. CONCLUSION Inadequate support for mobility and self-care is associated with higher Medicare spending, especially in the middle and lower ends of the spending distribution. Better support for the care needs of older adults with disability could offset some Medicare spending. PRIMARY FUNDING SOURCE The Commonwealth Fund.
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Affiliation(s)
- Jennifer L Wolff
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.L.W., L.H.N., A.W., J.M., K.D., J.D.K.)
| | - Lauren H Nicholas
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.L.W., L.H.N., A.W., J.M., K.D., J.D.K.)
| | - Amber Willink
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.L.W., L.H.N., A.W., J.M., K.D., J.D.K.)
| | - John Mulcahy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.L.W., L.H.N., A.W., J.M., K.D., J.D.K.)
| | - Karen Davis
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.L.W., L.H.N., A.W., J.M., K.D., J.D.K.)
| | - Judith D Kasper
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.L.W., L.H.N., A.W., J.M., K.D., J.D.K.)
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