@article {13234, title = {Individual and Dyadic Health-Related Quality of Life of People Living with Dementia and their Caregivers}, year = {2023}, abstract = {Many interventions target dyads of people living with Alzheimer{\textquoteright}s disease and related dementias (ADRD) and their caregivers. Without a dyadic measure of health-related quality of life (HRQOL), cost-utility analyses of these interventions require using the HRQOL of people with ADRD and caregivers, separately. We developed a dyadic measure of HRQOL that incorporates the interdependence between HRQOL of people living with ADRD and their caregivers and measures the dyad{\textquoteright}s collective benefits. First, we estimated dyadic HRQOL time trade-off-weights (TTO-weights), a dyadic preference-based measure of HRQOL. Second, we estimated the association between ADRD clinical features and TTO-weights. We used the Aging, Demographics, and Memory Study to identify people living with ADRD (n = 308) and their caregivers (n = 160 dyads) and predict their TTO-weights. We estimated dyadic TTO-weights using an Archimedean bivariate utility copula with a quadratic generating function. Finally, we used adjusted linear regression to examine the association between predicted TTO-weights and ADRD clinical features. Average (standard deviation) TTO-weights of people living with ADRD, and caregivers were 0.67 (0.14) and 0.83 (0.09), respectively. Average dyadic TTO-weight was 0.75(0.05). When the dyadic TTO-weight was <= 0.60, an increase in the TTO-weight of the dyad-member with the lowest HRQOL resulted in a larger gain in the dyadic TTO-weight than a similar increase in the TTO-weight for the dyad-member with the higher baseline TTO-weight (i.e., non-proportional tradeoffs). When the dyadic TTO-weight is > 0.60, an increase in the TTO-weight for either member of the dyad increases the dyad TTO-weight equally (constant tradeoffs). An additional functional limitation resulted in more than twice the decline in the TTO-weight of people living with ADRD compared to an additional behavioral symptom (-0.008 vs. -0.003). Behavioral symptoms were significantly associated with a decline in caregivers{\textquoteright} and dyadic TTO-weights. The HRQOL of people living with ADRD and their caregivers are correlated. The dyadic TTO-weights for people living with ADRD and their caregivers can be used in cost-utility analyses to assess the collective gains in HRQOL and tradeoffs of interventions that target members of the dyad.}, keywords = {Caregivers, Dementia}, doi = {https://doi.org/10.1007/s11482-023-10157-0}, author = {Mauricio Lopez-Mendez and Rowan Iskandar and Eric Jutkowitz} } @article {11216, title = {Identifying cohabiting couples in administrative data: evidence from Medicare address data}, journal = {Health Services and Outcomes Research Methodology}, volume = {21}, year = {2021}, pages = {238-247}, abstract = {Marital status is recognized as an important social determinant of health, income, and social support, but is rarely available in administrative data. We assessed the feasibility of using exact address data and zip code history to identify cohabiting couples using the 2018 Medicare Vital Status file and ZIP codes in the 2011{\textendash}2014 Master Beneficiary Summary Files. Medicare beneficiaries meeting our algorithm displayed characteristics consistent with assortative mating and resembled known married couples in the Health and Retirement Study linked to Medicare claims. Address information represents a promising strategy for identifying cohabiting couples in administrative data including healthcare claims and other data types.}, keywords = {Cohabitation, Couples, Marriage, Medicare}, isbn = {1572-9400}, doi = {10.1007/s10742-020-00229-1}, author = {Matta, Sasmira and Joanne W. Hsu and Theodore J Iwashyna and Micah Y. Baum and Kenneth M. Langa and Lauren Hersch Nicholas} } @mastersthesis {11093, title = {An Investigation of the Consequences and Costs Associated with Bereavement: Findings from the Health and Retirement Study (2004-2014)}, volume = {Doctor of Philosophy}, year = {2020}, school = {University of Georgia}, address = {Athens, GA}, abstract = {The loss of a loved one adversely affects the bereaved. Previous research reports that loss increases the risk of mortality, physical and mental health problems, and healthcare utilization. Using data from the 2004 to 2014 waves of the Health and Retirement Study (HRS), we estimated the risk for mortality, the number of years of healthy life lost, and the increase in medical expenditures associated with an increasing exposure to bereavement. HRS enrolls a representative sample of adults in the United States aged 50 years and older. Population sample weights are available in HRS allowing for estimates of population-level burden. The exposure to loss was defined as the total number of losses of both parents and spouses. Analyses included (1) Cox proportional hazards models (mortality risk) with an attributable fraction calculation; (2) linear regression models (years of healthy life lost) with an outcome combining survival adjusted by the self-reported measure of health combined with US Census data to estimate the annual years lost; and (3) a cost prediction model to estimate HRS respondent medical expenditures based on reported healthcare utilization, with propensity-score matching and regression models to estimate the increase in medical expenditures. Key findings from the analyses showed a persistent increase in mortality associated with an increase in the number of losses experienced by an individual. This increase in the mortality hazard was between 33\% and 49\% and may account for roughly one-third of the population burden of mortality. An estimated total of 3.6 million years of healthy life are lost annually due to bereavement with the majority of the burden experienced by persons 50 to 65 years of age. Any physical activity significantly reduces the impact of bereavement, especially as the number of losses accumulates. Over a two-year period, an exposure to loss generates increased healthcare utilization estimated to be roughly $2500 per bereaved individual. Our results add to a growing body of research concerning the impact of bereavement on health and well-being. These may be the first estimate of the population-level burden that an increasing exposure to loss places on adults in the US.}, keywords = {Bereavement, Loss, Mortality, Population-level health}, isbn = {9798645490010}, author = {Ingels, Justin B.} } @article {9273, title = {The impact of changes in episodic memory surrounding retirement on subsequent risk of disability, cardiovascular disease, and mortality}, journal = {Work, Aging and Retirement}, volume = {4}, year = {2018}, pages = {10{\textendash}20}, abstract = {Retirement is a key hallmark of life for many in modern society. The Baby Boom generation has resulted in increasing numbers of retirees. Given this trend, it is important to identify key factors that promote better health and longevity in the years following retirement. We used data from 4,266 participants of the Health and Retirement Study who retired over the course of the study to examine whether levels of episodic memory at retirement and rates of change before and after retirement would be associated with disability, cardiovascular disease, and mortality risk following retirement, above and beyond socio-demographics and known risk factors. Individuals who exhibited higher levels of episodic memory at the time of retirement and relative stability in episodic memory prior to and following retirement had a decreased likelihood for disability, cardiovascular disease incidence, and mortality following retirement. The effects of disability remained when controlling for socio-demographics and known risk factors, whereas the effects of level and change prior to retirement on cardiovascular disease incidence and mortality were no longer significant with the inclusion of known risk factors. Better episodic memory was consistently associated with lower risk of disability, cardiovascular disease, and mortality following retirement. Less decline or stability in episodic memory during the time prior to retirement was also associated with lower risk of disability and cardiovascular disease, but not with mortality risk, during the period after retirement. Our discussion focuses on the importance of maintaining episodic memory and possible mechanisms through which it affects health following retirement.}, keywords = {Cardiovascular disease, Cognitive Ability, Disabilities, Memory, Mortality}, issn = {2054-4642}, doi = {10.1093/workar/wax020}, url = {http://academic.oup.com/workar/article/doi/10.1093/workar/wax020/4085175/The-Impact-of-Changes-in-Episodic-Memoryhttp://academic.oup.com/workar/article-pdf/doi/10.1093/workar/wax020/19539531/wax020.pdf}, author = {Frank J Infurna and Andel, Ross} } @article {9233, title = {The impact of cognitive impairment on self-management in chronic obstructive pulmonary disease: A systematic review}, journal = {Respiratory Medicine}, volume = {129}, year = {2017}, month = {Jan-08-2017}, pages = {130-139}, abstract = {Objective To determine the characteristics of persons with cognitive impairment being able to self-manage in chronic obstructive pulmonary disease (COPD). Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance this systematic review examined all studies in English from 1st January 2000 to 20 February 2016, describing the relationship between cognition and COPD self-management domains in older community dwelling persons with dementia or cognitive impairment. Results Of 4474 studies identified, thirteen studies were eligible for inclusion. No studies differentiated populations into recognized dementia subtypes. Study aims were variable; most (n = 7) examined inhaler competency alone. Studies identified a link between worsening cognition and the need for assistance in activities of daily living. Only one study evaluated the impact of cognition on overall self-management and found no association between cognitive impairment and self-rated self-management. Mild degrees of cognitive impairment were associated with reduced symptom recall. Cognitive impairment in COPD was associated with high degrees of inhaler incompetency. Basic cognitive screening tests were able to predict inhaler incompetence with reduced overall cognitive function, dyspraxia, and/or executive function identified as predictors of incompetency. Conclusions Multiple measures of disability consistently demonstrated that cognitive impairment in COPD significantly increased the need for assistance in many aspects of daily living, treatment adherence, and effective self-management. Given the nature of neuropsychological deficits seen in COPD, dedicated screening tools are required. Future research should investigate the impact of cognitive dysfunction in COPD and identify how to support those that lack capacity to self-manage.}, keywords = {Cognitive Ability, COPD, Survey Methodology}, issn = {09546111}, doi = {10.1016/j.rmed.2017.06.006}, url = {http://www.sciencedirect.com/science/article/pii/S0954611117301725?_rdoc=1\&_fmt=high\&_origin=gateway\&_docanchor=\&md5=b8429449ccfc9c30159a5f9aeaa92ffb}, author = {Baird, Chelsea and Lovell, Janaka and Marilyn Johnson and Shiell, Kerrie and Ibrahim, Joseph E.} } @article {8820, title = {The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study.}, journal = {J Gen Intern Med}, volume = {32}, year = {2017}, month = {2017 01}, pages = {71-80}, abstract = {

BACKGROUND: Readmission rates after pneumonia, heart failure, and acute myocardial infarction hospitalizations are risk-adjusted for age, gender, and medical comorbidities and used to penalize hospitals.

OBJECTIVE: To assess the impact of disability and social determinants of health on condition-specific readmissions beyond current risk adjustment.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of Medicare patients using 1) linked Health and Retirement Study-Medicare claims data (HRS-CMS) and 2) Healthcare Cost and Utilization Project State Inpatient Databases (Florida, Washington) linked with ZIP Code-level measures from the Census American Community Survey (ACS-HCUP). Multilevel logistic regression models assessed the impact of disability and selected social determinants of health on readmission beyond current risk adjustment.

MAIN MEASURES: Outcomes measured were readmissions <=30~days after hospitalizations for pneumonia, heart failure, or acute myocardial infarction. HRS-CMS models included disability measures (activities of daily living [ADL] limitations, cognitive impairment, nursing home residence, home healthcare use) and social determinants of health (spouse, children, wealth, Medicaid, race). ACS-HCUP model measures were ZIP Code-percentage of residents >=65~years of age with ADL difficulty, spouse, income, Medicaid, and patient-level and hospital-level race.

KEY RESULTS: For pneumonia, >=3 ADL difficulties (OR 1.61, CI 1.079-2.391) and prior home healthcare needs (OR 1.68, CI 1.204-2.355) increased readmission in HRS-CMS models (N = 1631); ADL difficulties (OR 1.20, CI 1.063-1.352) and {\textquoteright}other{\textquoteright} race (OR 1.14, CI 1.001-1.301) increased readmission in ACS-HCUP models (N = 27,297). For heart failure, children (OR 0.66, CI 0.437-0.984) and wealth (OR 0.53, CI 0.349-0.787) lowered readmission in HRS-CMS models (N = 2068), while black (OR 1.17, CI 1.056-1.292) and {\textquoteright}other{\textquoteright} race (OR 1.14, CI 1.036-1.260) increased readmission in ACS-HCUP models (N = 37,612). For acute myocardial infarction, nursing home status (OR 4.04, CI 1.212-13.440) increased readmission in HRS-CMS models (N = 833); {\textquoteright}other{\textquoteright} patient-level race (OR 1.18, CI 1.012-1.385) and hospital-level race (OR 1.06, CI 1.001-1.125) increased readmission in ACS-HCUP models (N = 17,496).

CONCLUSIONS: Disability and social determinants of health influence readmission risk when added to the current Medicare risk adjustment models, but the effect varies by condition.

}, keywords = {Activities of Daily Living, Cognitive Dysfunction, Comorbidity, Disability Evaluation, Female, Heart Failure, Humans, Logistic Models, Male, Myocardial Infarction, Patient Readmission, Pneumonia, Retrospective Studies, Risk Adjustment, Social determinants of health}, issn = {1525-1497}, doi = {10.1007/s11606-016-3869-x}, url = {http://link.springer.com/10.1007/s11606-016-3869-xhttp://link.springer.com/content/pdf/10.1007/s11606-016-3869-x.pdfhttp://link.springer.com/content/pdf/10.1007/s11606-016-3869-x.pdfhttp://link.springer.com/article/10.1007/s11606-016-3869-x/fulltext.html}, author = {Meddings, Jennifer and Reichert, Heidi and Shawna N Smith and Theodore J Iwashyna and Kenneth M. Langa and Timothy P Hofer and Laurence F McMahon} } @article {9248, title = {Individual and health system variation in rehospitalizations the year after pneumonia.}, journal = {Medicine (Baltimore)}, volume = {96}, year = {2017}, month = {2017 Aug}, pages = {e7695}, abstract = {Little is known about variation in patterns of recovery among patients discharged alive from hospitalizations for pneumonia.The aim of the is observational cohort study was to characterize the variation in patterns of hospital readmission and survival in the year after discharge for pneumonia in 3 different health systems.The 3 cohorts consisted of (1) the Health and Retirement Study participants enrolled in Fee-for-service Medicare (FFS), (2) Veterans Administration (VA) Healthcare system, and (3) Kaiser Permanente of Northern California (KPNC). The 365-day survival and re-hospitalizations were determined for each cohort. Multinomial logistic regression was used to identify potential contributors to the different patterns.We identified 2731, 23,536, and 39,147 hospitalizations for pneumonia in FFS Medicare, VA, and KPNC, respectively, of whom 88.1\%, 92.8\%, and 89.7\% survived to hospital discharge. The median patient survived to 1 year and was rehospitalized twice in FFS (9.0\%), once in VA (14.1\%) and KPNC (9.1\%). Of the patients who survived the hospitalization, 33.3\% (FFS), 30.2\% (VA), and 26.8\% (KPNC) died during the subsequent year. Of those who survived, 29.8\% (FFS), 35.9\% (VA), and 46.1\% (KPNC) were never rehospitalized. 11.9\% (FFS), 11.9\% (VA), and 11.7\% (KPNC) had greater than 3 hospitalizations. Age, race, gender, comorbidity, ICU use, and hospital length stay collectively explained little (5-7\%) of the variation in the recovery pattern.There is significant variation in the year after the hospitalization for pneumonia across individuals, but less so across health systems. There may be important opportunities to better classify these heterogeneous individual-level pathways.}, keywords = {Hospitalization}, issn = {1536-5964}, doi = {10.1097/MD.0000000000007695}, author = {Elizabeth M Viglianti and Hallie C Prescott and Liu, Vincent and Gabriel J. Escobar and Theodore J Iwashyna} } @article {8685, title = {The Influence of Sociodemographic and Psychosocial Factors on Advance Care Planning.}, journal = {J Gerontol Soc Work}, volume = {59}, year = {2016}, month = {2016 07}, pages = {401-422}, abstract = {

This study investigated sociodemographic and psychosocial factors that enhance or impede the completion of advance care planning, analyzing data from the Health and Retirement Study. The analytic subsample included the panel participants who died between 2006 and 2010 and who had answered the psychosocial and lifestyle questionnaire when they were alive. Multinomial logistic regression was executed to answer the research question (N~=~1,056). The study found that persons who were older, who were women, who identified themselves as White, and who had higher levels of income and education were more likely to be motivated to complete advance care planning. Having greater sense of control was found to weaken the adverse relationship between being African American and the completion of advance directives. Having cancer, suffering from the illnesses for longer periods of time, and having experience of nursing home institutionalization also predicted the completion of advance care planning. Implications include incorporating a culturally tailored approach for racial/ethnic minorities and using advance directives that are clear and easily understood. In addition, future research needs to include a larger minority population and examine the extent to which variations between racial/ethnic groups exist in relation to advance care planning.

}, keywords = {Advance care planning, Advance directives, African Americans, Aged, Aged, 80 and over, Continental Population Groups, European Continental Ancestry Group, Female, Health Status, Hispanic Americans, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Psychology, Social Class}, issn = {1540-4048}, doi = {10.1080/01634372.2016.1229709}, author = {Inoue, Megumi} } @article {8115, title = {Increased 1-year healthcare use in survivors of severe sepsis.}, journal = {Am J Respir Crit Care Med}, volume = {190}, year = {2014}, note = {Times Cited: 1}, month = {2014 Jul 01}, pages = {62-9}, publisher = {190}, abstract = {

RATIONALE: Hospitalizations for severe sepsis are common, and a growing number of patients survive to hospital discharge. Nonetheless, little is known about survivors{\textquoteright} post-discharge healthcare use.

OBJECTIVES: To measure inpatient healthcare use of severe sepsis survivors compared with patients{\textquoteright} own presepsis resource use and the resource use of survivors of otherwise similar nonsepsis hospitalizations.

METHODS: This is an observational cohort study of survivors of severe sepsis and nonsepsis hospitalizations identified from participants in the Health and Retirement Study with linked Medicare claims, 1998-2005. We matched severe sepsis and nonsepsis hospitalizations by demographics, comorbidity burden, premorbid disability, hospitalization length, and intensive care use.

MEASUREMENTS AND MAIN RESULTS: Using Medicare claims, we measured patients{\textquoteright} use of inpatient facilities (hospitals, long-term acute care hospitals, and skilled nursing facilities) in the 2 years surrounding hospitalization. Severe sepsis survivors spent more days (median, 16 [interquartile range, 3-45] vs. 7 [0-29]; P < 0.001) and a higher proportion of days alive (median, 9.6\% [interquartile range, 1.4-33.8\%] vs. 1.9\% [0.0-7.9\%]; P < 0.001) admitted to facilities in the year after hospitalization, compared with the year prior. The increase in facility-days was similar for nonsepsis hospitalizations. However, the severe sepsis cohort experienced greater post-discharge mortality (44.2\% [95\% confidence interval, 41.3-47.2\%] vs. 31.4\% [95\% confidence interval, 28.6-34.2\%] at 1 year), a steeper decline in days spent at home (difference-in-differences, -38.6 d [95\% confidence interval, -50.9 to 26.3]; P < 0.001), and a greater increase in the proportion of days alive spent in a facility (difference-in-differences, 5.4\% [95\% confidence interval, 2.8-8.1\%]; P < 0.001).

CONCLUSIONS: Healthcare use is markedly elevated after severe sepsis, and post-discharge management may be an opportunity to reduce resource use.

}, keywords = {Aged, Female, Health Facilities, Humans, Insurance Claim Review, Long-term Care, Male, Medical Record Linkage, Medicare, Mortality, Outcome Assessment, Health Care, Patient Readmission, Prospective Studies, Sepsis, Skilled Nursing Facilities, Survivors, United States}, issn = {1535-4970}, doi = {10.1164/rccm.201403-0471OC}, author = {Hallie C Prescott and Kenneth M. Langa and Liu, Vincent and Gabriel J. Escobar and Theodore J Iwashyna} } @article {8028, title = {An investigation of activity profiles of older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {69}, year = {2014}, month = {2014 Sep}, pages = {809-21}, publisher = {69}, abstract = {

OBJECTIVES: In this study, we advance knowledge about activity engagement by considering many activities simultaneously to identify profiles of activity among older adults. Further, we use cross-sectional data to explore factors associated with activity profiles and prospective data to explore activity profiles and well-being outcomes.

METHOD: We used the core survey data from the years 2008 and 2010, as well as the 2009 Health and Retirement Study Consumption and Activities Mail Survey (HRS CAMS). The HRS CAMS includes information on types and amounts of activities. We used factor analysis and latent class analysis to identify activity profiles and regression analyses to assess antecedents and outcomes associated with activity profiles.

RESULTS: We identified 5 activity profiles: Low Activity, Moderate Activity, High Activity, Working, and Physically Active. These profiles varied in amount and type of activities. Demographic and health factors were related to profiles. Activity profiles were subsequently associated with self-rated health and depression symptoms.

DISCUSSION: The use of a 5-level categorical activity profile variable may allow more complex analyses of activity that capture the "whole person." There is clearly a vulnerable group of low-activity individuals as well as a High Activity group that may represent the "active ageing" vision.

}, keywords = {Aged, Aged, 80 and over, Aging, Black or African American, Cohort Studies, Cross-Sectional Studies, Employment, Female, Florida, Health Surveys, Hispanic or Latino, Human Activities, Humans, Male, Middle Aged, Models, Psychological, Motor Activity, Prospective Studies, Regression Analysis, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu002}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2014/02/12/geronb.gbu002.abstract}, author = {Morrow-Howell, Nancy and Putnam, Michelle and Lee, Yung Soo and Jennifer C. Greenfield and Inoue, Megumi and Chen, Huajuan} }