@article {12407, title = {Medicare spending associated with a dementia diagnosis among older adults.}, journal = {Journal of the American Geriatrics Society}, volume = {70}, year = {2022}, pages = {2592-2601}, abstract = {

BACKGROUND: Over 6 million Americans have Alzheimer{\textquoteright}s Disease or Related Dementia (ADRD) but whether spikes in spending surrounding a new diagnosis reflect pre-diagnosis morbidity, diagnostic testing, or treatments for comorbidities is unknown.

METHODS: We used the 1998-2018 Health and Retirement Study and linked Medicare claims from older (>=65) adults to assess incremental quarterly spending changes just before versus just after a clinical diagnosis (diagnosis cohort, n~=~2779) and, for comparative purposes, for a cohort screened as impaired based on the validated Telephone Interview for Cognitive Status (TICS) (impairment cohort, n~=~2318). Models were adjusted for sociodemographic and health characteristics. Spending patterns were examined separately by sex, race, education, dual eligibility, and geography.

RESULTS: Among the diagnosis cohort, mean (SD) overall spending was $4773 ($9774) per quarter - 43\% of which was spending on hospital care ($2048). In adjusted analyses, spending increased by $8400 (p < 0.001), or 156\%, from $5394 in the quarter prior to $13,794 in the quarter including the diagnosis. Among the cohort in which impairment was incidentally detected using the TICS, adjusted spending did not change from just before to after detection of impairment, from $2986 before and $2962 after detection (p~=~0.90). Incremental spending changes did not differ by sex, race, education, dual eligibility, or geography.

CONCLUSION: Large, transient spending increases accompany an ADRD diagnosis that may not be attributed to impairment or changes in functional status due to dementia. Further study may help reveal how treatment for comorbidities is associated with the clinical diagnosis of dementia, with potential implications for Medicare spending.

}, keywords = {Dementia, Diagnosis, impairment, Medicare, utilization}, issn = {1532-5415}, doi = {10.1111/jgs.17835}, author = {Hoffman, Geoffrey J and Donovan T Maust and Harris, Melissa and Ha, Jinkyung and Davis, Matthew A} } @article {11671, title = {Trends and Disparities in Functional Impairment among US Adults Age 55-64, 2002 to 2016.}, journal = {Journal of General Internal Medicine}, volume = {36}, year = {2021}, pages = {3903-3906}, abstract = {Over the past decade, US midlife morbidity and mortality have increased, contributing to declines in life expectan cy.1 This worsening health status has been experienced disproportionately by low{\textendash}socioeconomic status (SES) and racial/ethnic minority individuals2, 3 and is associated with functional deterioration among low-SES middle-aged adults.4 Yet it is unclear if disparities in functional status are rising. Functional impairment may not be recognized as a health problem for middle-aged adults, but it is common and, as for older adults, associated with disability and death.5 Our objective was to examine functional trends among US midlife adults to determine whether and how changes in disparities are concentrated among particular demographic groups. }, keywords = {Mortality, Racial Disparities, socioeconomic status}, issn = {1525-1497}, doi = {10.1007/s11606-020-06209-y}, author = {Tipirneni, Renuka and Karmakar, Monita and Donovan T Maust} } @article {9280, title = {Association between spousal caregiver well-being and care recipient healthcare expenditures}, journal = {Journal of the American Geriatrics Society}, volume = {65}, year = {2017}, pages = {2220-2226}, abstract = {Objectives To measure the association between spousal depression, general health, fatigue and sleep, and future care recipient healthcare expenditures and emergency department (ED) use. Design Prospective cohort study. Setting Health and Retirement Study. Participants Home-dwelling spousal dyads in which one individual (care recipient) was aged 65 and older and had one or more activity of daily living or instrumental activity of daily living disabilities and was enrolled in Medicare Part B (N = 3,101). Exposure Caregiver sleep (Jenkins Sleep Scale), depressive symptoms (Center for Epidemiologic Studies Depression-8 Scale), and self-reported general health measures. Measurements Primary outcome was care recipient Medicare expenditures. Secondary outcome was care recipient ED use. Follow-up was 6 months. Results Caregiver depressive symptoms score and six of 17 caregiver well-being measures were prospectively associated with higher care recipient expenditures after minimal adjustment (P < .05). Higher care recipient expenditures remained significantly associated with caregiver fatigue (cost increase, $1,937, 95\% confidence interval (CI) = $770{\textendash}3,105) and caregiver sadness (cost increase, $1,323, 95\% CI = $228{\textendash}2,419) after full adjustment. Four of 17 caregiver well-being measures, including severe fatigue, were significantly associated with care recipient ED use after minimal adjustment (P < .05). Greater odds of care recipient ED use remained significantly associated with caregiver fatigue (odds ratio (OR) = 1.24, 95\% CI = 1.01{\textendash}1.52) and caregiver fair to poor health (OR = 1.23, 95\% CI = 1.04{\textendash}1.45) after full adjustment. Caregiver total sleep score was not associated with care recipient outcomes. Conclusion Poor caregiver well-being, particularly severe fatigue, is independently and prospectively associated with higher care recipient Medicare expenditures and ED use.}, keywords = {Caregiving, Marriage, Medical Expenses, Medicare/Medicaid/Health Insurance, Well-being}, doi = {10.1111/jgs.15039}, url = {http://doi.wiley.com/10.1111/jgs.15039http://onlinelibrary.wiley.com/wol1/doi/10.1111/jgs.15039/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111\%2Fjgs.15039}, author = {Claire K. Ankuda and Donovan T Maust and Mohammed U Kabeto and Ryan J McCammon and Kenneth M. Langa and Deborah A Levine} } @article {9321, title = {Distress Associated with Dementia-Related Psychosis and Agitation in Relation to Healthcare Utilization and Costs.}, journal = {American Journal of Geriatric Psychiatry}, volume = {25}, year = {2017}, month = {2017 Oct}, pages = {1074-1082}, abstract = {

OBJECTIVES: Explore the relationship between behavioral and psychological symptoms of dementia (BPSD; specifically, delusions, hallucinations, and agitation/aggression) and associated caregiver distress with emergency department (ED) utilization, inpatient hospitalization, and expenditures for direct medical care.

DESIGN/SETTING/PARTICIPANTS: Retrospective cross-sectional cohort of participants with dementia (N = 332) and informants from the Aging, Demographics, and Memory Study, a nationally representative survey of U.S. adults >70 years old.

MEASUREMENTS: BPSD of interest and associated informant distress (trichotomized as none/low/high) were assessed using the Neuropsychiatric Inventory (NPI). Outcomes were determined from one year of Medicare claims and examined according to presence of BPSD and associated informant distress, adjusting for participant demographics, dementia severity, and comorbidity.

RESULTS: Fifty-eight (15\%) participants with dementia had clinically significant delusions, hallucinations, or agitation/aggression. ED visits, inpatient admissions, and costs were not significantly higher among the group with significant BPSD. In fully adjusted models, a high level of informant distress was associated with all outcomes: ED visit incident rate ratio (IRR) 3.03 (95\% CI: 1.98-4.63; p < 0.001), hospitalization IRR 2.78 (95\% CI: 1.73-4.46; p < 0.001), and relative cost ratio 2.00 (95\% CI: 1.12-3.59; p = 0.02).

CONCLUSIONS: A high level of informant distress related to participant BPSD, rather than the symptoms themselves, was associated with increased healthcare utilization and costs. Effectively identifying, educating, and supporting distressed caregivers may help reduce excess healthcare utilization for the growing number of older adults with dementia.

}, keywords = {Dementia, Depressive symptoms, Healthcare, Stress}, issn = {1545-7214}, doi = {10.1016/j.jagp.2017.02.025}, author = {Donovan T Maust and Helen C Kales and Ryan J McCammon and Frederic C. Blow and Amanda N Leggett and Kenneth M. Langa} } @article {8918, title = {Psychotropic use and associated neuropsychiatric symptoms among patients with dementia in the USA.}, journal = {International Journal of Geriatric Psychiatry}, volume = {32}, year = {2017}, month = {2017 Feb}, pages = {164-174}, abstract = {

OBJECTIVE: To determine the national prevalence of psychotropic use and association with neuropsychiatric symptoms among patients with dementia.

METHODS: Participants diagnosed with dementia (n = 414) in the Aging, Demographics, and Memory Study, a nationally representative survey of US adults >70 years old. Diagnosis was based on in-person clinical assessment and informant interview. Information collected included demographics, place of residence, 10-item Neuropsychiatric Inventory (NPI), and prescribed medications (antipsychotic, sedative-hypnotic, antidepressant, mood stabilizer).

RESULTS: Of 414 participants with dementia, 41.4\% were prescribed a psychotropic medication, including 84.0\% of nursing home residents and 28.6\% of community-dwellers. Of participants, 23.5\% were prescribed an antidepressant. Compared with the total NPI score of those on no medication (4.5), those on antipsychotics and those on sedative-hypnotics had much higher scores (respectively: 12.6, p < 0.001; 11.8, p = 0.03), although those antidepressants did not (6.9, p = 0.15). A larger proportion of patients on antipsychotics exhibited psychosis and agitation compared with those on no medication, while those on antidepressants exhibited more depressive symptoms. In multivariable logistic regression that included dementia severity and nursing home residence, nursing home residence was the characteristic most strongly associated with psychotropic use (odds ratio ranging from 8.96 [p < 0.001] for antipsychotics to 15.59 [p < 0.001] for sedative-hypnotics). More intense psychotic symptoms and agitation were associated with antipsychotic use; more intense anxiety and agitation were associated with sedative-hypnotic use. More intense depression and apathy were not associated with antidepressant use.

CONCLUSIONS: In this nationally representative sample, 41.4\% of patients were taking psychotropic medication. While associated with neuropsychiatric symptoms, nursing home residence was most strongly tied to use. Copyright {\textcopyright} 2016 John Wiley \& Sons, Ltd.

}, keywords = {ADAMS, Antidepressants, Dementia, Drug use, Older Adults, Psychiatry}, issn = {1099-1166}, doi = {10.1002/gps.4452}, author = {Donovan T Maust and Kenneth M. Langa and Frederic C. Blow and Helen C Kales} }