Journal of the American Geriatrics Society最新文献

Background: Antipsychotic and other psychotropic medication use is prevalent among community-dwelling older adults with dementia despite the potential for adverse effects. Two Centers for Medicare & Medicaid Services (CMS) initiatives, the National Partnership to Improve Dementia Care ("the Partnership") and the Five Star Quality Rating System for antipsychotic use reporting, have been successful in reducing antipsychotic use in nursing home residents. We assessed if these initiatives had a spillover effect in antipsychotic and other psychotropic medication use among community dwellers with dementia due to potential overlap in prescribers across settings.

Methods: Among community-dwelling older adults with dementia, we examined psychotropic medication class use (i.e., antipsychotics, antidepressants, anxiolytics, anticonvulsants/mood stabilizers, antidementia) in 2010-2017 Medicare fee-for-service claims using interrupted time series analyses across three periods ("Pre-Partnership": July 1, 2010 to March 31, 2012; "Post-Partnership": April 1, 2012 to January 31, 2015; "Five Star Quality Rating": February 1, 2015 to December 31, 2017).

Results: We included 1,289,401 community dwellers with dementia contributing 26,609,697 person-months. The mean age was 80 years, most were female (70%), approximately 80% were non-Hispanic Whites, 10% were non-Hispanic Blacks, and 5% were Hispanic ethnicity. Antipsychotic use was declining pre-Partnership (β = -0.06, 95% CI: -0.08, -0.05) and post-Partnership (β = -0.02, 95% CI: -0.02, -0.01). Post-Five Star Quality Rating, antipsychotic use remained stable with a nearly flat slope (β = -0.01, 95% CI: -0.01, 0.00). Anticonvulsant and antidepressant use increased and anxiolytic and antidementia medication use decreased among community-dwelling older adults with dementia.

Conclusions: These two CMS policies on antipsychotic use for nursing home residents were not associated with a spillover effect to community-dwelling older adults with dementia. Strategies to monitor the appropriateness of psychotropic medication use may be warranted for community-dwellers with dementia.

Background: Medicare Advantage (MA) plans must cover all telehealth services offered by Traditional Medicare (TM), but have flexibility to provide additional telehealth services. It is not known whether these flexibilities are associated with telehealth availability and use. In this study, we examined differences in telehealth availability and use between TM and MA beneficiaries.

Methods: This cross-sectional study analyzed beneficiaries who participated in the 2021 Medicare Current Beneficiary Survey. Our primary outcomes were telehealth availability and use, assessed both overall and by modality (telephone only, video only, and both). Our key independent variable was full-year enrollment in MA versus TM. Differences in outcomes between TM and MA beneficiaries were estimated using logistic regression models that adjusted for beneficiary characteristics. The analysis of telehealth availability included all beneficiaries in the sample, while the analysis of telehealth use was limited to those offered telehealth services. In a secondary analysis, we examined differences between TM and MA beneficiaries in the availability of technology that may enable telehealth use and experience using the internet to seek information.

Results: Among 8130 Medicare beneficiaries, MA beneficiaries were 2.9 (95% CI: 0.6-5.2) percentage points more likely to have a provider who offered telehealth services than TM beneficiaries, including both telephone and video options. However, MA beneficiaries were 3.5 (-6.7, -0.4) percentage points less likely to use telehealth services than TM beneficiaries. Video-only options were used less frequently among MA beneficiaries compared to those in TM (-2.7 [-5.1, -0.3]). Despite lower telehealth use, MA beneficiaries had comparable or higher rates of technology access and internet experience compared to TM beneficiaries.

Conclusion: Our findings suggest that greater access to telehealth services among MA beneficiaries did not translate into greater telehealth use. Future research is warranted to explore the underlying mechanisms behind lower use of telehealth services among MA beneficiaries.

Objectives: The number of older adults struggling to maintain adequate housing is growing. Prior studies have used various criteria to measure housing insecurity; however, no standardized definition exists to date. Using a multidimensional approach, our study sought to calculate population-based estimates of various forms of housing insecurity among community-living older Americans and determine how these estimates differ across key characteristics.

Methods: This study utilized data from the 2011 round of the National Health and Aging Trends Study (NHATS), a prospective longitudinal study of Medicare beneficiaries aged 65 years or older. Three key forms of housing insecurity were operationalized: poor housing affordability (PHA), poor housing quality (PHQ), and poor neighborhood quality (PNQ). Population-based estimates of these forms of housing insecurity were calculated using analytic sampling weights and stratified by age, gender, race and ethnicity, frailty status, and dementia status.

Results: Totally 6466 participants were included in the analysis, representing 29,848,119 community-living older Americans. The mean (standard deviation) age was 77.3 (7.7) years; by weighted percentages, 56.0% identified as female, 81.3% as White, 8.2% Black, and 7.1% Hispanic. At least one form of housing insecurity was identified in 38.5% of older Americans. Individually, the prevalence of PHA was 14.8%, PHQ 24%, and PNQ 12.5%. The prevalence of at least one form of housing insecurity was higher among persons of color (62.9% Black and 66% Hispanic vs White; p < 0.001), those with frailty (40.9% pre-frail and 49.4% frail vs robust; p < 0.001), and those with cognitive impairment (48.1% possible and 51% probable dementia vs no dementia; p < 0.001).

Discussion: Nearly one in three community-living older Americans experience at least one form of housing insecurity. This was most common among vulnerable subgroups. Our multidimensional approach to defining various forms of housing insecurity can be used for future studies focused on improving social determinants of health among high-risk older adults.