Health care utilization before and after a dementia diagnosis in Medicare Advantage versus traditional Medicare

Journal of the American Geriatrics Society, Journal Year: 2023, Volume and Issue: 72(6), P. 1856 - 1866

Published: Sept. 5, 2023

Abstract Background Half of all Medicare beneficiaries are enrolled in Advantage (MA). Many studies document lower care utilization and mortality MA than traditional (TM), but evidence for persons with Alzheimer's disease related dementias (ADRD) is limited. Methods We conducted a retrospective cohort study 2015–2018 claims encounter data community‐dwelling aged 65 over TM an incident ADRD diagnosis 2017. compared monthly hospitalization rates outpatient visits 12 months before after 1 year from diagnosis. Models adjusted sociodemographic characteristics comorbidities. Sensitivity analyses addressed residual confounding using control group arthritis/glaucoma or excluding Special Needs Plans, potential underreporting by restricting to plans high completeness. Results Among 454,508 diagnosed 2017, 250,837 (55%) were 203,671 (45%) MA. Four diagnosis, hospitalizations similar In the month, 36.5% had 25.4% MA, difference 10.7 percentage points [95% CI: 10.3, 11.1]. Beneficiaries averaged 10.5 month 8.4 1.59 1.47–1.70]. Utilization differences narrowed remained higher many months. One‐year was 27.9% 22.2% MA; odds ratio 1.152 1.135–1.169] those Controlling substantially reduced difference. Conclusion Hospitalization increased more post‐diagnosis, not comparisons quality life caregiver burden needed.

Language: Английский

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Prevalence of Comorbid Depression and Insomnia Among Veterans Hospitalized for Heart Failure with Alzheimer Disease and Related Disorders

American Journal of Geriatric Psychiatry, Journal Year: 2023, Volume and Issue: 31(6), P. 428 - 437

Published: Feb. 8, 2023

Language: Английский

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Utilization of Low- and High-Value Health Care by Individuals With and Without Cognitive Impairment

The American Journal of Managed Care, Journal Year: 2024, Volume and Issue: 30(7), P. 316 - 323

Published: July 1, 2024

Cognitive impairment and dementia have rising prevalence impact the health care utilization lives of older adults. Receipt low-value (LV) underutilization high-value (HV) by individuals with these cognitive disorders may negative consequences for patient health, system efficiency, societal welfare. Evidence on value among cognitively impaired is limited; we thus ascertained receipt LV HV in adults normal cognition, without (CIND), dementia.

Language: Английский

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Racial and ethnic differences in disease course Medicare expenditures for beneficiaries with dementia

Journal of the American Geriatrics Society, Journal Year: 2024, Volume and Issue: 72(4), P. 1223 - 1233

Published: March 20, 2024

Abstract Background Research on racial and ethnic disparities in costs of care during the course dementia is sparse. We analyzed Medicare expenditures for beneficiaries with to identify when are highest whether they differ by race ethnicity. Methods data from 2000–2016 Health Retirement Study (HRS) linked corresponding claims estimate total four phases: (1) year before a diagnosis, (2) first following (3) ongoing after year, (4) last life. estimated each patient's phase‐specific disease using race‐specific survival model monthly adjusted patient characteristics. investigated healthcare utilization service type across races/ethnicities phases care. Results Adjusted mean non‐Hispanic (NH) Black ($165,730) Hispanic ($160,442) exceeded NH Whites ($136,326). In preceding immediately initial Blacks ($26,337 $20,429) Hispanics ($21,399–23,176 17,182–18,244). The life was responsible greatest cost contribution: $51,294 (NH Blacks), $47,469 (Hispanics), $39,499 Whites). These differences were driven greater use high‐cost services (e.g., emergency department, inpatient intensive care), especially Conclusions had higher than Whites. Expenditures every phase Further research should address mechanisms such methods improve communication, shared decision‐making, access appropriate all populations.

Language: Английский

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Preserving cognitive vitality: Value of cognitive rehabilitation in addressing cognitive deficits in the elderly

Journal of the Pakistan Medical Association, Journal Year: 2024, Volume and Issue: 74(5), P. 1009 - 1012

Published: April 22, 2024

The recent advancements in medical sciences has resultedin not only increasing life expectancy of the elderly but hasalso improved survival rate with neurologicaldisorders including those head trauma . This hasresulted an number persons cognitivedeficits. Cognitive functions such as executive functioningand memory play important role success arehabilitation programme and therefore can positivelycontribute to public health goals. Considering cognitivedecline at present no cure pharmacologicaltherapies have a limited role, efforts are usually made todelay onset progression cognitive decline andimprove quality life. Literature suggests that active lifestyle, regular exercise, actively performing activities dailyliving significant impact on skills. Inaddition different models rehabilitation andapproaches be integrated into practice improvecognitive reserve cause neuroplastic changes tofacilitate function by providing stimulusand training. Moreover technological advancements,the computerized intervention field is growing.This integrates conventional interventionwith digital smart devices provide engaging costeffective alternate approach. review aims highlightthe importance suggest afew evidence based approaches may consideredby professionals promote Pakistan.Keywords: Cognition, Decline, CognitiveRehabilitation, Elderly, Executive functions, Memory.

Language: Английский

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The effect of dementia on patterns of healthcare use in older adults with diabetes

Journal of the American Geriatrics Society, Journal Year: 2024, Volume and Issue: 72(8), P. 2391 - 2401

Published: May 31, 2024

Abstract Background For persons with diabetes, incidence of dementia has been associated increased hospitalization; however, little is known about healthcare use preceding and following incident dementia. We describe utilization in the 3 years pre‐ post‐incident among older adults diabetes. Methods used National Health Aging Trends Study (NHATS) linked to Medicare fee‐for‐service claims from 2011 2018. included community‐dwelling ≥65 who had diabetes without matched (identified validated NHATS algorithm) at year controls using coarsened exact matching. examined annual outpatient visits, emergency department (ED) hospitalization, post‐acute skilled nursing facility (SNF) onset. Results 195 1107 controls. Groups a similar age (81.6 vs 81.7 years) were 56.4% female. Persons more likely be minority racial ethnic groups (26.7% 21.3% Black, non‐Hispanic, 15.3% 6.7% other race or Hispanic). observed larger decrease visits dementia, primarily due decreasing specialty (mean visits: pre‐dementia/matching 6.8 (SD 2.6) 6.4 controls, p < 0.01 post‐dementia/matching 4.6 2.3) 5.5 2.7) 0.01). Hospitalization, ED SNF higher for rose both (e.g., 3.9 5.4) 2.2 4.8) 0.001; 4.5 4.7) 3.5 6.1) = 0.04). Conclusions Older have rates acute care use, but over time, visits.

Language: Английский

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Time to Dementia Diagnosis Among Veterans with Comorbid Insomnia and Depressive Episodes

Journal of Alzheimer s Disease, Journal Year: 2024, Volume and Issue: 100(3), P. 899 - 909

Published: July 8, 2024

Background: Older adults with heart failure are at elevated risk of Alzheimer’s disease and related dementias (AD/ADRD). Research suggests that insomnia depressive episodes contribute somewhat dissociable impacts on for AD/ADRD in this patient population, although the temporal ordering effects is unknown. Objective: This study examined time to dementia diagnosis among patients comorbid and/or an epidemiological sample. Methods: Secondary data analyses were conducted using a cohort 203,819 Veterans primary admission 129 VA Medical Centers. Results: Patients diagnoses both had shortest 1-year (Hazard ratio = 1.43, 95% CI [1.36, 1.51]) 3-year follow-up points 1.40, [1.34, 1.47]) versus one or neither comorbidity. Conclusions: Individuals comorbidities onset. Screening these may help identify who could benefit from enhanced monitoring early intervention strategies more rapid detection management symptoms.

Language: Английский

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National Institute on Aging’s Critical Support of Alzheimer’s Disease and Related Dementias Research

Public Policy & Aging Report, Journal Year: 2024, Volume and Issue: unknown

Published: Sept. 19, 2024

Journal Article National Institute on Aging's Critical Support of Alzheimer's Disease and Related Dementias Research Get access David C Grabowski, PhD Department Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA Address correspondence to: C. PhD. Email: [email protected] https://orcid.org/0000-0003-2915-5770 Search for other works by this author on: Oxford Academic Google Scholar Public Policy & Aging Report, prae020, https://doi.org/10.1093/ppar/prae020 Published: 22 November 2024 history Received: 19 July Editorial decision: 13 August

Language: Английский

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Medicare Fee-For-Service Spending for Fall Injury and Non-Fall Events: The Health, Aging and Body Composition (ABC) Study

Innovation in Aging, Journal Year: 2024, Volume and Issue: 8(6)

Published: Jan. 1, 2024

Abstract Background and Objectives Fall injuries are prevalent in older adults, yet whether higher spending occurs after nonfracture (NFFI) fracture is unknown. We examined incident fall injuries, including NFFI fractures, were associated with Medicare 12 months events adults. Research Design Methods The Health, Aging, Body Composition Study included 1 595 community-dwelling adults (53% women, 37% Black; 76.7 ± 2.9 years) linked Fee-For-Service (FFS) claims at 2000/01 exam. Incident outpatient inpatient (N = 448) from exam to December 31, 2008 identified using the first claim a injury diagnosis code E-code, or with/without an E-code. Up 3 participants without 147) matched on nonfall 448 month. calculated change monthly FFS before versus index both groups. Generalized linear regression centered outcomes gamma distributions association of prepost expenditure changes (including fractures) adjusting for related covariates. Results Monthly increased (USD$2 261 vs $981), 105; USD$2 083 $1 277), 343; 315 $890) (all p &lt; .0001). However, covariates final models, not significantly larger increases spending/month (differential increase: USD$399.58 [95% CI: −USD$44.95 $844.11]). Fracture was similar USD$471.93 −USD$21.17 $965.02]). Discussion Implications Although substantial occurred increasing similarly, different compared events. Our results contribute understanding subsequent that may inform further research injury-related health care spending.

Language: Английский

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Hospitals serving high concentrations of patients with dementia are associated with lower mortality rates for patients with dementia

Published: Dec. 31, 2024

Abstract INTRODUCTION While hospital‐related spending is substantially higher for ADRD populations, it unknown whether differences exist in the use of hospital services those hospitals serving high proportions patients with dementia. METHODS We used 2014–2019 Medicare claims to compare treating (321 dementia concentration [HDCH]) and low (2887 non‐HDCHs) populations according finances, utilization, quality. RESULTS More than one‐quarter HDCH have HDCHs are small, treat minoritized patient low‐profit margins poor overall performance, but associated lower 1‐month mortality risk populations. DISCUSSION Large treated at a subset poorly resourced, performing US However, unlike larger, better‐performing hospitals, appear risk. This may reflect benefits specialization or other treatment smaller, community hospitals.

Language: Английский

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