Health and Financial Implications of Early-Stage Alzheimer's Disease and Related Dementias

早期阿尔茨海默病和相关痴呆症对健康和财务的影响

基本信息

批准号：
10349260
负责人：
Lauren Hersch Nicholas
金额：
$ 250.88万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-15 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10349260
关键词：
Health Financial Implications Early Stage

项目摘要

Project Summary/Abstract Alzheimer's Disease and Related Dementias (ADRD) are chronic, disabling cognitive impairments that will affect an estimated 12 million Americans by 2050. Undetected, these changes can lead to financial losses from elder abuse and fraud, forgetting to pay bills, and compromised financial decision-making. Often, cognitive impairment is not discovered until after patients have lost significant sums of money and experienced additional functional decline. One possible solution is to recognize the early signs of ADRD in financial data. In pilot data (R21AG053698), we linked 20 years of Medicare claims to quarterly credit reports, demonstrating that ADRD patients without a spouse/partner are more likely to miss bill payments, develop subprime credit, and experience adverse financial events for years prior to their diagnosis, a pattern unique to ADRD. Our prior work suggests that banking and credit data can be used to screen for dementia in the clinical setting, and to protect patients and families from ADRD-linked financial exploitation and other losses, including health effects of dealing with additional financial stress. We propose to test these hypotheses in the following aims, using newly created financial data linkages and partnering with patients, government, and industry: Aim 1: Test whether and when unique financial symptoms of ADRD are present in credit data prior to clinical diagnosis in coupled households. Aim 2: Test whether unique financial symptoms of ADRD can be observed in banking and brokerage data before accountholders experience elder mistreatment, fraud, and diminished capacity. Aim 3: Compare 4-year rates of mortality and hospitalization among spouses of ADRD patients with and without adverse credit events by the time of diagnosis. Aim 4: Assess the feasibility and ethical implications of using financial data to detect ADRD. We will use a 20-year panel of Medicare claims linked to consumer credit reports for Aims 1 and 3 and more than 10 years of account information from a large US bank in Aim 2. We will compare ADRD to other health conditions and sources of elder mistreatment to determine whether it has a unique financial presentation. Our study team includes an interdisciplinary group of physicians, economists, ethicists, and health services researchers with a long history of collaboration in partnership with the Federal Reserve, patient and industry stakeholders. Findings from this study will provide the most comprehensive information to date on the prevalence and magnitude of financial losses and elder mistreatment prior to ADRD diagnosis, as well as their impact on spousal health. This information is critical for many public and private decisions ranging from when and whether to begin screening for ADRD, the potential role of financial institutions in protecting clients who may be unaware of their early cognitive decline, and whether consumer data are sufficiently informative about health to require additional privacy protection.

项目概要/摘要阿尔茨海默氏病和相关痴呆症 (ADRD) 是一种慢性、致残性认知障碍，到 2050 年，预计将影响 1200 万美国人。这些变化如果未被发现，可能会导致经济损失虐待老人和欺诈、忘记支付账单以及财务决策受损。经常，直到患者损失了大笔金钱并经历了认知障碍之后才发现认知障碍额外的功能下降。一种可能的解决方案是识别财务数据中 ADRD 的早期迹象。在试点数据 (R21AG053698) 中，我们将 20 年的医疗保险索赔与季度信用报告联系起来，证明没有配偶/伴侣的 ADRD 患者更有可能错过账单付款、发展次级信贷、并在诊断前数年经历不良财务事件，这是 ADRD 独有的模式。我们之前的工作表明，银行和信贷数据可用于临床筛查痴呆症保护患者和家庭免受 ADRD 相关的经济剥削和其他损失，包括应对额外财务压力对健康的影响。我们建议在以下方面检验这些假设目标，使用新创建的财务数据链接并与患者、政府和行业合作：目标 1：在临床前测试信用数据中是否以及何时出现 ADRD 的独特财务症状夫妻家庭的诊断。目标 2：测试是否可以观察到 ADRD 的独特财务症状在账户持有人遭受老年人虐待、欺诈和减少之前，在银行和经纪数据中容量。目标 3：比较 ADRD 患者配偶的 4 年死亡率和住院率并且在诊断时没有不良信用事件。目标 4：评估可行性和道德性使用财务数据检测 ADRD 的影响。我们将使用与目标 1 和 3 的消费者信用报告相关的 20 年医疗保险索赔小组目标 2 中一家美国大型银行超过 10 年的账户信息。我们将 ADRD 与其他健康状况和虐待老年人的来源，以确定其是否具有独特的财务状况推介会。我们的研究团队包括由医生、经济学家、伦理学家和健康专家组成的跨学科小组与美联储、患者和患者有着长期合作历史的服务研究人员行业利益相关者。这项研究的结果将提供迄今为止最全面的信息 ADRD 诊断前经济损失和老年人虐待的普遍性和程度，以及它们的情况对配偶健康的影响。这些信息对于许多公共和私人决策至关重要，包括何时以及是否开始筛查 ADRD、金融机构在保护客户方面的潜在作用可能没有意识到他们早期的认知能力下降，以及消费者数据是否足以提供有关以下方面的信息：健康需要额外的隐私保护。