TY - JOUR T1 - Medicare claims data underestimate hallucinations in older adults with dementia JF - The American Journal of Geriatric Psychiatry Y1 - 2022 A1 - Ali G Hamedani A1 - Weintraub, Daniel A1 - Allison W Willis KW - Dementia KW - Hallucinations KW - Medicare KW - sensitivity KW - specificity KW - validity AB - Objective Administrative claims data are used to study the incidence and outcomes of dementia-related hallucinations, but the validity of International Classification of Diseases (ICD) codes for identifying dementia-related hallucinations is unknown. Methods We analyzed Medicare-linked survey data from two nationally representative studies of U.S. older adults (the National Health and Aging Trends Study and the Health and Retirement Study) which contain validated cognitive assessments and a screening question for hallucinations. We identified older adults who had dementia or were permanent nursing home residents, and we combined this with questionnaire responses to define dementia-related hallucinations. Using Medicare claims data, we calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ICD codes for dementia-related hallucinations overall and within prespecified strata of age, neurologic comorbidity, and health care utilization. Results We included 2,337 older adults with dementia in our cohort. Among 3,789 person-years of data, 1,249 (33.0%) had hallucations, and of these 286 had a qualifying ICD code for dementia-related hallucinations or psychosis (sensitivity 22.9%). Of 2,540 person-years of dementia without hallucinations, 284 had a diagnosis code for hallucinations (specificity 88.8%). PPV was 50.2%, and NPV was 70.1%. Sensitivity was greatest (57.0%) among those seeing a psychiatrist. Otherwise, there were no significant differences in sensitivity, specificity, PPV, or NPV by age, neurologic diagnosis, or neurologist care. Conclusion Dementia-related hallucinations are poorly captured in administrative claims data, and estimates of their prevalence and outcomes using these data are likely to be biased. VL - 30 SN - 1064-7481 IS - 3 ER - TY - JOUR T1 - Self-reported vision and hallucinations in older adults: results from two longitudinal US health surveys JF - Age and Ageing Y1 - 2020 A1 - Ali G Hamedani A1 - Thibault, Dylan P A1 - Shea, Judy A A1 - Allison W Willis KW - blindness KW - Hallucinations KW - Health Surveys KW - Older adult KW - Proxy KW - self-report KW - vision AB - Vision loss may be a risk factor for hallucinations, but this has not been studied at the population level.To determine the association between self-reported vision loss and hallucinations in a large community-based sample of older adults, we performed a cross-sectional and longitudinal analysis of two large, nationally representative US health surveys: the National Health and Aging Trends Study (NHATS) and the Health and Retirement Study (HRS). Visual impairment and hallucinations were self- or proxy-reported. Multivariate single and mixed effects logistic regression models were built to examine whether visual impairment and history of cataract surgery were associated with hallucinations.In NHATS (n = 1520), hallucinations were more prevalent in those who reported difficulty reading newspaper print (OR 1.77, 95\% confidence interval (CI): 1.32–2.39) or recognising someone across the street (OR 2.48, 95\% CI: 1.86–3.31) after adjusting for confounders. In HRS (n = 3682), a similar association was observed for overall (OR 1.32, 95\% CI: 1.08–1.60), distance (OR 1.61, 95\% CI: 1.32–1.96) and near eyesight difficulties (OR 1.52, 95\% CI: 1.25–1.85). In neither sample was there a significant association between cataract surgery and hallucinations after adjusting for covariates.Visual dysfunction is associated with increased odds of hallucinations in the older US adult population. This suggests that the prevention and treatment of vision loss may potentially reduce the prevalence of hallucinations in older adults. UR - https://academic.oup.com/ageing/advance-article-abstract/doi/10.1093/ageing/afaa043/5816673 N1 - afaa043 ER -