Health Care Costs of Alzheimer's and Related Dementias Within a Medicare Managed Care Provider

Initiatives Targeting Patients: A Systematic Review of Knowledge Translation Pain Assessment and Management Studies Focusing on Older Adults

OBJECTIVES

Older adults frequently experience persistent pain but are often unaware of self-management and other strategies that can help improve their condition. In a related article, we reported on pain assessment and management knowledge translation initiatives related to older adults that were targeting health professionals. In this paper, we report on initiatives targeting older adults.

MATERIALS AND METHODS

Using systematic review methodology, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycInfo, and Web of Science databases were searched from inception to June 2023. Pain-related knowledge translation programs targeted towards older adults, their informal caregivers, and health care professionals were examined.

RESULTS

From an initial 21,669 search results, 172 studies met our inclusion criteria. Of these studies, 49 targeted older adults. These studies varied widely in focus and delivery format, but the majority were associated with a significant risk of bias. Older adults with musculoskeletal pain were the primary recipients of education. Most programs were classified as knowledge mobilization initiatives. The remainder were considered self-management programs. Knowledge users were satisfied with the suitability of the information presented, and patient outcomes were a primary concern across all studies. Behavioral changes and pain management outcomes, however, were underemphasized in the literature.

CONCLUSION

Knowledge acquisition outcomes are overrepresented in the current literature compared with behavioral outcomes changes. Nonetheless, older adults report benefitting from the guidance provided in self-management programs when applying knowledge to practice. Future research is needed to better understand the facilitators and barriers to pain management changes in this population.

Promise and peril of claims-based dementia ascertainment in causal inference

Festa and colleagues highlight underrecognized factors that may bias research, policy, and population health strategies predicated upon claims-based ascertainment of Alzheimer’s Disease and Related Dementias within the United States.

A 14-Year Longitudinal Analysis of Healthcare Expenditure on Dementia and Related Factors (DEMENCOST Study)

BACKGROUND

The large number of dementia cases produces a great pressure on health and social care services, which requires efficient planning to meet the needs of patients through infrastructure, equipment, and financial, technical, and personal resources adjusted to their demands. Dementia analysis requires studies with a very precise patient characterization of both the disease and comorbidities present, and long-term follow-up of patients in clinical aspects and patterns of resource utilization and costs generated.

OBJECTIVE

To describe and quantify direct healthcare expenditure and its evolution from three years before and up to ten years after the diagnosis of dementia, compared to a matched group without dementia.

METHODS

Retrospective cohort design with follow-up from 6 to 14 years. We studied 996 people with dementia (PwD) and 2,998 controls matched for age, sex, and comorbidity. This paper adopts the provider's perspective as the perspective of analysis and refers to the costs actually incurred in providing the services. Aggregate costs and components per patient per year were calculated and modelled.

RESULTS

Total health expenditure increases in PwD from the year of diagnosis and in each of the following 7 years, but not thereafter. Health status and mortality are factors explaining the evolution of direct costs. Dementia alone is not a statistically significant factor in explaining differences between groups.

CONCLUSION

The incremental direct cost of dementia may not be as high or as long as studies with relatively short follow-up suggest. Dementia would have an impact on increasing disease burden and mortality.

Cognitive measures lacking in EHR prior to dementia or Alzheimer's disease diagnosis

Introduction

The extent that cognitive measures are documented in electronic health records (EHR) is important for quality care and addressing disparities in timely diagnosis of dementia or Alzheimer's disease (AD).

Methods

Analysis of U.S. EHR data to describe the frequency and factors associated with cognitive measures prior to diagnosis of dementia (N = 111,125) or AD (N = 30,203).

Results

Only 11% of dementia patients and 24% of AD patients had a cognitive measure documented in the 5 years prior to diagnosis. Black race, older age, non‐commercial health insurance, lower mean neighborhood income, greater in‐patient stays, and fewer out‐patient visits were associated with lacking cognitive measures.

Discussion

Extensive missing cognitive data and differences in the availability of cognitive measures by race, age, and socioeconomic factors hinder patient care and limit utility of EHR for dementia research. Structured fields and prompts for cognitive data inputs at the point of care may help address these gaps.