%0 Journal Article %J The Journals of Gerontology, Series A %D 2022 %T Validation of Claims Algorithms to Identify Alzheimer's Disease and Related Dementias. %A Ellen P McCarthy %A Chang, Chiang-Hua %A Tilton, Nicholas %A Mohammed U Kabeto %A Kenneth M. Langa %A Julie P W Bynum %K Accuracy %K algorithm %K Dementia %K Diagnosis %K Medicare %X

BACKGROUND: Using billing data generated through healthcare delivery to identify individuals with dementia has become important in research. To inform tradeoffs between approaches, we tested the validity of different Medicare claims-based algorithms.

METHODS: We included 5,784 Medicare-enrolled, Health and Retirement Study participants aged >65 years in 2012 clinically assessed for cognitive status over multiple waves and determined performance characteristics of different claims-based algorithms.

RESULTS: Positive predictive value (PPV) of claims ranged from 53.8-70.3% and was highest using a revised algorithm and 1-year of observation. The trade-off of greater PPV was lower sensitivity; sensitivity could be maximized using 3-years of observation. All algorithms had low sensitivity (31.3-56.8%) and high specificity (92.3-98.0%). Algorithm test performance varied by participant characteristics, including age and race.

CONCLUSIONS: Revised algorithms for dementia diagnosis using Medicare administrative data have reasonable accuracy for research purposes, but investigators should be cognizant of the trade-offs in accuracy among the approaches they consider.

%B The Journals of Gerontology, Series A %V 77 %P 1261-1271 %G eng %N 6 %R 10.1093/gerona/glab373 %0 Journal Article %J Jamia Open %D 2020 %T Cardiovascular disease risk prediction for people with type 2 diabetes in a population-based cohort and in electronic health record data %A Szymonifka, Jackie %A Conderino, Sarah %A Christine T Cigolle %A Ha, Jinkyung %A Mohammed U Kabeto %A Yu, Jaehong %A John A. Dodson %A Thorpe, Lorna %A Caroline S Blaum %A Zhong, Judy %K Cardiovascular disease %K type 2 diabetes %X Electronic health records (EHRs) have become a common data source for clinical risk prediction, offering large sample sizes and frequently sampled metrics. There may be notable differences between hospital-based EHR and traditional cohort samples: EHR data often are not population-representative random samples, even for particular diseases, as they tend to be sicker with higher healthcare utilization, while cohort studies often sample healthier subjects who typically are more likely to participate. We investigate heterogeneities between EHR- and cohort-based inferences including incidence rates, risk factor identifications/quantifications, and absolute risks.This is a retrospective cohort study of older patients with type 2 diabetes using EHR from New York University Langone Health ambulatory care (NYULH-EHR, years 2009–2017) and from the Health and Retirement Survey (HRS, 1995–2014) to study subsequent cardiovascular disease (CVD) risks. We used the same eligibility criteria, outcome definitions, and demographic covariates/biomarkers in both datasets. We compared subsequent CVD incidence rates, hazard ratios (HRs) of risk factors, and discrimination/calibration performances of CVD risk scores.The estimated subsequent total CVD incidence rate was 37.5 and 90.6 per 1000 person-years since T2DM onset in HRS and NYULH-EHR respectively. HR estimates were comparable between the datasets for most demographic covariates/biomarkers. Common CVD risk scores underestimated observed total CVD risks in NYULH-EHR.EHR-estimated HRs of demographic and major clinical risk factors for CVD were mostly consistent with the estimates from a national cohort, despite high incidences and absolute risks of total CVD outcome in the EHR samples. %B Jamia Open %@ 2574-2531 %G eng %R https://doi.org/10.1093/jamiaopen/ooaa059 %0 Journal Article %J JAMA Intern Med %D 2017 %T A Comparison of the Prevalence of Dementia in the United States in 2000 and 2012. %A Kenneth M. Langa %A Eric B Larson %A Eileen M. Crimmins %A Jessica Faul %A Deborah A Levine %A Mohammed U Kabeto %A David R Weir %K Aged %K Dementia %K Female %K Humans %K Male %K Prevalence %K Risk Factors %K United States %X

Importance: The aging of the US population is expected to lead to a large increase in the number of adults with dementia, but some recent studies in the United States and other high-income countries suggest that the age-specific risk of dementia may have declined over the past 25 years. Clarifying current and future population trends in dementia prevalence and risk has important implications for patients, families, and government programs.

Objective: To compare the prevalence of dementia in the United States in 2000 and 2012.

Design, Setting, and Participants: We used data from the Health and Retirement Study (HRS), a nationally representative, population-based longitudinal survey of individuals in the United States 65 years or older from the 2000 (n = 10 546) and 2012 (n = 10 511) waves of the HRS.

Main Outcomes and Measures: Dementia was identified in each year using HRS cognitive measures and validated methods for classifying self-respondents, as well as those represented by a proxy. Logistic regression was used to identify socioeconomic and health variables associated with change in dementia prevalence between 2000 and 2012.

Results: The study cohorts had an average age of 75.0 years (95% CI, 74.8-75.2 years) in 2000 and 74.8 years (95% CI, 74.5-75.1 years) in 2012 (P = .24); 58.4% (95% CI, 57.3%-59.4%) of the 2000 cohort was female compared with 56.3% (95% CI, 55.5%-57.0%) of the 2012 cohort (P < .001). Dementia prevalence among those 65 years or older decreased from 11.6% (95% CI, 10.7%-12.7%) in 2000 to 8.8% (95% CI, 8.2%-9.4%) (8.6% with age- and sex-standardization) in 2012 (P < .001). More years of education was associated with a lower risk for dementia, and average years of education increased significantly (from 11.8 years [95% CI, 11.6-11.9 years] to 12.7 years [95% CI, 12.6-12.9 years]; P < .001) between 2000 and 2012. The decline in dementia prevalence occurred even though there was a significant age- and sex-adjusted increase between years in the cardiovascular risk profile (eg, prevalence of hypertension, diabetes, and obesity) among older US adults.

Conclusions and Relevance: The prevalence of dementia in the United States declined significantly between 2000 and 2012. An increase in educational attainment was associated with some of the decline in dementia prevalence, but the full set of social, behavioral, and medical factors contributing to the decline is still uncertain. Continued monitoring of trends in dementia incidence and prevalence will be important for better gauging the full future societal impact of dementia as the number of older adults increases in the decades ahead.

%B JAMA Intern Med %V 177 %P 51-58 %8 2017 01 01 %G eng %U http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2016.6807http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2587084 %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/27893041?dopt=Abstract %! JAMA Intern Med %R 10.1001/jamainternmed.2016.6807 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2012 %T Clinical complexity and mortality in middle-aged and older adults with diabetes. %A Christine T Cigolle %A Mohammed U Kabeto %A Pearl G. Lee %A Caroline S Blaum %K Activities of Daily Living %K Aged %K Comorbidity %K Diabetes Complications %K Diabetes Mellitus %K Female %K Health Status %K Humans %K Male %K Middle Aged %K Proportional Hazards Models %K Self Care %X

BACKGROUND: Middle-aged and older adults with diabetes are heterogeneous and may be characterized as belonging to one of three clinical groups: a relatively healthy group, a group having characteristics likely to make diabetes self-management difficult, and a group with poor health status for whom current management targets have uncertain benefit.

METHODS: We analyzed waves 2004-2008 of the Health and Retirement Study and the supplemental Health and Retirement Study 2003 Diabetes Study. The sample included adults with diabetes 51 years and older (n = 3,507, representing 13.6 million in 2004). We investigated the mortality outcomes for the three clinical groups, using survival analysis and Cox proportional hazard models.

RESULTS: The 5-year survival probabilities were Relatively Healthy Group, 90.8%; Self-Management Difficulty Group, 79.4%; and Uncertain Benefit Group, 52.5%. For all age groups and clinical groups, except those 76 years and older in the Uncertain Benefit Group, survival exceeded 50%.

CONCLUSIONS: This study reveals the substantial survival of middle-aged and older adults with diabetes, regardless of health status. These findings have implications for the clinical management of and future research about diabetes patients with multiple comorbidities.

%B J Gerontol A Biol Sci Med Sci %I 67 %V 67 %P 1313-20 %8 2012 Dec %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/22492022?dopt=Abstract %4 Mortality/Diabetes Mellitus/Disease management/Physiological aspects/Prevalence/Demographic aspects/Diabetics/Health aspects/Older people %$ 69726 %R 10.1093/gerona/gls095 %0 Journal Article %J Med Care %D 2010 %T Hospitalizations and deaths among adults with cardiovascular disease who underuse medications because of cost: a longitudinal analysis. %A Michele M Heisler %A Choi, Hwajung %A Allison B Rosen %A Sandeep Vijan %A Mohammed U Kabeto %A Kenneth M. Langa %A John D Piette %K Aged %K Aged, 80 and over %K Cardiovascular Diseases %K Female %K Financing, Personal %K Health Care Costs %K Health Services Accessibility %K Health Status Disparities %K Hospitalization %K Humans %K Logistic Models %K Longitudinal Studies %K Male %K Medication Adherence %K Middle Aged %K Multivariate Analysis %K Risk Factors %K United States %X

CONTEXT: It is well-documented that the financial burden of out-of-pocket expenditures for prescription drugs often leads people with medication-sensitive chronic illnesses to restrict their use of these medications. Less is known about the extent to which such cost-related medication underuse is associated with increases in subsequent hospitalizations and deaths.

OBJECTIVE: We compared the risk of hospitalizations among 5401 and of death among 6135 middle-aged and elderly adults with one or more cardiovascular diseases (diabetes, coronary artery disease, heart failure, and history of stroke) according to whether participants did or did not report restricting prescription medications because of cost.

DESIGN AND SETTING: A retrospective biannual cohort study across 4 cross-sectional waves of the Health and Retirement Study, a nationally representative survey of adults older than age 50. Using multivariate logistic regression to adjust for baseline differences in sociodemographic and health characteristics, we assessed subsequent hospitalizations and deaths between 1998 and 2006 for respondents who reported that they had or had not taken less medicine than prescribed because of cost.

RESULTS: Respondents with cardiovascular disease who reported underusing medications due to cost were significantly more likely to be hospitalized in the next 2 years, even after adjusting for other patient characteristics (adjusted predicted probability of 47% compared with 38%, P < 0.001). The more survey waves respondents reported cost-related medication underuse during 1998 to 2004, the higher the probability of being hospitalized in 2006 (adjusted predicted probability of 54% among respondents reporting cost-related medication underuse in all 4 survey waves compared with 42% among respondents reporting no underuse, P < 0.001). There was no independent association of cost-related medication underuse with death.

CONCLUSIONS: In this nationally representative cohort, middle-aged and elderly adults with cardiovascular disease who reported cutting back on medication use because of cost were more likely to report being hospitalized over a subsequent 2-year period after they had reported medication underuse. The more extensively respondents reported cost-related underuse over time, the higher their adjusted predicted probability of subsequent hospitalization.

%B Med Care %I 48 %V 48 %P 87-94 %8 2010 Feb %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/20068489?dopt=Abstract %2 PMC3034735 %4 Cardiovascular Diseases: drug therapy/Cardiovascular Diseases: economics/mortality/Health Care Costs/Services Accessibility: economics/Health Status Disparities/Hospitalization: economics/Hospitalization: statistics and numerical data/Logistic Models/Longitudinal Studies/Medication Adherence/Multivariate Analysis/Risk Factors %$ 22180 %R 10.1097/MLR.0b013e3181c12e53 %0 Journal Article %J Alzheimers Dement %D 2008 %T Trends in the prevalence and mortality of cognitive impairment in the United States: is there evidence of a compression of cognitive morbidity? %A Kenneth M. Langa %A Eric B Larson %A Jason H. Karlawish %A David M Cutler %A Mohammed U Kabeto %A Scott Y H Kim %A Allison B Rosen %K Aged %K Aged, 80 and over %K Cognition Disorders %K Female %K Humans %K Male %K Neurology %K Prevalence %K Quality of Life %K Socioeconomic factors %K United States %X

BACKGROUND: Recent medical, demographic, and social trends might have had an important impact on the cognitive health of older adults. To assess the impact of these multiple trends, we compared the prevalence and 2-year mortality of cognitive impairment (CI) consistent with dementia in the United States in 1993 to 1995 and 2002 to 2004.

METHODS: We used data from the Health and Retirement Study (HRS), a nationally representative population-based longitudinal survey of U.S. adults. Individuals aged 70 years or older from the 1993 (N = 7,406) and 2002 (N = 7,104) waves of the HRS were included. CI was determined by using a 35-point cognitive scale for self-respondents and assessments of memory and judgment for respondents represented by a proxy. Mortality was ascertained with HRS data verified by the National Death Index.

RESULTS: In 1993, 12.2% of those aged 70 or older had CI compared with 8.7% in 2002 (P < .001). CI was associated with a significantly higher risk of 2-year mortality in both years. The risk of death for those with moderate/severe CI was greater in 2002 compared with 1993 (unadjusted hazard ratio, 4.12 in 2002 vs 3.36 in 1993; P = .08; age- and sex-adjusted hazard ratio, 3.11 in 2002 vs 2.53 in 1993; P = .09). Education was protective against CI, but among those with CI, more education was associated with higher 2-year mortality.

CONCLUSIONS: These findings support the hypothesis of a compression of cognitive morbidity between 1993 and 2004, with fewer older Americans reaching a threshold of significant CI and a more rapid decline to death among those who did. Societal investment in building and maintaining cognitive reserve through formal education in childhood and continued cognitive stimulation during work and leisure in adulthood might help limit the burden of dementia among the growing number of older adults worldwide.

%B Alzheimers Dement %I 4 %V 4 %P 134-44 %8 2008 Mar %G eng %N 2 %L newpubs20090908/Langa_etal_AD.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18631957?dopt=Abstract %2 PMC2390845 %4 Dementia/Epidemiology/heart disease/Education %$ 20300 %R 10.1016/j.jalz.2008.01.001 %0 Journal Article %J Ann Intern Med %D 2007 %T Geriatric conditions and disability: the Health and Retirement Study. %A Christine T Cigolle %A Kenneth M. Langa %A Mohammed U Kabeto %A Zhiyi Tian %A Caroline S Blaum %K Accidental Falls %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Body Mass Index %K Chronic disease %K Cognition Disorders %K Comorbidity %K Cross-Sectional Studies %K Disability Evaluation %K Dizziness %K Female %K Geriatric Assessment %K Geriatrics %K Hearing Disorders %K Humans %K Male %K Prevalence %K Retirement %K Urinary incontinence %K Vision Disorders %X

BACKGROUND: Geriatric conditions, such as incontinence and falling, are not part of the traditional disease model of medicine and may be overlooked in the care of older adults. The prevalence of geriatric conditions and their effect on health and disability in older adults has not been investigated in population-based samples.

OBJECTIVE: To investigate the prevalence of geriatric conditions and their association with dependency in activities of daily living by using nationally representative data.

DESIGN: Cross-sectional analysis.

SETTING: Health and Retirement Study survey administered in 2000.

PARTICIPANTS: Adults age 65 years or older (n = 11 093, representing 34.5 million older Americans) living in the community and in nursing homes.

MEASUREMENTS: Geriatric conditions (cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment, hearing impairment) and dependency in activities of daily living (bathing, dressing, eating, transferring, toileting).

RESULTS: Of adults age 65 years or older, 49.9% had 1 or more geriatric conditions. Some conditions were as prevalent as common chronic diseases, such as heart disease and diabetes. The association between geriatric conditions and dependency in activities of daily living was strong and significant, even after adjustment for demographic characteristics and chronic diseases (adjusted risk ratio, 2.1 [95% CI, 1.9 to 2.4] for 1 geriatric condition, 3.6 [CI, 3.1 to 4.1] for 2 conditions, and 6.6 [CI, 5.6 to 7.6] for > or =3 conditions).

LIMITATIONS: The study was cross-sectional and based on self-reported data. Because measures were limited by the survey questions, important conditions, such as delirium and frailty, were not assessed. Survival biases may influence the estimates.

CONCLUSIONS: Geriatric conditions are similar in prevalence to chronic diseases in older adults and in some cases are as strongly associated with disability. The findings suggest that geriatric conditions, although not a target of current models of health care, are important to the health and function of older adults and should be addressed in their care.

%B Ann Intern Med %I 147 %V 147 %P 156-64 %8 2007 Aug 07 %G eng %N 3 %L newpubs20071002_Cigolle_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17679703?dopt=Abstract %4 ADL and IADL Impairments/Geriatrics/Chronic Disease/Health care %$ 18010 %R 10.7326/0003-4819-147-3-200708070-00004 %0 Journal Article %J J Am Geriatr Soc %D 2005 %T Setting eligibility criteria for a care-coordination benefit. %A Christine T Cigolle %A Kenneth M. Langa %A Mohammed U Kabeto %A Caroline S Blaum %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Case Management %K Chronic disease %K Cognition Disorders %K Comorbidity %K Cross-Sectional Studies %K Disability Evaluation %K Disease Management %K Eligibility Determination %K Female %K Geriatric Assessment %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Medicare %K Middle Aged %K Retirement %K United States %X

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.

%B J Am Geriatr Soc %I 53 %V 53 %P 2051-9 %8 2005 Dec %G eng %N 12 %L pubs_2005_Cigolle_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16398887?dopt=Abstract %4 Chronic Disease/Cognition Disorders/ADL and IADL Impairments/Caregiving %$ 15640 %R 10.1111/j.1532-5415.2005.00496.x %0 Journal Article %J Value Health %D 2004 %T Out-of-pocket health-care expenditures among older Americans with cancer. %A Kenneth M. Langa %A A. Mark Fendrick %A M.E. Chernew %A Mohammed U Kabeto %A Paisley, Kerry L. %A Hayman, James A. %K Aged %K Aged, 80 and over %K Cost of Illness %K Family Characteristics %K Female %K Financing, Personal %K Health Expenditures %K Health Services Research %K Humans %K Insurance, Health %K Longitudinal Studies %K Male %K Medicaid %K Medicare %K Michigan %K Neoplasms %X

OBJECTIVE: There is currently limited information regarding the out-of-pocket expenditures (OOPE) for medical care made by elderly individuals with cancer. We sought to quantify OOPE for community-dwelling individuals age 70 or older with: 1) no cancer (No CA), 2) a history of cancer, not undergoing current treatment (CA/No Tx), and 3) a history of cancer, undergoing current treatment (CA/Tx).

METHODS: We used data from the 1995 Asset and Health Dynamics Study, a nationally representative survey of community-dwelling elderly individuals. Respondents identified their cancer status and reported OOPE for the prior 2 years for: 1) hospital and nursing home stays, 2) outpatient services, 3) home care, and 4) prescription medications. Using a multivariable two-part regression model to control for differences in sociodemographics, living situation, functional limitations, comorbid chronic conditions, and insurance coverage, the additional cancer-related OOPE were estimated.

RESULTS: Of the 6370 respondents, 5382 (84%) reported No CA, 812 (13%) reported CA/No Tx, and 176 (3%) reported CA/Tx. The adjusted mean annual OOPE for the No CA, CA/No Tx, and CA/Tx groups were 1210 dollars, 1450 dollars, and 1880 dollars, respectively (P < .01). Prescription medications (1120 dollars per year) and home care services (250 dollars) accounted for most of the additional OOPE associated with cancer treatment. Low-income individuals undergoing cancer treatment spent about 27% of their yearly income on OOPE compared to only 5% of yearly income for high-income individuals with no cancer history (P < .01).

CONCLUSIONS: Cancer treatment in older individuals results in significant OOPE, mainly for prescription medications and home care services. Economic evaluations and public policies aimed at cancer prevention and treatment should take note of the significant OOPE made by older Americans with cancer.

%B Value Health %I 7 %V 7 %P 186-94 %8 2004 Mar-Apr %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/15164808?dopt=Abstract %4 Health Care Costs/Health Expenditures %$ 11532 %R 10.1111/j.1524-4733.2004.72334.x %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2002 %T Informal caregiving for diabetes and diabetic complications among elderly americans. %A Kenneth M. Langa %A Sandeep Vijan %A Rodney A. Hayward %A M.E. Chernew %A Caroline S Blaum %A Mohammed U Kabeto %A David R Weir %A Steven J. Katz %A Robert J. Willis %A A. Mark Fendrick %K Aged %K Aged, 80 and over %K Caregivers %K Cost of Illness %K Costs and Cost Analysis %K Diabetes Complications %K Diabetes Mellitus %K Disabled Persons %K Female %K Health Surveys %K Humans %K Hypoglycemic Agents %K Insulin %K Male %K Time Factors %X

OBJECTIVES: Little is known regarding the amount of time spent by unpaid caregivers providing help to elderly individuals for disabilities associated with diabetes mellitus (DM). We sought to obtain nationally representative estimates of the time, and associated cost, of informal caregiving provided to elderly individuals with diabetes, and to determine the complications of DM that contribute most significantly to the subsequent need for informal care.

METHODS: We estimated multivariable regression models using data from the 1993 Asset and Health Dynamics Among the Oldest Old Study, a nationally representative survey of people aged 70 or older (N = 7,443), to determine the weekly hours of informal caregiving and imputed cost of caregiver time for community-dwelling elderly individuals with and without a diagnosis of DM.

RESULTS: Those without DM received an average of 6.1 hr per week of informal care, those with DM taking no medications received 10.5 hr, those with DM taking oral medications received 10.1 hr, and those with DM taking insulin received 14.4 hr of care (p <.01). Disabilities related to heart disease, stroke, and visual impairment were important predictors of diabetes-related informal care. The total cost of informal caregiving for elderly individuals with diabetes in the United States was between $3 and $6 billion per year, similar to previous estimates of the annual paid long-term care costs attributable to DM.

DISCUSSION: Diabetes imposes a substantial burden on elderly individuals, their families, and society, both through increased rates of disability and the significant time that informal caregivers must spend helping address the associated functional limitations. Future evaluations of the costs of diabetes, and the cost-effectiveness of diabetes interventions, should consider the significant informal caregiving costs associated with the disease.

%B J Gerontol B Psychol Sci Soc Sci %I 57B %V 57 %P S177-86 %8 2002 May %G eng %N 3 %L pubs_2002_Langa_KJGSeriesB.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11983744?dopt=Abstract %4 Aged, 80 and Over/Caregivers/Cost of Illness/Costs and Cost Analysis/Diabetes Mellitus/Complications/Therapy/Disabled Persons/Female/Health Surveys/Hypoglycemic Agents/Insulin/Support, Non U.S. Government/Support, U.S. Government--non PHS/Support, U.S. Government--PHS/Time Factors %$ 4080 %R 10.1093/geronb/57.3.s177 %0 Journal Article %J J Clin Oncol %D 2001 %T Estimating the cost of informal caregiving for elderly patients with cancer. %A Hayman, James A. %A Kenneth M. Langa %A Mohammed U Kabeto %A Steven J. Katz %A DeMonner, Sonya M. %A M.E. Chernew %A Slavin, Mitchell B. %A A. Mark Fendrick %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Caregivers %K Cost of Illness %K Family %K Female %K Home Nursing %K Humans %K Male %K Multivariate Analysis %K Neoplasms %K Regression Analysis %K United States %X

PURPOSE: As the United States population ages, the increasing prevalence of cancer is likely to result in higher direct medical and nonmedical costs. Although estimates of the associated direct medical costs exist, very little information is available regarding the prevalence, time, and cost associated with informal caregiving for elderly cancer patients.

MATERIALS AND METHODS: To estimate these costs, we used data from the first wave (1993) of the Asset and Health Dynamics (AHEAD) Study, a nationally representative longitudinal survey of people aged 70 or older. Using a multivariable, two-part regression model to control for differences in health and functional status, social support, and sociodemographics, we estimated the probability of receiving informal care, the average weekly number of caregiving hours, and the average annual caregiving cost per case (assuming an average hourly wage of $8.17) for subjects who reported no history of cancer (NC), having a diagnosis of cancer but not receiving treatment for their cancer in the last year (CNT), and having a diagnosis of cancer and receiving treatment in the last year (CT).

RESULTS: Of the 7,443 subjects surveyed, 6,422 (86%) reported NC, 718 (10%) reported CNT, and 303 (4%) reported CT. Whereas the adjusted probability of informal caregiving for those respondents reporting NC and CNT was 26%, it was 34% for those reporting CT (P <.05). Those subjects reporting CT received an average of 10.0 hours of informal caregiving per week, as compared with 6.9 and 6.8 hours for those who reported NC and CNT, respectively (P <.05). Accordingly, cancer treatment was associated with an incremental increase of 3.1 hours per week, which translates into an additional average yearly cost of $1,200 per patient and just over $1 billion nationally.

CONCLUSION: Informal caregiving costs are substantial and should be considered when estimating the cost of cancer treatment in the elderly.

%B J Clin Oncol %I 19 %V 19 %P 3219-25 %8 2001 Jul 01 %G eng %N 13 %L pubs_2001_Hayman_JJClinOnc.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11432889?dopt=Abstract %4 Activities of Daily Living/Aged, 80 and Over/Caregivers/Cost of Illness/Family/Psychology/Female/Home Nursing/Economics/Statistics and Numerical Data/Human/Multivariate Analysis/Neoplasms/Complications/Therapy/Regression Analysis/United States %$ 4250 %R 10.1200/JCO.2001.19.13.3219 %0 Journal Article %J Med Care %D 2001 %T The explosion in paid home health care in the 1990s: who received the additional services? %A Kenneth M. Langa %A M.E. Chernew %A Mohammed U Kabeto %A Steven J. Katz %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Chronic disease %K Family Characteristics %K Female %K Financing, Government %K Frail Elderly %K Geriatric Assessment %K Health Care Surveys %K Health Expenditures %K health policy %K Home Care Services %K Home Nursing %K Humans %K Longitudinal Studies %K Male %K Marital Status %K Multivariate Analysis %K Social Support %K Socioeconomic factors %K Surveys and Questionnaires %K United States %K Utilization Review %X

OBJECTIVE: Public expenditures for home health care grew rapidly in the 1990s, but it remains unclear to whom the additional services were targeted. This study tests whether the rapidly increasing expenditures were targeted to the elderly with high levels of disability and low levels of social support, 2 groups that have historically been higher users of paid home health and nursing home services.

METHODS: The Asset and Health Dynamics Study, a nationally representative, longitudinal survey of people > or = 70 years of age (n = 7,443), was used to determine the association of level of disability and level of social support with the use of paid home care services in both 1993 and 1995. Multivariable regression models were used to adjust for sociodemographics, recent hospital or nursing home admissions, chronic medical conditions, and receipt of informal care from family members.

RESULTS: Those with higher levels of disability received more adjusted weekly hours of paid home care in both 1993 and 1995. In 1993, users of paid home care with the least social support (unmarried living alone) received more adjusted weekly hours of care than the unmarried elderly living with others (24 versus 13 hours, P < 0.01) and the married (24 versus 18 hours, P = 0.06). However, by 1995, those who were unmarried and living with others were receiving the most paid home care: 40 versus 26 hours for the unmarried living alone (P < 0.05) and 24 hours for the married (P < 0.05).

CONCLUSIONS: The recent large increase in formal home care services went disproportionately to those with greater social support. Home care policy changes in the early 1990s resulted in a shift in the distribution of home care services toward the elderly living with their children.

%B Med Care %I 39 %V 39 %P 147-57 %8 2001 Feb %G eng %N 2 %L pubs_2001_Langa_KMedCare.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11176552?dopt=Abstract %4 Activities of Daily Living/Classification/Aged, 80 and Over/Chronic Disease/Family Characteristics/Female/Financing, Government/Frail Elderly/Geriatric Assessment/Health Care Surveys/Health Expenditures/Health Policy/Home Care Services/Home Nursing/Longitudinal Studies/Marital Status/Multivariate Analysis/Questionnaires/Social Support/Socioeconomic Factors/Support, Non U.S. Government/United States/Utilization Review %$ 4095 %R 10.1097/00005650-200102000-00005 %0 Journal Article %J J Gen Intern Med %D 2001 %T National estimates of the quantity and cost of informal caregiving for the elderly with dementia. %A Kenneth M. Langa %A M.E. Chernew %A Mohammed U Kabeto %A A. Regula Herzog %A Mary Beth Ofstedal %A Robert J. Willis %A Robert B Wallace %A Mucha, L.M. %A Walter L. Straus %A A. Mark Fendrick %K Aged %K Aged, 80 and over %K Caregivers %K Cost of Illness %K Dementia %K Female %K Health Care Costs %K Humans %K Male %K Multivariate Analysis %K Regression Analysis %K Severity of Illness Index %K Time Factors %K United States %X

OBJECTIVE: Caring for the elderly with dementia imposes a substantial burden on family members and likely accounts for more than half of the total cost of dementia for those living in the community. However, most past estimates of this cost were derived from small, nonrepresentative samples. We sought to obtain nationally representative estimates of the time and associated cost of informal caregiving for the elderly with mild, moderate, and severe dementia.

DESIGN: Multivariable regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people age 70 years or older (N = 7,443).

SETTING: National population-based sample of the community-dwelling elderly.

MAIN OUTCOME MEASURES: Incremental weekly hours of informal caregiving and incremental cost of caregiver time for those with mild dementia, moderate dementia, and severe dementia, as compared to elderly individuals with normal cognition. Dementia severity was defined using the Telephone Interview for Cognitive Status.

RESULTS: After adjusting for sociodemographics, comorbidities, and potential caregiving network, those with normal cognition received an average of 4.6 hours per week of informal care. Those with mild dementia received an additional 8.5 hours per week of informal care compared to those with normal cognition (P < .001), while those with moderate and severe dementia received an additional 17.4 and 41.5 hours (P < .001), respectively. The associated additional yearly cost of informal care per case was 3,630 dollars for mild dementia, 7,420 dollars for moderate dementia, and 17,700 dollars for severe dementia. This represents a national annual cost of more than 18 billion dollars.

CONCLUSION: The quantity and associated economic cost of informal caregiving for the elderly with dementia are substantial and increase sharply as cognitive impairment worsens. Physicians caring for elderly individuals with dementia should be mindful of the importance of informal care for the well-being of their patients, as well as the potential for significant burden on those (often elderly) individuals providing the care.

%B J Gen Intern Med %I 16 %V 16 %P 770-8 %8 2001 Nov %G eng %N 11 %L pubs_2001_Langa_KJGIM.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11722692?dopt=Abstract %4 Aged, 80 and Over/Caregivers/Economics/Cost of Illness/Dementia/Economics/Therapy/Female/Health Care Costs/Multivariate Analysis/Regression Analysis/Severity of Illness Index/Support, Non U.S. Government/Support, U.S. Government--PHS/Time Factors/United States %$ 4090 %R 10.1111/j.1525-1497.2001.10123.x