@article {8905, title = {The Relationship of Obesity to Hospice Use and Expenditures: A Cohort Study.}, journal = {Annals of Internal Medicine}, year = {2017}, month = {2017 Feb 07}, abstract = {

Background: Obesity complicates medical, nursing, and informal care in severe illness, but its effect on hospice use and Medicare expenditures is unknown.

Objective: To describe the associations between body mass index (BMI) and hospice use and Medicare expenditures in the last 6 months of life.

Design: Retrospective cohort.

Setting: The HRS (Health and Retirement Study).

Participants: 5677 community-dwelling Medicare fee-for-service beneficiaries who died between 1998 and 2012.

Measurements: Hospice enrollment, days enrolled in hospice, in-home death, and total Medicare expenditures in the 6 months before death. BMI was modeled as a continuous variable with a quadratic functional form.

Results: For decedents with BMI of 20 kg/m2, the predicted probability of hospice enrollment was 38.3\% (95\% CI, 36.5\% to 40.2\%), hospice duration was 42.8 days (CI, 42.3 to 43.2 days), probability of in-home death was 61.3\% (CI, 59.4\% to 63.2\%), and total Medicare expenditures were $42~803 (CI, $41~085 to $44~521). When BMI increased to 30 kg/m2, the predicted probability of hospice enrollment decreased by 6.7 percentage points (CI, -9.3 to -4.0 percentage points), hospice duration decreased by 3.8 days (CI, -4.4 to -3.1 days), probability of in-home death decreased by 3.2 percentage points (CI, -6.0 to -0.4 percentage points), and total Medicare expenditures increased by $3471 (CI, $955 to $5988). For morbidly obese decedents (BMI >=40 kg/m2), the predicted probability of hospice enrollment decreased by 15.2 percentage points (CI, -19.6 to -10.9 percentage points), hospice duration decreased by 4.3 days (CI, -5.7 to -2.9 days), and in-home death decreased by 6.3 percentage points (CI, -11.2 to -1.5 percentage points) versus decedents with BMI of 20 kg/m2.

Limitation: Baseline data were self-reported, and the interval between reported BMI and time of death varied.

Conclusion: Among community-dwelling decedents in the HRS, increasing obesity was associated with reduced hospice use and in-home death and higher Medicare expenditures in the last 6 months of life.

Primary Funding Source: Robert Wood Johnson Foundation Clinical Scholars Program.

}, keywords = {Hospice, Medicare/Medicaid/Health Insurance, Obesity, Older Adults}, issn = {1539-3704}, doi = {10.7326/M16-0749}, author = {Tamara B Harris and Byhoff, Elena and Chithra R Perumalswami and Kenneth M. Langa and Alexi A Wright and Jennifer J Griggs} } @article {7708, title = {Chemotherapy was not associated with cognitive decline in older adults with breast and colorectal cancer: findings from a prospective cohort study.}, journal = {Med Care}, volume = {50}, year = {2012}, month = {2012 Oct}, pages = {849-55}, abstract = {

OBJECTIVES: This study tested 2 hypotheses: (1) chemotherapy increases the rate of cognitive decline in breast and colorectal cancer patients beyond what is typical of normal aging and (2) chemotherapy results in systematic cognitive declines when compared with breast and colorectal cancer patients who did not receive chemotherapy.

SUBJECTS: Data came from personal interviews with a prospective cohort of patients with breast (n=141) or colorectal cancer (n=224) with incident disease drawn from the nationally representative Health and Retirement Study (1998-2006) with linked Medicare claims.

MEASURES: The 27-point modified Telephone Interview for Cognitive Status was used to assess cognitive functioning, focusing on memory and attention. We defined the smallest clinically significant change as 0.4 points per year.

RESULTS: We used Bayesian hierarchical linear models to test the hypotheses, adjusting for multiple possible confounders. Eighty-eight patients were treated with chemotherapy; 277 were not. The mean age at diagnosis was 75.5. Patients were followed for a median of 3.1 years after diagnosis, with a range of 0 to 8.3 years. We found no differences in the rates of cognitive decline before and after diagnosis for patients who received chemotherapy in adjusted models (P=0.86, one-sided 95\% posterior intervals lower bound: 0.09 worse after chemotherapy), where patients served as their own controls. Moreover, the rate of cognitive decline after diagnosis did not differ between patients who had chemotherapy and those who did not (P=0.84, one-sided 95\% posterior intervals lower bound: 0.11 worse for chemotherapy group in adjusted model).

CONCLUSIONS: There was no evidence of cognitive decline associated with chemotherapy in this sample of older adults with breast and colorectal cancer.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Aging, Antineoplastic Agents, Antineoplastic Protocols, Bayes Theorem, Breast Neoplasms, Cognition Disorders, Colorectal Neoplasms, Female, Health Behavior, Humans, Interviews as Topic, Male, Memory, Prospective Studies}, issn = {1537-1948}, doi = {10.1097/MLR.0b013e31825a8bb0}, author = {Victoria A. Shaffer and Edgar C. Merkle and Angela Fagerlin and Jennifer J Griggs and Kenneth M. Langa and Theodore J Iwashyna} }