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.

项目摘要/摘要阿尔茨海默氏病和相关痴呆症（ADRD）是慢性的，使认知障碍使人致残到2050年将影响估计有1200万美国人。未被发现，这些变化可能导致财务损失从虐待老人和欺诈中，忘记支付账单，并妥协了财务决策。经常，直到患者损失了大量金钱并经历过，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Medicare主张与季度信用报告联系起来没有配偶/伴侣的ADRD患者更有可能错过账单付款，建立次级信贷，并在诊断前经历不良财务事件，这是ADRD独有的模式。我们先前的工作表明，银行和信贷数据可用于筛查临床中的痴呆症设置，并保护患者和家庭免受与ADRD连接的财务剥削和其他损失，包括应对额外的财务压力的健康影响。我们建议在以下来检验这些假设目的，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：在临床之前测试信用数据中是否存在ADRD的独特财务症状以及何时存在耦合家庭的诊断。目标2：测试是否可以观察到ADRD的独特财务症状在Accountholter之前的银行和经纪数据中，经历了虐待，欺诈和减少的老年人容量。 AIM 3：比较ADRD患者配偶的4年死亡率和住院并且在诊断时没有不良信用事件。目标4：评估可行性和道德使用财务数据检测ADRD的含义。我们将使用20年的Medicare索赔小组，该索赔与AIMS 1和3的消费者信用报告有关来自AIM 2的美国大型银行有10年以上的帐户信息。我们将将ADRD与其他ADRD进行比较健康状况和老年人虐待的来源，以确定其是否具有独特的财务状况推介会。我们的学习团队包括一个跨学科的医师，经济学家，伦理学家和健康与美联储，患者和行业利益相关者。这项研究的发现将提供迄今为止最全面的信息经济损失的患病率和严重性和在ADRD诊断之前的虐待年龄对配偶健康的影响。这些信息对于许多公共和私人决定至关重要以及是否开始筛选ADRD，金融机构在保护客户中的潜在作用可能没有意识到它们的早期认知能力下降，以及消费者数据是否足够有用健康需要额外的隐私保护。