Health Services Use and Outcomes in Older Adults with Dementia Living Undiagnosed or Unaware of Dementia

未确诊或不了解痴呆症的痴呆症老年人的卫生服务使用和结果

基本信息

批准号：
9899185
负责人：
Halima Amjad
金额：
$ 16.38万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-01 至 2023-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9899185
关键词：
Accident and Emergency department Address Adverse event Advisory Committees Affect Aging Algorithms Alzheimer&apos s Disease Alzheimer&apos s disease related dementia American Awareness Belief Blood Vessels Caring Characteristics Classification Clinical Cognitive Communities Coupled Data Dementia Detection Diagnosis Disclosure Disease Early Diagnosis Education Elderly Emergency department visit Family Family health status Frontotemporal Dementia Health Health Services Health system Healthcare Hispanics Home environment Hospitalization Hospitals Impaired cognition Impairment Individual Intervention Interview Knowledge Length of Stay Lewy Bodies Light Link Medical Medicare claim Medication Management Minority Outcome Participant Patient-Focused Outcomes Patients Persons Population Prevalence Prevention Preventive Preventive service Principal Investigator Race Research Risk Sampling Self Management Services Social Behavior Subgroup Target Populations Translating United States Visit Vulnerable Populations Work adverse outcome base behavioral impairment career clinical Diagnosis cohort cost dementia care early awareness epidemiology study family support functional decline functional disability health service use hospital readmission hospitalization rates iatrogenic injury improved outcome novel strategies prevent therapy design trend

项目摘要

PROJECT SUMMARY Astoundingly, about half of approximately 5.7 million persons living with Alzheimer’s disease and related dementias in the United States are undiagnosed. Persons with undiagnosed dementia are living with cognitive impairment that affects everyday activities but has not been detected by patients, families, and/or clinicians. Additionally, in one third of diagnosed patients, they or their families are unaware of a dementia diagnosis. Thus, diagnosis does not always translate to awareness and understanding of a significant condition. Though most individuals with dementia are undiagnosed or unaware, early diagnosis and disclosure is controversial in the absence of disease-modifying treatments. The United States Preventive Services Task Force has not yet found evidence of benefit for early dementia detection on patient outcomes. This proposal seeks to build evidence of whether early diagnosis and awareness, related but distinct concepts, could improve outcomes. A novel approach to identifying potential benefits of early dementia diagnosis is to identify negative outcomes occurring when persons are undiagnosed or unaware. Such outcomes could potentially be prevented through earlier, transparent diagnosis linked to proactive care. This project focuses on health services use, specifically emergency department (ED) visits, hospitalization, hospitalization outcomes, and spending as outcomes that may be affected by lack of dementia diagnosis or awareness. ED visits and hospitalization are common and associated with adverse outcomes in diagnosed dementia; it is not known whether ED and hospitalization rates and outcomes are similar in undiagnosed dementia. Persons with undiagnosed dementia may in fact have higher rates, worse outcomes, and greater spending in the absence of dementia detection, care, and support. To address this hypothesis, the proposal leverages the National Health and Aging Trends Study, a nationally representative cohort of older Americans that identifies participants with probable dementia through a validated interview and assessment-based algorithm. Linked Medicare claims data for 4,311 participants offers the opportunity to examine longitudinal health services outcomes in persons with probable dementia who are undiagnosed or unaware of the diagnosis. Dementia diagnoses will encompass Alzheimer’s disease and related disorders (e.g. vascular, mixed, Lewy body, and frontotemporal dementia). Aim 1 investigates whether dementia diagnosis or awareness is associated with risk of all-cause and potentially preventable ED visits and hospitalizations over four years, comparing undiagnosed versus diagnosed and unaware versus aware of diagnosis. Aim 2 compares annual healthcare spending, and among participants hospitalized, annual hospital length of stay, days at home, and 30-day readmissions by diagnosis and awareness status. Aim 3 identifies predictors of ED visits and hospitalizations among persons undiagnosed or unaware. These aims will contribute to limited knowledge of outcomes in undiagnosed dementia, potential benefits of earlier, transparent diagnosis, and subgroups who may particularly benefit from earlier diagnosis and proactive medical care.

项目摘要令人震惊的是，在美国，大约 570 万患有阿尔茨海默病和相关痴呆症的患者中，约有一半未得到诊断。未确诊的痴呆症患者患有影响日常活动的认知障碍，但患者、家人和/或并未发现。此外，在三分之一的确诊患者中，他们或他们的家人并不知道痴呆症的诊断，因此，尽管大多数患有痴呆症的人，诊断并不总是意味着对重大疾病的认识和理解。由于未确诊或不知情，在缺乏疾病缓解治疗的情况下，早期诊断和披露存在争议。美国预防服务工作组尚未发现早期痴呆症检测对患者结果是否有益的证据。早期诊断和意识，相关但不同的概念，可以改善结果，识别早期痴呆症诊断的潜在好处是识别在人们未确诊或不知情时发生的负面事件，通过早期、透明的诊断可以预防这种结果。该项目的重点是主动护理。医疗服务的使用，特别是急诊科 (ED) 就诊、住院治疗、住院结果和支出，因为缺乏痴呆症诊断或住院治疗可能会影响结果，并且与诊断出的痴呆症的不良结果相关；目前尚不清楚未确诊痴呆症患者的急诊室率和住院率及结果是否相似。在缺乏痴呆症检测、护理和支持的情况下，未确诊痴呆症患者的发病率实际上可能更高、结果更差、支出也更多。该提案利用了国民健康老龄化趋势研究是一个具有全国代表性的美国老年人群体，通过对 4,311 名参与者进行验证的访谈和基于评估的关联医疗保险索赔数据来识别可能患有痴呆症的参与者，为检查可能患有痴呆症的人的纵向医疗服务结果提供了机会。未确诊或不知道痴呆症诊断将包括阿尔茨海默氏病和相关疾病（例如血管性痴呆、混合性痴呆、路易体痴呆和额颞叶痴呆）。或意识与四年内全因和可能可预防的急诊就诊和住院的风险相关，比较未诊断与诊断以及不知道与知道诊断的情况。目标 2 比较年度医疗保健支出，以及住院参与者的年度住院时间，目标 3 确定未确诊或未知晓患者的急诊就诊和住院治疗的预测因素。痴呆症、早期、透明诊断的潜在好处，以及可能特别受益于早期诊断和积极医疗护理的亚群体。