American Journal of Geriatric Psychiatry最新文献

英文中文

Medicare Payments and ACOs for Dementia Patients Across Race and Social Vulnerability 不同种族和社会弱势人群痴呆症患者的医疗保险支付和 ACO。

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-07-02 DOI: 10.1016/j.jagp.2024.06.011

Jie Chen Ph.D , Seyeon Jang M.S , Min Qi Wang Ph.D

Objectives

This study investigated variations in Medicare payments for Alzheimer's disease and related dementia (ADRD) by race, ethnicity, and neighborhood social vulnerability, together with cost variations by beneficiaries' enrollment in Accountable Care Organizations (ACOs).

Methods

We used merged datasets of longitudinal Medicare Beneficiary Summary File (2016–2020), the Social Vulnerability Index (SVI), and the Medicare Shared Savings Program (MSSP) ACO to measure beneficiary-level ACO enrollment at the diagnosis year of ADRD. We analyzed Medicare payments for patients newly diagnosed with ADRD for the year preceding the diagnosis and for the subsequent 3 years. The dataset included 742,175 Medicare fee-for-service (FFS) beneficiaries aged 65 and older with a new diagnosis of ADRD in 2017 who remained in the Medicare FFS plan from 2016 to 2020.

Results

Among those newly diagnosed, Black and Hispanic patients encountered higher total costs compared to White patients, and ADRD patients living in the most vulnerable areas experienced the highest total costs compared to patients living in other regions. These cost differences persisted over 3 years postdiagnosis. Patients enrolled in ACOs incurred lower costs across all racial and ethnic groups and SVI areas. For ADRD patients living in the areas with the highest vulnerability, the cost differences by ACO enrollment of the total Medicare costs ranged from $4,403.1 to $6,922.7, and beneficiaries’ savings ranged from $114.5 to $726.6 over three years post-ADRD diagnosis by patient's race and ethnicity.

Conclusions

Black and Hispanic ADRD patients and ADRD patients living in areas with higher social vulnerability would gain more from ACO enrollment compared to their counterparts.

研究目的：本研究调查了阿尔茨海默病及相关痴呆症（ADRD）的医疗保险支付因种族、民族和邻里社会脆弱性而产生的差异，以及因受益人加入责任医疗组织（ACOs）而产生的成本差异：我们使用了纵向医疗保险受益人摘要档案（2016-2020 年）、社会脆弱性指数（SVI）和医疗保险共同储蓄计划（MSSP）ACO 的合并数据集，以衡量 ADRD 诊断年份的受益人级别 ACO 注册情况。我们分析了新确诊 ADRD 患者在确诊前一年及随后三年的医疗保险支付情况。数据集包括 742,175 名年龄在 65 岁及以上、2017 年新诊断为 ADRD 且在 2016 年至 2020 年期间仍在联邦医疗保险 FFS 计划中的联邦医疗保险付费服务（FFS）受益人：在新确诊的患者中，黑人和西班牙裔患者的总费用高于白人患者，与生活在其他地区的患者相比，生活在最脆弱地区的 ADRD 患者的总费用最高。这些费用差异在确诊后 3 年内持续存在。加入 ACO 的患者在所有种族和民族群体以及 SVI 地区的费用都较低。对于生活在最脆弱地区的 ADRD 患者，根据患者的种族和民族，在 ADRD 诊断后三年内，加入 ACO 的医疗保险总费用差异从 4,403.1 美元到 6,922.7 美元不等，受益人节省的费用从 114.5 美元到 726.6 美元不等：结论：黑人和西班牙裔 ADRD 患者以及生活在社会脆弱性较高地区的 ADRD 患者与同类患者相比，将从 ACO 注册中获益更多。

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引用次数: 0

Neuropsychiatric Symptom Profile in Alzheimer's Disease and Their Relationship With Functional Decline 阿尔茨海默病的神经精神症状及其与功能衰退的关系

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-06-29 DOI: 10.1016/j.jagp.2024.06.005

Carolyn W. Zhu Ph.D. , Lon S. Schneider M.D. , Gregory A. Elder M.D. , Laili Soleimani M.D. , Hillel T. Grossman M.D. , Amy Aloysi M.D., M.P.H. , Corbett Schimming M.D. , Mary Sano Ph.D.

Objective

Understanding the course of individual neuropsychiatric symptoms (NPS) and their relationship with function is important for planning targeted interventions for preventing and delaying functional decline. This study aims to disentangle relative contributions of individual NPS on functional decline.

Methods

Longitudinal study of 9,358 well-characterized participants with baseline diagnoses of Mild Cognitive Impairment or AD in the National Alzheimer's Coordinating Center Uniform Data Set. Function was measured using the Functional Assessment Questionnaire (FAQ). Clinician judgment of seven common behavioral symptoms were examined simultaneously: apathy-withdrawal, depressed mood, visual or auditory hallucinations, delusions, disinhibition, irritability, and agitation.

Results

Apathy was the most common NPS at baseline (33.7%) and throughout follow-up, endorsed by clinicians in 63.7% of visits. Apathy was the most persistent with 36.7% of participants having clinician-endorsed apathy in ≥50% of their visits. Apathy strongly correlated with faster rate of functional decline. Compared to those who never had apathy, baseline FAQ was worse in those with intermittent or persistent/always apathy (intermittent: estimated coefficient ±SE=1.228±0.210, 95% CI=[0.817, 1.639]; persistent/always: 2.354±0.244 (95% CI=[1.876, 2.832], both p <0.001). Over time, rate of functional decline was faster in those with intermittent and persistent/always apathy (intermittent: 0.454±0.091, 95% CI=[0.276, 0.632]; persistent/always: 0.635±0.102, 95% CI=[0.436, 0.835], both p <0.001). Worse agitation, delusions, and hallucinations also correlated with functional decline, but magnitudes of the estimates were smaller.

Conclusion

Individual NPS may be sensitive targets for tracking longitudinal change in function. The study raises awareness of the need for more comprehensive assessment of functional decline in AD patients with noncognitive symptoms.

目的：了解个体神经精神症状（NPS）的病程及其与功能的关系，对于规划有针对性的干预措施以预防和延缓功能衰退非常重要。本研究旨在厘清个别神经精神症状对功能衰退的相对影响：方法：对国家阿尔茨海默氏症协调中心统一数据集中的 9358 名特征明确、基线诊断为轻度认知功能障碍或注意力缺失症的参与者进行纵向研究。功能使用功能评估问卷（FAQ）进行测量。同时检查临床医生对七种常见行为症状的判断：冷漠-退缩、情绪低落、视觉或听觉幻觉、妄想、抑制、易怒和激动：在基线（33.7%）和整个随访期间，冷漠是最常见的 NPS，在 63.7% 的随访中得到了临床医生的认可。冷漠是最持久的症状，36.7% 的参与者在≥50% 的就诊中出现过临床医生认可的冷漠症状。淡漠与功能衰退的速度密切相关。与从未出现过淡漠的人相比，间歇性或持续/总是出现淡漠的人的基线常见问题解答更差（间歇性：估计系数±SE=1.228±0.210，95% CI=[0.817，1.639]；持续/总是：2.354±0.244（95% CI=[1.876，2.832]，均为 p 结论：与从未出现过淡漠的人相比，间歇性或持续/总是出现淡漠的人的基线常见问题解答更差：单个 NPS 可能是追踪功能纵向变化的敏感目标。该研究使人们认识到，有必要对有非认知症状的AD患者的功能衰退进行更全面的评估。

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引用次数: 0

Shadows 阴影

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-06-21 DOI: 10.1016/j.jagp.2024.06.004

引用次数: 0

Scientific Autobiography of a Japanese Psychiatrist Turned Cognitive-Behavioral Therapist, Clinical Epidemiologist and Smartphone App Developer 日本精神病学家转行成为认知行为治疗师、临床流行病学家和智能手机应用程序开发人员的科学自传。

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-06-19 DOI: 10.1016/j.jagp.2024.05.015

引用次数: 0

Response to Letter to the Editor 致编辑的回信。

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-06-15 DOI: 10.1016/j.jagp.2024.06.003

引用次数: 0

Commentary on Differential Psychological Treatment Effects in Patients With Late-Life Depression and a History of Childhood Maltreatment 晚年抑郁症和童年虐待史患者的心理治疗效果差异评述

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-06-15 DOI: 10.1016/j.jagp.2024.06.002

引用次数: 0

A Culturally Adapted Perioperative Mental Health Intervention for Older Black Surgical Patients 针对老年黑人手术患者的文化适应性围手术期心理健康干预措施

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-06-11 DOI: 10.1016/j.jagp.2024.06.001

Objectives

Perioperative mental health of older Black surgical patients is associated with poor surgical outcomes; however, evidence-based perioperative interventions are lacking. Our two study objectives included: first, examine factors affecting perioperative care experiences of older Black surgical patients with mental health problems, and second, ascertain design and implementation requirements for a culturally-adapted perioperative mental health intervention.

Design Setting and Participants

We conducted six focus groups with older Black patients (n = 15; ≥50 years; surgery within the past 5 years and/or interest in mental health research; history of distress, anxiety, or depression coping with surgery/hospitalization/) from a large academic medical center. We engaged study partners, including interventionists and community members, to gather insights on intervention and implementation needs. We followed a hybrid inductive-deductive thematic approach using open coding and the National Institute on Minority Health and Health Disparities Research Framework.

Results

Patients reported that their psychological well-being and long-term mental health outcomes were not appropriately considered during perioperative care. Perceived stressors included interpersonal and structural barriers to using mental healthcare services, clinician treatment biases and ageism in care, and lack of healthcare professional connections/resources. Patients utilized various coping strategies, including talk therapy, faith/spirituality, and family and friends.

Conclusion

This study offers valuable insights into the experiences of older Black surgical patients and the critical elements for developing a personalized perioperative mental health intervention to support their well-being before, during, and after surgery. Our findings demonstrated a need for a patient-centered and culturally adapted intervention targeting the individual/behavioral and interpersonal levels. Informed by the cultural adaptation framework, we propose a multi-component intervention that integrates psychological and pharmacological components.

目的老年黑人手术患者围手术期的心理健康与手术效果不佳有关；然而，目前还缺乏基于证据的围手术期干预措施。我们的两个研究目标包括：第一，研究影响有心理健康问题的老年黑人手术患者围手术期护理经验的因素；第二，确定适应文化的围手术期心理健康干预措施的设计和实施要求。设计环境和参与者我们与来自一家大型学术医疗中心的老年黑人患者（n = 15；≥50 岁；在过去 5 年内做过手术和/或对心理健康研究感兴趣；有应对手术/住院的痛苦、焦虑或抑郁史）进行了六次焦点小组讨论。我们邀请了研究合作伙伴，包括干预专家和社区成员，以收集关于干预和实施需求的见解。我们采用了归纳-演绎混合主题方法，使用开放式编码和美国国家少数民族健康和健康差异研究所研究框架。结果患者表示，在围手术期护理过程中，他们的心理健康和长期心理健康结果没有得到适当考虑。患者感知到的压力因素包括使用心理保健服务的人际障碍和结构性障碍、临床医生的治疗偏见和护理中的年龄歧视，以及缺乏医疗保健专业人员的联系/资源。患者使用了各种应对策略，包括谈话疗法、信仰/灵性以及家人和朋友。结论：本研究为了解老年黑人手术患者的经历以及制定个性化围手术期心理健康干预措施的关键因素提供了宝贵的见解，以支持他们在手术前、手术中和手术后的身心健康。我们的研究结果表明，有必要针对个人/行为和人际关系层面采取以患者为中心、适应文化的干预措施。在文化适应框架的指导下，我们提出了一种整合了心理和药物成分的多成分干预措施。

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引用次数: 0

Information for Subscribers 订户须知

IF 7.2 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-06-08 DOI: 10.1016/S1064-7481(24)00339-7

引用次数: 0

Living Alone With Mild-to-Moderate Dementia Over a Two-Year Period: Longitudinal Findings From the IDEAL Cohort 轻度至中度痴呆症患者独居两年：IDEAL 队列的纵向研究结果

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-06-06 DOI: 10.1016/j.jagp.2024.05.012

Objectives

To compare the experiences of people with dementia living alone or with others and how these may change over two years.

Design

We analysed longitudinal data from three assessment waves, one year apart, in the British IDEAL cohort.

Setting

Participants with mild-to-moderate dementia were recruited through National Health Service providers, where possible with a family caregiver, and interviewed at home.

Participants

The current analyses include 281 people with dementia living alone and 1,244 living with others at baseline; follow-up data were available for 200 and 965 respectively at time 2 and 144 and 696 respectively at time 3. For those living alone, 140 nonresident caregivers contributed at baseline, 102 at time 2 and 81 at time 3. For those living with others, 1,127 family caregivers contributed at baseline, 876 at time 2 and 670 at time 3.

Measurements

Assessments covered: cognitive and functional ability; self-reported perceptions of health, mood, social engagement, quality of life, satisfaction with life and well-being; use of in-home and community care; and transitions into residential care.

Results

People living alone tended to have better cognitive and functional ability and were more frequent users of in-home care. However, they experienced poorer physical, social, and psychological health and reduced quality of life, satisfaction with life, and well-being. These differences persisted over time and rates of transition into residential care were higher.

Conclusions

To facilitate continuing in place for people with dementia living alone, a dual focus on supporting functional ability and add ressing psychosocial needs is essential in the context of an enabling policy framework.

目标比较痴呆症患者独自生活或与他人共同生活的经历，以及这些经历在两年内可能发生的变化。设计我们分析了英国 IDEAL 队列中相隔一年的三次评估波的纵向数据。参与者目前的分析包括基线时独居的 281 名痴呆患者和与他人同住的 1244 名痴呆患者；分别有 200 人和 965 人在第 2 次和 144 人和 696 人在第 3 次获得了随访数据。对于独居痴呆症患者，140 名非居住地照护者在基线时提供了数据，102 名在第二时间提供了数据，81 名在第三时间提供了数据。评估内容包括：认知和功能能力；对健康、情绪、社会参与、生活质量、生活满意度和幸福感的自我报告；居家和社区护理的使用情况；以及向住宿护理的过渡情况。结果独居者的认知和功能能力往往更好，也更经常使用居家护理。但是，他们的身体、社交和心理健康状况较差，生活质量、生活满意度和幸福感也较低。这些差异会随着时间的推移而持续存在，而且过渡到寄宿护理的比例也更高。结论要促进独居痴呆症患者的居家养老，在有利的政策框架下，必须同时关注支持功能能力和满足社会心理需求。

{"title":"Living Alone With Mild-to-Moderate Dementia Over a Two-Year Period: Longitudinal Findings From the IDEAL Cohort","authors":"","doi":"10.1016/j.jagp.2024.05.012","DOIUrl":"10.1016/j.jagp.2024.05.012","url":null,"abstract":"<div><h3>Objectives</h3><div>To compare the experiences of people with dementia living alone or with others and how these may change over two years.</div></div><div><h3>Design</h3><div>We analysed longitudinal data from three assessment waves, one year apart, in the British IDEAL cohort.</div></div><div><h3>Setting</h3><div>Participants with mild-to-moderate dementia were recruited through National Health Service providers, where possible with a family caregiver, and interviewed at home.</div></div><div><h3>Participants</h3><div>The current analyses include 281 people with dementia living alone and 1,244 living with others at baseline; follow-up data were available for 200 and 965 respectively at time 2 and 144 and 696 respectively at time 3. For those living alone, 140 nonresident caregivers contributed at baseline, 102 at time 2 and 81 at time 3. For those living with others, 1,127 family caregivers contributed at baseline, 876 at time 2 and 670 at time 3.</div></div><div><h3>Measurements</h3><div>Assessments covered: cognitive and functional ability; self-reported perceptions of health, mood, social engagement, quality of life, satisfaction with life and well-being; use of in-home and community care; and transitions into residential care.</div></div><div><h3>Results</h3><div>People living alone tended to have better cognitive and functional ability and were more frequent users of in-home care. However, they experienced poorer physical, social, and psychological health and reduced quality of life, satisfaction with life, and well-being. These differences persisted over time and rates of transition into residential care were higher.</div></div><div><h3>Conclusions</h3><div>To facilitate continuing in place for people with dementia living alone, a dual focus on supporting functional ability and add ressing psychosocial needs is essential in the context of an enabling policy framework.</div></div>","PeriodicalId":55534,"journal":{"name":"American Journal of Geriatric Psychiatry","volume":"32 11","pages":"Pages 1309-1321"},"PeriodicalIF":4.4,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141404774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Psychedelics and Older Adults: What Do They Do Compared to Younger People? 迷幻药与老年人：与年轻人相比，他们会做些什么？

IF 4.4 2区医学 Q1 GERIATRICS & GERONTOLOGY

American Journal of Geriatric Psychiatry

Pub Date : 2024-06-05 DOI: 10.1016/j.jagp.2024.05.010

引用次数: 0

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