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Gianattasio KZ, Wachsmuth J, Murphy R, Hartzman A, Montazer J, Cutroneo E, Wittenborn J, Power MC, Rein DB. Case Definition for Diagnosed Alzheimer Disease and Related Dementias in Medicare. JAMA Netw Open 2024; 7:e2427610. [PMID: 39226058 PMCID: PMC11372506 DOI: 10.1001/jamanetworkopen.2024.27610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Importance Lack of a US dementia surveillance system hinders efforts to support and address disparities among persons living with Alzheimer disease and related dementias (ADRD). Objective To review diagnosis and prescription drug code ADRD identification algorithms to develop and implement case definitions for national surveillance. Design, Setting, and Participants In this cross-sectional study, a systematic literature review was conducted to identify unique International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and prescription drug codes used by researchers to identify ADRD in administrative records. Code frequency of use, characteristics of beneficiaries identified by codes, and expert and author consensus around code definitions informed code placement into categories indicating highly likely, likely, and possible ADRD. These definitions were applied cross-sectionally to 2017 to 2019 Medicare fee-for-service (FFS) claims and Medicare Advantage (MA) encounter data to classify January 2019 Medicare enrollees. Data analysis was conducted from September 2022 to March 2024. Exposures ICD-10-CM and national drug codes in FFS claims or MA encounters. Main Outcomes and Measures The primary outcome was counts and rates of beneficiaries meeting each case definition. Category-specific age, sex, race and ethnicity, MA enrollment, dual-eligibility, long-term care utilization, mortality, and rural residence distributions, as well as frailty scores and FFS monthly expenditures were also analyzed. Beneficiary characteristics were compared across categories, and age-standardized to minimize confounding by age. Results Of the 60 000 869 beneficiaries included (50 853 806 aged 65 years or older [84.8%]; 32 567 891 female [54.3%]; 5 555 571 Hispanic [9.3%]; 6 318 194 non-Hispanic Black [10.5%]; 44 384 980 non-Hispanic White [74.0%]), there were 4 312 496 (7.2%) with highly likely ADRD, 1 124 080 (1.9%) with likely ADRD, and 2 572 176 (4.3%) with possible ADRD, totaling more than 8.0 million with diagnostic evidence of at least possible ADRD. These beneficiaries were older, more frail, more likely to be female, more likely to be dual-eligible, more likely to use long-term care, and more likely to die in 2019 compared with beneficiaries with no evidence of ADRD. These differences became larger when moving from the possible ADRD group to the highly likely ADRD group. Mean (SD) FFS monthly spending was $2966 ($4921) among beneficiaries with highly likely ADRD compared with $936 ($2952) for beneficiaries with no evidence of ADRD. Differences persisted after age standardization. Conclusions and Relevance This cross-sectional study of 2019 Medicare beneficiaries identified more than 5.4 million Medicare beneficiaries with evidence of at least likely ADRD in 2019 using the diagnostic case definition. Pending validation against clinical and other methods of ascertainment, this approach can be adopted provisionally for national surveillance.
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Affiliation(s)
| | | | - Ryan Murphy
- NORC at the University of Chicago, Bethesda, Maryland
| | - Alex Hartzman
- NORC at the University of Chicago, Bethesda, Maryland
| | | | - Erin Cutroneo
- NORC at the University of Chicago, Bethesda, Maryland
| | | | - Melinda C Power
- Department of Epidemiology, George Washington University School of Public Health, Washington, DC
| | - David B Rein
- NORC at the University of Chicago, Bethesda, Maryland
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Thunell J, Wood K, Wharton W, Joyce G, Ferido P, Zissimopoulos J. Population Dementia Incidence and Direct Oral Anticoagulant Use in a Representative Population With Atrial Fibrillation. Neurology 2024; 103:e209568. [PMID: 38857466 PMCID: PMC11226323 DOI: 10.1212/wnl.0000000000209568] [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: 09/21/2023] [Accepted: 05/01/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Incidence and prevalence of atrial fibrillation (AF), a risk factor of dementia, have been increasing over time. Oral anticoagulation reduces risk of stroke and other negative outcomes of AF and may reduce dementia health inequities. The objective of this study was to estimate dementia incidence in patients with newly-diagnosed AF and taking an anticoagulant as use of direct oral anticoagulants (DOACs) increased. METHODS We used a retrospective cohort design with annual incident AF cohorts of community-dwelling Medicare Fee-for-Service beneficiaries, enrolled in Parts A, B, and D from 2007 to 2017. The sample was limited to beneficiaries aged 67 years and older with incident AF; no prior dementia; and use of anticoagulants warfarin, dabigatran, rivaroxaban, apixaban, or edoxaban in year t. RESULTS A total of 1,083,338 beneficiaries were included in the study, 58.5% female, with mean (SD) age 77.2 (6.75) years. Among anticoagulated, incident AF cohorts, use of DOACs increased from 10.6% in their first year of availability (2011) to 41.4% in 2017. Among incident AF cohorts taking any oral anticoagulant, 3-year dementia incidence did not change significantly over the cohorts after adjusting for confounders. For example, incidence was 9.1% (95% CI 8.9-9.4) among White persons diagnosed with AF in 2007 and 2008 and 8.9% (95% CI 8.7-9.1) in 2017. Across cohorts, dementia incidence was consistently highest for Black persons, followed by American Indian/Alaska Native and White persons, and lowest for Asian persons. In 2017, 10.9% (95% CI 10.4-11.3) of Black persons in the cohort developed dementia within 3 years, 9.4% (95% CI 8.0-10.9) of American Indian/Alaska Native, 8.9% (95% CI 8.7-9.1) of White, 8.7% (95% CI 8.2-9.1) of Hispanic, and 6.9% (95% CI 6.4-7.4) of Asian persons. Across race/ethnicity, 3-year stroke risk decreased consistently over time; however, the increasing availability of DOACs did not alter the trend. DISCUSSION Increased use of DOACs among incident AF cohorts from 2007 to 2017 was not associated with significant declines in dementia or stroke risk. Consideration of similar stroke and dementia risk, as well as differences in cost, is warranted when weighing the risks and benefits of available oral anticoagulants.
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Affiliation(s)
- Johanna Thunell
- From the Schaeffer Center for Health Policy and Economics (J.T., G.J., P.F., J.Z.), and Sol Price School of Public Policy (J.T., J.Z., P.F.), University of Southern California, Los Angeles; Woodruff School of Nursing (K.W.), and Department of Neurology (W.W.), School of Medicine, Emory University, Atlanta, GA; and Mann School of Pharmacy (G.J.), University of Southern California
| | - Kathryn Wood
- From the Schaeffer Center for Health Policy and Economics (J.T., G.J., P.F., J.Z.), and Sol Price School of Public Policy (J.T., J.Z., P.F.), University of Southern California, Los Angeles; Woodruff School of Nursing (K.W.), and Department of Neurology (W.W.), School of Medicine, Emory University, Atlanta, GA; and Mann School of Pharmacy (G.J.), University of Southern California
| | - Whitney Wharton
- From the Schaeffer Center for Health Policy and Economics (J.T., G.J., P.F., J.Z.), and Sol Price School of Public Policy (J.T., J.Z., P.F.), University of Southern California, Los Angeles; Woodruff School of Nursing (K.W.), and Department of Neurology (W.W.), School of Medicine, Emory University, Atlanta, GA; and Mann School of Pharmacy (G.J.), University of Southern California
| | - Geoffrey Joyce
- From the Schaeffer Center for Health Policy and Economics (J.T., G.J., P.F., J.Z.), and Sol Price School of Public Policy (J.T., J.Z., P.F.), University of Southern California, Los Angeles; Woodruff School of Nursing (K.W.), and Department of Neurology (W.W.), School of Medicine, Emory University, Atlanta, GA; and Mann School of Pharmacy (G.J.), University of Southern California
| | - Patricia Ferido
- From the Schaeffer Center for Health Policy and Economics (J.T., G.J., P.F., J.Z.), and Sol Price School of Public Policy (J.T., J.Z., P.F.), University of Southern California, Los Angeles; Woodruff School of Nursing (K.W.), and Department of Neurology (W.W.), School of Medicine, Emory University, Atlanta, GA; and Mann School of Pharmacy (G.J.), University of Southern California
| | - Julie Zissimopoulos
- From the Schaeffer Center for Health Policy and Economics (J.T., G.J., P.F., J.Z.), and Sol Price School of Public Policy (J.T., J.Z., P.F.), University of Southern California, Los Angeles; Woodruff School of Nursing (K.W.), and Department of Neurology (W.W.), School of Medicine, Emory University, Atlanta, GA; and Mann School of Pharmacy (G.J.), University of Southern California
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Thunell JA, Joyce GF, Ferido PM, Chen Y, Guadamuz JS, Qato DM, Zissimopoulos JM. Diagnoses and Treatment of Behavioral and Psychological Symptoms of Dementia Among Racially and Ethnically Diverse Persons Living with Dementia. J Alzheimers Dis 2024; 99:513-523. [PMID: 38669535 DOI: 10.3233/jad-231266] [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: 04/28/2024]
Abstract
Background Behavioral and psychological symptoms of dementia (BPSD) and prescribed central nervous system (CNS) active drugs to treat them are prevalent among persons living with Alzheimer's disease and related dementias (PLWD) and lead to negative outcomes for PLWD and their caregivers. Yet, little is known about racial/ethnic disparities in diagnosis and use of drugs to treat BPSD. Objective Quantify racial/ethnic disparities in BPSD diagnoses and CNS-active drug use among community-dwelling PLWD. Methods We used a retrospective cohort of community-dwelling Medicare Fee-for-Service beneficiaries with dementia, continuously enrolled in Parts A, B and D, 2017-2019. Multivariate logistic models estimated rates of BPSD diagnosis and, conditional on diagnosis, CNS-active drug use. Results Among PLWD, 67.1% had diagnoses of an affective, psychosis or hyperactivity symptom. White (68.3%) and Hispanic (63.9%) PLWD were most likely, Blacks (56.6%) and Asians (52.7%) least likely, to have diagnoses. Among PLWD with BPSD diagnoses, 78.6% took a CNS-active drug. Use was highest among whites (79.3%) and Hispanics (76.2%) and lowest among Blacks (70.8%) and Asians (69.3%). Racial/ethnic differences in affective disorders were pronounced, 56.8% of white PLWD diagnosed; Asians had the lowest rates (37.8%). Similar differences were found in use of antidepressants. Conclusions BPSD diagnoses and CNS-active drug use were common in our study. Lower rates of BPSD diagnoses in non-white compared to white populations may indicate underdiagnosis in clinical settings of treatable conditions. Clinicians' review of prescriptions in this population to reduce poor outcomes is important as is informing care partners on the risks/benefits of using CNS-active drugs.
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Affiliation(s)
- Johanna A Thunell
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC Sol Price School of Public Policy, Los Angeles, CA, USA
| | - Geoffrey F Joyce
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC School of Pharmacy, Los Angeles, CA, USA
| | - Patricia M Ferido
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
| | - Yi Chen
- Rush Alzheimer's Disease Center, Chicago, IL, USA
| | - Jenny S Guadamuz
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC School of Pharmacy, Los Angeles, CA, USA
| | - Dima M Qato
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC School of Pharmacy, Los Angeles, CA, USA
| | - Julie M Zissimopoulos
- USC Schaeffer Center for Health Policy and Economics, Los Angeles, CA, USA
- USC Sol Price School of Public Policy, Los Angeles, CA, USA
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Schiaffino MK, Schumacher JR, Nalawade V, Nguyen PTN, Yakuta M, Gilbert PE, Dale W, Murphy JD, Moore AA. The disproportionate burden of Alzheimer's disease and related dementias (ADRD) in diverse older adults diagnosed with cancer. J Geriatr Oncol 2023; 14:101610. [PMID: 37666209 PMCID: PMC11086668 DOI: 10.1016/j.jgo.2023.101610] [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: 04/18/2023] [Revised: 06/26/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Older adults living with Alzheimer's disease and related dementias (ADRD) who are then diagnosed with cancer are an understudied population. While the role of cognitive impairment during and after cancer treatment have been well-studied, less is understood about patients who are living with ADRD and then develop cancer. The purpose of this study is to contribute evidence about our understanding of this vulnerable population. MATERIALS AND METHODS This was a retrospective cohort study of a linked, representative family of databases of cancer registries and Medicare administrative claims that make up the SEER-Medicare database. Older adults ages 68 and older with a first primary cancer type: breast, cervical, colorectal, lung, oral, or prostate were eligible for inclusion (N = 337,932). Prevalence estimates of ADRD across cancer types and a 5% non-cancer comparison sample were compared by patient factors. RESULTS The overall prevalence of patients who had an ADRD diagnosis anytime in the three years prior to their cancer diagnosis was 5.6%. Patients with ADRD were more likely to be female, older (over age 75), a racial/ethnic minority, single, with multiple chronic conditions, and a tumor diagnosed early (stage I) or were unstaged. Black patients with colorectal and oral cancer had the highest and second highest prevalence of ADRD compared to White patients (13.46% vs 7.95% and 12.64% vs 7.82% respectively, p < .0001). We observed the highest prevalence of ADRD among Black patients for breast (11.85%), cervical (11.98%), lung (8.41%), prostate (4.83), and the 5% sample (9.50%, p > .0001). DISCUSSION The higher prevalence of ADRD among Black and Latine older adults with cancer not only aligns with the trend observed in our non-cancer comparison sample, but also, these findings demonstrate the compounded risk experienced by minoritized older adults over the life course. The greater than expected prevalence of patients with ADRD who go on to develop cancer demonstrates better assessment of cognition is urgently needed. Accurate identification of these vulnerable populations is critical to improve assessment, care coordination, and address inequities in screening and treatment planning.
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Affiliation(s)
- Melody K Schiaffino
- School of Public Health, San Diego State University, San Diego, CA, USA; Center for Health Equity, Education, and Research, School of Medicine, UC San Diego, La Jolla, CA, USA; Division of Radiation Medicine and Applied Sciences, School of Medicine, UC San Diego, La Jolla, CA, USA; Division of Geriatrics, Gerontology, and Palliative Medicine, UC San Diego, CA, USA.
| | - Jessica R Schumacher
- Department of Surgery, School of Medicine, UNC Chapel Hill, Chapel Hill, NC, USA.
| | - Vinit Nalawade
- Division of Radiation Medicine and Applied Sciences, School of Medicine, UC San Diego, La Jolla, CA, USA.
| | - Phuong Thi Ngoc Nguyen
- Interdisciplinary Graduate Program in Informatics, University of Iowa, Iowa City, IA, USA.
| | - Melissa Yakuta
- San Diego Health and Human Services Agency, San Diego, CA, USA.
| | - Paul E Gilbert
- Department of Psychology, San Diego State University, San Diego, CA, USA.
| | - William Dale
- Department of Supportive Care Medicine, City of Hope, Duarte, CA, USA.
| | - James D Murphy
- Center for Health Equity, Education, and Research, School of Medicine, UC San Diego, La Jolla, CA, USA; Division of Radiation Medicine and Applied Sciences, School of Medicine, UC San Diego, La Jolla, CA, USA.
| | - Alison A Moore
- Division of Geriatrics, Gerontology, and Palliative Medicine, UC San Diego, CA, USA.
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Bélanger E, Rosendaal N, Gutman R, Lake D, Santostefano CM, Meyers DJ, Gozalo PL. Identifying Medicare beneficiaries with Alzheimer's disease and related dementia using home health OASIS assessments. J Am Geriatr Soc 2023; 71:3229-3236. [PMID: 37358283 PMCID: PMC10592468 DOI: 10.1111/jgs.18487] [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: 12/19/2022] [Revised: 04/24/2023] [Accepted: 05/21/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Home health services are an important site of care following hospitalization among Medicare beneficiaries, providing health assessments that can be leveraged to detect diagnoses that are not available in other data sources. In this work, we aimed to develop a parsimonious and accurate algorithm using home health outcome and assessment information set (OASIS) measures to identify Medicare beneficiaries with a diagnosis of Alzheimer's disease and related dementia (ADRD). METHODS We conducted a retrospective cohort study of Medicare beneficiaries with a complete OASIS start of care assessment in 2014, 2016, 2018, or 2019 to determine how well the items from various versions could identify those with an ADRD diagnosis by the assessment date. The prediction model was developed iteratively, comparing the performance of different models in terms of sensitivity, specificity, and accuracy of prediction, from a multivariable logistic regression model using clinically relevant variables, to regression models with all available variables and predictive modeling techniques, to estimate the best performing parsimonious model. RESULTS The most important predictors of having a diagnosis of ADRD by the start of care OASIS assessment were a prior discharge diagnosis of ADRD among those admitted from an inpatient setting, and frequently exhibiting symptoms of confusion. Results from the parsimonious model were consistent across the four annual cohorts and OASIS versions with high specificity (above 96%), but poor sensitivity (below 58%). The positive predictive value was high, over 87% across study years. CONCLUSIONS The proposed algorithm has high accuracy, requires a single OASIS assessment, is easy to implement without sophisticated statistical models, and can be used across four OASIS versions and in situations where claims are not available to identify individuals with a diagnosis of ADRD, including the growing population of Medicare Advantage beneficiaries.
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Affiliation(s)
- Emmanuelle Bélanger
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Nicole Rosendaal
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Roee Gutman
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Derek Lake
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Christopher M Santostefano
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - David J Meyers
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Pedro L Gozalo
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
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Dinesh D, Shao Q, Palnati M, McDannold S, Zhang Q, Monfared AAT, Jasuja GK, Davila H, Xia W, Moo LR, Miller DR, Palacios N. The epidemiology of mild cognitive impairment, Alzheimer's disease and related dementia in U.S. veterans. Alzheimers Dement 2023; 19:3977-3984. [PMID: 37114952 DOI: 10.1002/alz.13071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/25/2022] [Accepted: 11/10/2022] [Indexed: 04/29/2023]
Abstract
INTRODUCTION US veterans have a unique dementia risk profile that may be evolving over time. METHODS Age-standardized incidence and prevalence of Alzheimer's disease (AD), AD and related dementias (ADRD), and mild cognitive impairment (MCI) was estimated from electronic health records (EHR) data for all veterans aged 50 years and older receiving Veterans Health Administration (VHA) care from 2000 to 2019. RESULTS The annual prevalence and incidence of AD declined, as did ADRD incidence. ADRD prevalence increased from 1.07% in 2000 to 1.50% in 2019, primarily due to an increase in the prevalence of dementia not otherwise specified. The prevalence and incidence of MCI increased sharply, especially after 2010. The prevalence and incidence of AD, ADRD, and MCI were highest in the oldest veterans, in female veterans, and in African American and Hispanic veterans. DISCUSSION We observed 20-year trends of declining prevalence and incidence of AD, increasing prevalence of ADRD, and sharply increasing prevalence and incidence of MCI.
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Affiliation(s)
- Deepika Dinesh
- Department of Public Health, University of Massachusetts at Lowell, Zuckerberg College of Health Sciences, Lowell, Massachusetts, USA
- Center for Population Health, Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell, Massachusetts, USA
| | - Qing Shao
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
| | - Madhuri Palnati
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
| | - Sarah McDannold
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
| | - Quanwu Zhang
- Easai Inc., Neurology Business Group, Woodcliff Lake, New Jersey, USA
| | - Amir Abbas Tahami Monfared
- Easai Inc., Neurology Business Group, Woodcliff Lake, New Jersey, USA
- McGill University, Epidemiology, Biostatistics, and Occupational Health, Montreal, Quebec, Canada
| | - Guneet K Jasuja
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Heather Davila
- Center for Access & Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa, USA
- General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Weiming Xia
- Bedford VA Healthcare System, Geriatric Research and Education Clinical Center, Bedford, Massachusetts, USA
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Lauren R Moo
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
- Bedford VA Healthcare System, Geriatric Research and Education Clinical Center, Bedford, Massachusetts, USA
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
| | - Donald R Miller
- Center for Population Health, Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell, Massachusetts, USA
- Bedford VA Healthcare System, Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, USA
| | - Natalia Palacios
- Department of Public Health, University of Massachusetts at Lowell, Zuckerberg College of Health Sciences, Lowell, Massachusetts, USA
- Center for Population Health, Department of Biomedical and Nutritional Sciences, University of Massachusetts, Lowell, Massachusetts, USA
- Bedford VA Healthcare System, Geriatric Research and Education Clinical Center, Bedford, Massachusetts, USA
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Thunell JA, Ferido P, Zissimopoulos JM. COVID-19 hospitalization and mortality in community-dwelling racially and ethnically diverse persons living with dementia. J Am Geriatr Soc 2023; 71:1429-1439. [PMID: 36637869 PMCID: PMC10175159 DOI: 10.1111/jgs.18230] [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: 05/12/2022] [Revised: 12/08/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Community-dwelling persons living with dementia (PLWD) are vulnerable to COVID-19 infection, severity, and mortality due to the high prevalence of comorbidities, reliance on caregivers, and potential inability to employ risk reduction measures, among other factors. METHODS We used a retrospective cohort of Medicare Fee-For-Service beneficiaries enrolled from January 2018 to September 2020 (n = 13,068,583), a comparison cohort from January 2019 to April 2021 (n = 13,250,297), and logistic regression to estimate the effect of dementia on COVID-19 hospitalization and mortality in community-dwelling older persons. RESULTS COVID-19 diagnoses were higher among persons living with dementia (PLWD) than those without dementia. Conditional on COVID-19 in the 2020 cohort, White PLWD were at higher risk of hospitalization compared to White persons without dementia (aOR 1.31, 95% CI: 1.26-1.36) and marginal for Black PLWD (aOR 1.10, 95% CI: 1.01-1.20), no significant differences were found within other racial/ethnic groups. PLWD were 1.8 times (aOR 1.78, 95% CI: 1.72-1.84) more likely to die within 30 days of COVID-19 on average. Within racial/ethnic groups, the estimate for White PLWD, compared with White persons without dementia, was highest (aOR 2.01, 95% CI: 1.92-2.10), followed by Black PLWD (aOR 1.55, 95% CI: 1.41-1.70), and smallest among Hispanic PLWD (aOR 1.37, 95% CI: 1.24-1.50). PLWD hospitalized with COVID-19 were 1.6 times (aOR 1.59, 95% CI: 1.52-1.67) more likely to die within 30 days than similar persons without dementia. Estimates from the 2021 cohort, when vaccines were available to older persons, were similar to those in 2020. CONCLUSIONS Community-dwelling PLWD experienced worse outcomes after a COVID-19 diagnosis than their counterparts without dementia. Results demonstrating higher mortality, but not hospitalization rates, for all races/ethnicities except White PLWD suggest there may have been differential care/treatment that point to potential health care system inequities that persisted into 2021. Understanding the mechanisms underlying these differences may improve ongoing care for community-dwelling PLWD.
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Affiliation(s)
- Johanna A Thunell
- Price School of Public Policy, University of Southern California, Los Angeles, California, USA
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Patricia Ferido
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Julie M Zissimopoulos
- Price School of Public Policy, University of Southern California, Los Angeles, California, USA
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
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Arbeev KG, Bagley O, Yashkin AP, Duan H, Akushevich I, Ukraintseva SV, Yashin AI. Understanding Alzheimer's disease in the context of aging: Findings from applications of stochastic process models to the Health and Retirement Study. Mech Ageing Dev 2023; 211:111791. [PMID: 36796730 PMCID: PMC10085865 DOI: 10.1016/j.mad.2023.111791] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/27/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023]
Abstract
There is growing literature on applications of biodemographic models, including stochastic process models (SPM), to studying regularities of age dynamics of biological variables in relation to aging and disease development. Alzheimer's disease (AD) is especially good candidate for SPM applications because age is a major risk factor for this heterogeneous complex trait. However, such applications are largely lacking. This paper starts filling this gap and applies SPM to data on onset of AD and longitudinal trajectories of body mass index (BMI) constructed from the Health and Retirement Study surveys and Medicare-linked data. We found that APOE e4 carriers are less robust to deviations of trajectories of BMI from the optimal levels compared to non-carriers. We also observed age-related decline in adaptive response (resilience) related to deviations of BMI from optimal levels as well as APOE- and age-dependence in other components related to variability of BMI around the mean allostatic values and accumulation of allostatic load. SPM applications thus allow revealing novel connections between age, genetic factors and longitudinal trajectories of risk factors in the context of AD and aging creating new opportunities for understanding AD development, forecasting trends in AD incidence and prevalence in populations, and studying disparities in those.
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Affiliation(s)
- Konstantin G Arbeev
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC 27705, USA.
| | - Olivia Bagley
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC 27705, USA
| | - Arseniy P Yashkin
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC 27705, USA
| | - Hongzhe Duan
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC 27705, USA
| | - Igor Akushevich
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC 27705, USA
| | - Svetlana V Ukraintseva
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC 27705, USA
| | - Anatoliy I Yashin
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC 27705, USA
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Bae-Shaaw YH, Shier V, Sood N, Seabury SA, Joyce G. Potentially Inappropriate Medication Use in Community-Dwelling Older Adults Living with Dementia. J Alzheimers Dis 2023; 93:471-481. [PMID: 37038818 DOI: 10.3233/jad-221168] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Background: The Beers Criteria identifies potentially inappropriate medications (PIMs) that should be avoided in older adults living with dementia. Objective: The aim of this study was to provide estimates of the prevalence and persistence of PIM use among community-dwelling older adults living with dementia in 2011-2017. Methods: Medicare claims data were used to create an analytic dataset spanning from 2011 to 2017. The analysis included community-dwelling Medicare fee-for-service beneficiaries aged 65 and older who were enrolled in Medicare Part D plans, had diagnosis for dementia, and were alive for at least one calendar year. Dementia status was determined using Medicare Chronic Conditions Date Warehouse (CCW) Chronic Condition categories and Charlson Comorbidity Index. PIM use was defined as 2 or more prescription fills with at least 90 days of total days-supply in a calendar year. Descriptive statistics were used to report the prevalence and persistence of PIM use. Results: Of 1.6 million person-year observations included in the sample, 32.7% used one or more PIMs during a calendar year in 2011-2017. Breakdown by drug classes showed that 14.9% of the sample used anticholinergics, 14.0% used benzodiazepines, and 11.0% used antipsychotics. Conditional on any use, mean annual days-supply for all PIMs was 270.6 days (SD = 102.7). The mean annual days-supply for antipsychotic use was 302.7 days (SD = 131.2). Conclusion: Significant proportion of community-dwelling older adults with dementia used one or more PIMs, often for extended periods of time. The antipsychotic use in the community-dwelling older adults with dementia remains as a significant problem.
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Affiliation(s)
- Yuna H. Bae-Shaaw
- University of Southern California School of Pharmacy, Los Angeles, CA, USA
| | - Victoria Shier
- University of Southern California Sol Price School of Public Policy, Los Angeles, CA, USA
| | - Neeraj Sood
- University of Southern California Sol Price School of Public Policy, Los Angeles, CA, USA
| | - Seth A. Seabury
- University of Southern California School of Pharmacy, Los Angeles, CA, USA
| | - Geoffrey Joyce
- University of Southern California School of Pharmacy, Los Angeles, CA, USA
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Rini JF, Tsoy E, Peet B, Best J, Tanner JA, Asken BM, Sanchez A, Apple AC, VandeVrede L, Stephens ML, Erkkinen M, Kramer JH, Miller BL. Feasibility and Acceptability of a Multidisciplinary Academic Telemedicine System for Memory Care in Response to COVID-19. Neurol Clin Pract 2022; 12:e199-e209. [PMID: 36540141 PMCID: PMC9757120 DOI: 10.1212/cpj.0000000000200099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/26/2022] [Indexed: 01/30/2023]
Abstract
Background and Objectives In response to the restrictions imposed by the COVID-19 pandemic, the University of California San Francisco Memory and Aging Center (UCSF MAC) has deployed a comprehensive telemedicine model for the diagnosis and management of Alzheimer disease and related dementias. This review summarizes a large academic behavioral neurology clinic's experience transitioning to telemedicine services, including the impact on clinic care indicators, access metrics, and provider's experience. We compared these outcomes from 3 years before COVID-19 to 12 months after the transition to video teleconferencing (VTC) encounters. Methods Patient demographics and appointment data (dates, visit types, and departments) were extracted from our institution's electronic health record database from January 1, 2017, to May 1, 2021. We present data as descriptive statistics and comparisons using Wilcoxon rank-sum tests and Fisher exact tests. The results of anonymous surveys conducted among the clinic's providers are reported as descriptive findings. Results After the implementation of telemedicine services, the proportion of clinic encounters completed via VTC increased from 1.9% to 86.4%. There was a statistically significant decline in both the percentage of scheduled appointments that were canceled (32.9% vs 27.9%; p < 0.01) and total cancelations per month (mean 240.3 vs 179.4/mo; p < 0.01). There was an increase in the percentage of completed scheduled appointments (60.2% vs 64.8%; p < 0.01) and an increase in the average estimated commuting distance patients would need to drive for follow-up appointments (mean 49.8 vs 54.7 miles; p < 0.01). The transition to telemedicine services did not significantly affect the clinic's patient population as measured by age, gender, estimated income, area deprivation index, or self-reported racial/ethnic identity. The results of the provider survey revealed that physicians reported a more positive experience relative to neuropsychologists. Both types of providers reported telemedicine services as a reasonable equivalent and acceptable alternative to in-person evaluations with notable caveats. Discussion UCSF MAC's comprehensive integration of telemedicine services maintained critical ambulatory care to patients living with dementia during the COVID-19 pandemic. The recognized benefits of our care model suggest dementia telemedicine may be used as a feasible and equivalent alternative to in-person ambulatory care in the after COVID-19 era.
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Affiliation(s)
- James Fraser Rini
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Elena Tsoy
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Bradley Peet
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - John Best
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Jeremy A Tanner
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Breton M Asken
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Alejandra Sanchez
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Alexandra C Apple
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Lawren VandeVrede
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Melanie L Stephens
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Michael Erkkinen
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Joel H Kramer
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Bruce L Miller
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
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11
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Thunell JA, Jacobson M, Joe EB, Zissimopoulos JM. Medicare's Annual Wellness Visit and diagnoses of dementias and cognitive impairment. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12357. [PMID: 36177153 PMCID: PMC9473487 DOI: 10.1002/dad2.12357] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/08/2022] [Accepted: 08/09/2022] [Indexed: 06/16/2023]
Abstract
Introduction Early detection of Alzheimer's disease and related dementias allows clinicians and patients to prepare for future needs and identify treatment options. Medicare's Annual Wellness Visit (AWV) requires detection of cognitive impairment and may increase dementia diagnosis. We estimated the relationship between AWV receipt and incident dementia. Methods Using a retrospective cohort of Medicare Fee-For-Service (FFS) beneficiaries enrolled for at least 3 years from 2009 to 2016 and two-stage least squares, we quantified the relationship between AWV and incident diagnosis of cognitive impairment/dementia, and by race/ethnicity. The county-level change in percent of beneficiaries receiving AWVs was used as an instrumental variable to account for unobserved factors associated with individuals' AWV receipt and diagnosis. Sample included 3,333,617 beneficiaries ages 67 years and older, without dementia at the beginning of the study. Results Beneficiaries included 2,713,573 White, 251,958 Black, 196,845 Hispanic, 95,719 Asian, 11,727 American Indian/Alaska Native, and 63,795 of other race/ethnicity. Using ordinary least squares, dementia incidence was -0.79 percentage points (95% CI -0.81 to -0.76) lower for persons receiving an AWV compared to no AWV. Using instrumental variables reversed the direction of the effect: AWV receipt increased dementia diagnoses by 0.47 percentage points (95% CI 0.14 to 0.80), 15% over baseline. AWVs increased diagnoses 2.0 percentage points (95% CI 0.05 to 3.94) among Blacks, 0.40 percentage points (95% CI 0.05 to 0.75) among Whites, but est were imprecise for Hispanics and Asians. Discussion Increasing AWV take-up and supporting physicians' performance of cognitive assessment may further improve dementia detection in the population and among groups at higher risk of undiagnosed dementia.
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Affiliation(s)
- Johanna A. Thunell
- University of Southern California Price School of Public PolicyLos AngelesCaliforniaUSA
- Schaeffer Center for Health Policy and EconomicsUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Mireille Jacobson
- Schaeffer Center for Health Policy and EconomicsUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- University of Southern California Leonard Davis School of GerontologyLos AngelesCaliforniaUSA
| | - Elizabeth B. Joe
- University of Southern California Keck School of MedicineLos AngelesCaliforniaUSA
- University of Southern California Department of NeurologyLos AngelesCaliforniaUSA
| | - Julie M. Zissimopoulos
- University of Southern California Price School of Public PolicyLos AngelesCaliforniaUSA
- Schaeffer Center for Health Policy and EconomicsUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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12
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Joyce G, Ferido P, Thunell J, Tysinger B, Zissimopoulos J. Benzodiazepine use and the risk of dementia. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12309. [PMID: 35874428 PMCID: PMC9297381 DOI: 10.1002/trc2.12309] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/14/2022] [Accepted: 05/05/2022] [Indexed: 04/26/2023]
Abstract
Introduction Benzodiazepines (BZDs) are commonly prescribed for anxiety and agitations, which are early symptoms of Alzheimer's disease and related dementias (ADRD). It is unclear whether BZDs causally affect ADRD risk or are prescribed in response to early symptoms of dementia. Methods We replicate prior case-control studies using longitudinal Medicare claims. To mitigate bias from prodromal use, we compare rates of ADRD diagnosis for beneficiaries exposed and unexposed to BZDs for cervical/lumbar pain, stenosis, and sciatica, none of which are associated with dementia. Results Approximately 8% of Medicare beneficiaries used a BZD in 2007, increasing to nearly 13% by 2013. Estimates from case-control designs are sensitive to duration of look-back period, health histories, medication use, and exclusion of decedents. Incident BZD use is not associated with an increased risk of dementia in an "uncontaminated" sample of beneficiaries prescribed a BZD for pain (odds ratios (ORs) of 1.007 [95% confidence interval [CI] = 0.885, 1.146] and 0.986 [95% CI = 0.877, 1.108], respectively, in the 2013 and 2013 to 2015 pooled samples). Higher levels of BZD exposure (>365 days over a 2-year period) are associated with increased odds of a dementia diagnosis, but the results are not statistically significant at the 5% or 10% levels (1.190 [95% CI = 0.925, 1.531] and 1.167 [95% CI = 0.919, 1.483]). Discussion We find little evidence of a causal relation between BZD use and dementia risk. Nonetheless, providers should limit the extended use in elderly populations.
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Affiliation(s)
- Geoffrey Joyce
- University of Southern California (USC)Schaeffer Center for Health Policy and EconomicsLos AngelesCALos Angeles County
- USC School of PharmacyLos AngelesCALos Angeles County
| | - Patricia Ferido
- University of Southern California (USC)Schaeffer Center for Health Policy and EconomicsLos AngelesCALos Angeles County
| | - Johanna Thunell
- University of Southern California (USC)Schaeffer Center for Health Policy and EconomicsLos AngelesCALos Angeles County
| | - Bryan Tysinger
- University of Southern California (USC)Schaeffer Center for Health Policy and EconomicsLos AngelesCALos Angeles County
- USC Price School of Public PolicyLos AngelesCALos Angeles County
| | - Julie Zissimopoulos
- University of Southern California (USC)Schaeffer Center for Health Policy and EconomicsLos AngelesCALos Angeles County
- USC Price School of Public PolicyLos AngelesCALos Angeles County
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13
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McCarthy EP, Chang CH, Tilton N, Kabeto MU, Langa KM, Bynum JPW. Validation of Claims Algorithms to Identify Alzheimer's Disease and Related Dementias. J Gerontol A Biol Sci Med Sci 2022; 77:1261-1271. [PMID: 34919686 PMCID: PMC9159657 DOI: 10.1093/gerona/glab373] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Using billing data generated through health care delivery to identify individuals with dementia has become important in research. To inform tradeoffs between approaches, we tested the validity of different Medicare claims-based algorithms. METHODS We included 5 784 Medicare-enrolled, Health and Retirement Study participants aged older than 65 years in 2012 clinically assessed for cognitive status over multiple waves and determined performance characteristics of different claims-based algorithms. RESULTS Positive predictive value (PPV) of claims ranged from 53.8% to 70.3% and was highest using a revised algorithm and 1 year of observation. The tradeoff of greater PPV was lower sensitivity; sensitivity could be maximized using 3 years of observation. All algorithms had low sensitivity (31.3%-56.8%) and high specificity (92.3%-98.0%). Algorithm test performance varied by participant characteristics, including age and race. CONCLUSION Revised algorithms for dementia diagnosis using Medicare administrative data have reasonable accuracy for research purposes, but investigators should be cognizant of the tradeoffs in accuracy among the approaches they consider.
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Affiliation(s)
- Ellen P McCarthy
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Chiang-Hua Chang
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas Tilton
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mohammed U Kabeto
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Kenneth M Langa
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Julie P W Bynum
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
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14
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Chen Y, Crimmins E, Ferido P, Zissimopoulos JM. Racial/Ethnic Disparities in Length of Life after Dementia Diagnosis: an 18-Year Follow-up Study of Medicare Beneficiaries. THE LANCET REGIONAL HEALTH - AMERICAS 2022; 8. [PMID: 35814361 PMCID: PMC9264371 DOI: 10.1016/j.lana.2021.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background Methods Findings Interpretation
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15
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Borson S, Chen A, Wang SE, Nguyen HQ. Patterns of incident dementia codes during the COVID-19 pandemic at an integrated healthcare system. J Am Geriatr Soc 2021; 69:3389-3396. [PMID: 34664262 PMCID: PMC8657536 DOI: 10.1111/jgs.17527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/26/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The COVID-19 pandemic delayed diagnosis and care for some acute conditions and reduced monitoring for some chronic conditions. It is unclear whether new diagnoses of chronic conditions such as dementia were also affected. We compared the pattern of incident Alzheimer's disease and related dementia (ADRD) diagnosis codes from 2017 to 2019 through 2020, the first pandemic year. METHODS Retrospective cohort design, leveraging 2015-2020 data on all members 65 years and older with no prior ADRD diagnosis, enrolled in a large integrated healthcare system for at least 2 years. Incident ADRD was defined as the first ICD-10 code at any encounter, including outpatient (face-to-face, video, or phone), hospital (emergency department, observation, or inpatient), or continuing care (home, skilled nursing facility, and long-term care). We also examined incident ADRD codes and use of telehealth by age, sex, race/ethnicity, and spoken language. RESULTS Compared to overall annual incidence rates for ADRD codes in 2017-2019, 2020 incidence was slightly lower (1.30% vs. 1.40%), partially compensating later in the year for reduced rates during the early months of the pandemic. No racial or ethnic group differences were identified. Telehealth ADRD codes increased fourfold, making up for a 39% drop from face-to-face outpatient encounters. Older age (85+) was associated with higher odds of receiving telecare versus face-to-face care in 2020 (OR:1.50, 95%CI: 1.25-1.80) and a slightly lower incidence of new codes; no racial/ethnic, sex, or language differences were identified in the mode of care. CONCLUSIONS Rates of incident ADRD codes dropped early in the first pandemic year but rose again to near pre-pandemic rates for the year as a whole, as clinicians rapidly pivoted to telehealth. With refinement of protocols for remote dementia detection and diagnosis, health systems could improve access to equitable detection and diagnosis of ADRD going forward.
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Affiliation(s)
- Soo Borson
- Department of Psychiatry and Behavioral Sciences, School of MedicineUniversity of WashingtonSeattleWashingtonUSA
- Department of Family MedicineUniversity of Southern California, Keck School of MedicineLos AngelesCaliforniaUSA
| | - Aiyu Chen
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCaliforniaUSA
| | - Susan E. Wang
- West Los Angeles Medical CenterKaiser Permanente Southern CaliforniaPasadenaCaliforniaUSA
| | - Huong Q. Nguyen
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCaliforniaUSA
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16
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Zhou B, Zissimopoulos J, Nadeem H, Crane MA, Goldman D, Romley JA. Association between exenatide use and incidence of Alzheimer's disease. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12139. [PMID: 33614900 PMCID: PMC7882542 DOI: 10.1002/trc2.12139] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/25/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Recent developments suggest that insulin-sensitizing agents used to treat type II diabetes (T2DM) may also prove useful in reducing the risk of Alzheimer's disease (AD). The objective of this study is to analyze the association between exenatide use among Medicare beneficiaries with T2DM and the incidence of AD. METHODS We performed a retrospective cohort analysis on claims data from a 20% random sample of Medicare beneficiaries with T2DM from 2007 to 2013 (n = 342,608). We compared rates of incident AD between 2009 and 2013 according to exenatide use in 2007-2008, measured by the number of 30-day-equivalent fills. We adjusted for demographics, comorbidities, and use of other drugs. Unmeasured confounding was assessed with an instrumental variables approach. RESULTS The sample was mostly female (65%), White (76%), and 74 years old on average. Exenatide users were more likely to be male (38% vs. 35%), White (87% vs. 76%), and younger (by 4.2 years) than non-users. Each additional 30-day-equivalent claim was associated with a 2.4% relative reduction in incidence (odds ratio 0.976; 95% confidence interval 0.963-0.989; P < .001). There was no evidence of unmeasured confounding. DISCUSSION Exenatide use is associated with a reduced incidence of AD among Medicare beneficiaries aged 65 years or older with T2DM. The association shown in this study warrants consideration by clinicians prescribing insulin sensitizing agents to patients.
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Affiliation(s)
- Bo Zhou
- USC Schaeffer Center for Health Policy and EconomicsLos AngelesCaliforniaUSA
- USC School of PharmacyLos AngelesCaliforniaUSA
| | - Julie Zissimopoulos
- USC Schaeffer Center for Health Policy and EconomicsLos AngelesCaliforniaUSA
- USC Price School of Public PolicyLos AngelesCaliforniaUSA
| | - Hasan Nadeem
- University of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | | | - Dana Goldman
- USC Schaeffer Center for Health Policy and EconomicsLos AngelesCaliforniaUSA
- USC School of PharmacyLos AngelesCaliforniaUSA
- USC Price School of Public PolicyLos AngelesCaliforniaUSA
| | - John A. Romley
- USC Schaeffer Center for Health Policy and EconomicsLos AngelesCaliforniaUSA
- USC School of PharmacyLos AngelesCaliforniaUSA
- USC Price School of Public PolicyLos AngelesCaliforniaUSA
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17
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Luth EA, Pan CX, Viola M, Prigerson HG. Dementia and Early Do-Not-Resuscitate Orders Associated With Less Intensive of End-of-Life Care: A Retrospective Cohort Study. Am J Hosp Palliat Care 2021; 38:1417-1425. [PMID: 33467864 DOI: 10.1177/1049909121989020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Dementia is a leading cause of death among US older adults. Little is known about end-of-life care intensity and do-not-resuscitate orders (DNRs) among patients with dementia who die in hospital. AIM Examine the relationship between dementia, DNR timing, and end-of-life care intensity. DESIGN Observational cohort study. SETTING/PARTICIPANTS Inpatient electronic health record extraction for 2,566 persons age 65 and older who died in 2 New York City hospitals in the United States from 2015 to 2017. RESULTS Multivariable logistic regression analyses modeled associations between dementia diagnosis, DNR timing, and 6 end-of-life care outcomes. 31% of subjects had a dementia diagnosis; 23% had a DNR on day of hospital admission. Patients with dementia were 18%-40% less likely to have received 4 of 6 types of intensive care (mechanical ventilation AOR: 0.82, 95%CI: 0.67 -1.00; intensive care unit admission AOR: 0.60, 95%CI: 0.49-0.83). Having a DNR on file was inversely associated with staying in the intensive care unit (AOR: 0.57, 95%CI: 0.47-0.70) and avoiding other intensive care measures. DNR placement later during the hospitalization and not having a DNR were associated with more intensive care compared to having a DNR upon admission. CONCLUSIONS Having dementia and a do-not resuscitate order upon hospital admission are associated with less intensive end-of-life care. Additional research is needed to understand why persons with dementia receive less intensive care. In clinical practice, encouraging advance care planning prior to and at hospital admission may be particularly important for patients wishing to avoid intensive end-of-life care, including patients with dementia.
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Barthold D, Joyce G, Ferido P, Drabo EF, Marcum ZA, Gray SL, Zissimopoulos J. Pharmaceutical Treatment for Alzheimer's Disease and Related Dementias: Utilization and Disparities. J Alzheimers Dis 2020; 76:579-589. [PMID: 32538845 PMCID: PMC7825250 DOI: 10.3233/jad-200133] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Four prescription drugs (donepezil, galantamine, memantine, and rivastigmine) are approved by the US FDA to treat symptoms of Alzheimer's disease (AD). Even modest effectiveness could potentially reduce the population-level burden of AD and related dementias (ADRD), especially for women and racial/ethnic minorities who have higher incidence of ADRD. OBJECTIVE Describe the prevalence of antidementia drug use and timing of initiation relative to ADRD diagnosis among a nationally representative group of older Americans, and if there are disparities in prevalence and timing by sex and race/ethnicity. METHODS Descriptive analyses and logistic regressions of Medicare claims (2008-2016) for beneficiaries who had an ADRD or dementia-related symptom diagnosis, or use of an FDA approved drug for AD. We investigate prevalence of use and timing of treatment initiation relative to ADRD diagnosis across time and beneficiary characteristics (age, sex, race/ethnicity, socioeconomic status, comorbidities). RESULTS Among persons diagnosed with ADRD or related symptoms, 33.3% used an approved drug over the study period. Odds of use was higher among Whites than non-Whites. Among ADRD drug users, 40% initiated use within 6 months of the initial ADRD or related symptoms diagnosis, and 16% initiated prior to a diagnosis. We observed disparities by race/ethnicity: 28% of Asians, 24% of Hispanics, 16% of Blacks, and 15% of Whites initiated prior to diagnosis. CONCLUSIONS The use of antidementia drugs is relatively low and varies widely by race/ethnicity. Heterogeneity in timing of initiation and use may affect health and cost outcomes, but these effects merit further study.
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Affiliation(s)
- Douglas Barthold
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Geoffrey Joyce
- School of Pharmacy, Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Patricia Ferido
- Price School of Public Policy, Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
| | - Emmanuel F. Drabo
- Health Policy and Management Department, Johns Hopkins University, Baltimore, MD, USA
| | - Zachary A. Marcum
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Shelly L. Gray
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - Julie Zissimopoulos
- Price School of Public Policy, Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
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