@article {9391, title = {Secular Trends in Dementia and Cognitive Impairment of U.S. Rural and Urban Older Adults}, journal = {American Journal of Preventive Medicine}, volume = {54}, year = {2018}, pages = {164-172}, abstract = {Introduction This is a nationally representative study of rural-urban disparities in the prevalence of probable dementia and cognitive impairment without dementia (CIND). Methods Data on non-institutionalized U.S. adults from the 2000 (n=16,386) and 2010 (n=16,311) cross-sections of the Health and Retirement Study were linked to respective Census assessments of the urban composition of residential census tracts. Relative risk ratios (RRR) for rural-urban differentials in dementia and CIND respective to normal cognitive status were assessed using multinomial logistic regression. Analyses were conducted in 2016. Results Unadjusted prevalence of dementia and CIND in rural and urban tracts converged so that rural disadvantages in the relative risk of dementia (RRR=1.42, 95\% CI=1.10, 1.83) and CIND (RRR=1.35, 95\% CI=1.13, 1.61) in 2000 no longer reached statistical significance in 2010. Adjustment for the strong protective role of educational attainment reduced rural disadvantages in 2000 to statistical nonsignificance, whereas adjustment for race/ethnicity resulted in a statistically significant increase in RRRs in 2010. Full adjustment for sociodemographic and health factors revealed persisting rural disadvantages for dementia and CIND in both periods with RRR in 2010 for dementia of 1.79 (95\% CI=1.31, 2.43) and for CIND of 1.38 (95\% CI=1.14, 1.68). Conclusions Larger gains in rural adults{\textquoteright} cognitive functioning between 2000 and 2010 that are linked with increased educational attainment demonstrate long-term public health benefits of investment in secondary education. Persistent disadvantages in cognitive functioning among rural adults compared with sociodemographically similar urban peers highlight the importance of public health planning for more rapidly aging rural communities.}, keywords = {Cognitive Ability, Dementia, Religion, Rural Settings, urban life}, issn = {07493797}, doi = {10.1016/j.amepre.2017.10.021}, url = {http://linkinghub.elsevier.com/retrieve/pii/S074937971730644Xhttp://api.elsevier.com/content/article/PII:S074937971730644X?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S074937971730644X?httpAccept=text/plain}, author = {Margaret M Weden and Regina A Shih and Mohammed U Kabeto and Kenneth M. Langa} } @article {6991, title = {Setting eligibility criteria for a care-coordination benefit.}, journal = {J Am Geriatr Soc}, volume = {53}, year = {2005}, month = {2005 Dec}, pages = {2051-9}, publisher = {53}, abstract = {

OBJECTIVES: To examine different clinically relevant eligibility criteria sets to determine how they differ in numbers and characteristics of individuals served.

DESIGN: Cross-sectional analysis of the 2000 wave of the Health and Retirement Study (HRS), a nationally representative longitudinal health interview survey of adults aged 50 and older.

SETTING: Population-based cohort of community-dwelling older adults, subset of an ongoing longitudinal health interview survey.

PARTICIPANTS: Adults aged 65 and older who were respondents in the 2000 wave of the HRS (n=10,640, representing approximately 33.6 million Medicare beneficiaries).

MEASUREMENTS: Three clinical criteria sets were examined that included different combinations of medical conditions, cognitive impairment, and activity of daily living/instrumental activity of daily living (ADL/IADL) dependency.

RESULTS: A small portion of Medicare beneficiaries (1.3-5.8\%) would be eligible for care coordination, depending on the criteria set chosen. A criteria set recently proposed by Congress (at least four severe complex medical conditions and one ADL or IADL dependency) would apply to 427,000 adults aged 65 and older in the United States. Criteria emphasizing cognitive impairment would serve an older population.

CONCLUSION: Several criteria sets for a Medicare care-coordination benefit are clinically reasonable, but different definitions of eligibility would serve different numbers and population groups of older adults.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Case Management, Chronic disease, Cognition Disorders, Comorbidity, Cross-Sectional Studies, Disability Evaluation, Disease Management, Eligibility Determination, Female, Geriatric Assessment, Health Surveys, Humans, Longitudinal Studies, Male, Medicare, Middle Aged, Retirement, United States}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2005.00496.x}, author = {Christine T Cigolle and Kenneth M. Langa and Mohammed U Kabeto and Caroline S Blaum} }