RESUMO
BACKGROUND: Limited evidence exists on the economic burden of individuals who progress from mild cognitive impairment (MCI) to Alzheimer disease and related dementia disorders (ADRD). OBJECTIVES: To assess the all-cause health care resource utilization and costs for individuals who develop ADRD following an MCI diagnosis compared to those with stable MCI. DESIGN: This was a retrospective cohort study from January 01, 2014, to December 31, 2019. SETTING: The Merative MarketScan Commercial and Medicare Databases were used. PARTICIPANTS: Individuals were included if they: (1) were aged 50 years or older; (2) had ≥1 claim with an MCI diagnosis based on the International Classification of Diseases, Ninth Revision (ICD-9) code of 331.83 or the Tenth Revision (ICD-10) code of G31.84; and had continuous enrollment. Individuals were excluded if they had a diagnosis of Parkinson's disease or ADRD or prescription of ADRD medication. MEASUREMENTS: Outcomes included all-cause utilization and costs per patient per year in the first 12 months following MCI diagnosis, in total and by care setting: inpatient admissions, emergency department (ED) visits, outpatient visits, and pharmacy claims. RESULTS: Out of the total of 5185 included individuals, 1962 (37.8%) progressed to ADRD (MCI-to-ADRD subgroup) and 3223 (62.2%) did not (Stable MCI subgroup). Adjusted all-cause utilization was higher for all care settings in the MCI-to-ADRD subgroup compared with the Stable MCI subgroup. Adjusted all-cause mean total costs ($34 599 vs $24 541; mean ratio [MR], 1.41 [95% CI, 1.31-1.51]; P<.001), inpatient costs ($47 463 vs $38 004; MR, 1.25 [95% CI, 1.08-1.44]; P=.002), ED costs ($4875 vs $3863; MR, 1.26 [95% CI, 1.11-1.43]; P<.001), and outpatient costs ($16 652 vs $13 015; MR, 1.28 [95% CI, 1.20-1.37]; P<.001) were all significantly higher for the MCI-to-ADRD subgroup compared with the Stable MCI subgroup. CONCLUSIONS: Individuals who progressed from MCI to ADRD had significantly higher health care costs than individuals with stable MCI. Early identification of MCI and delaying its progression is important to improve patient and economic outcomes.
Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Progressão da Doença , Humanos , Doença de Alzheimer/economia , Disfunção Cognitiva/economia , Disfunção Cognitiva/diagnóstico , Masculino , Feminino , Estados Unidos , Estudos Retrospectivos , Idoso , Pessoa de Meia-Idade , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Idoso de 80 Anos ou mais , Medicare/economia , Efeitos Psicossociais da DoençaRESUMO
Background: Impact of Alzheimer's disease (AD) progression on patient health-related quality of life (HRQoL), caregiver time, and societal costs is not well characterized in early AD. Objective: To assess the association of change in cognition with HRQoL, caregiver time, and societal costs over 36 months, and estimate the impact of slowing disease progression on these outcomes. Methods: This post-hoc analysis included patients with amyloid-positive mild cognitive impairment (MCI) and mild AD dementia (MILD AD) from the 36-month GERAS-US study. Disease progression was assessed using the Mini-Mental State Examination score. Change in outcomes associated with slowing AD progression was estimated using coefficients from generalized linear models. Results: At baseline, 300 patients had MCI and 317 had MILD AD. Observed natural progression over 36 months was associated with: 5.1 point decline in the Bath Assessment of Subjective Quality of Life in Dementia (BASQID) score (for HRQoL), increase in 1,050âhours of total caregiver time, and $8,504 total societal costs for MCI; 6.6 point decline in the BASQID score, increase in 1,929âhours of total caregiver time, and $12,795 total societal costs for MILD AD per person. Slowing AD progression by 30% could result in per person savings in HRQoL decline, total caregiver time, and total societal costs: for MCI: 1.5 points, 315 hours, and $2,638; for MILD AD: 2.0 points, 579âhours, and $3,974. Conclusions: Slowing AD progression over 36 months could slow decline in HRQoL and save caregiver time and societal cost in patients with MCI and MILD AD.
Assuntos
Doença de Alzheimer , Cuidadores , Disfunção Cognitiva , Efeitos Psicossociais da Doença , Progressão da Doença , Qualidade de Vida , Humanos , Doença de Alzheimer/economia , Doença de Alzheimer/psicologia , Qualidade de Vida/psicologia , Masculino , Feminino , Cuidadores/psicologia , Cuidadores/economia , Idoso , Disfunção Cognitiva/economia , Disfunção Cognitiva/psicologia , Idoso de 80 Anos ou mais , Estados Unidos , Testes de Estado Mental e DemênciaRESUMO
Background: Cognitive impairment (CI) raises risks for unplanned healthcare utilisation and expenditures and for premature mortality. It may also reduce risks for planned expenditures. Therefore, the net cost implications for those with CI remain unknown. Method: We examined differences in healthcare utilisation and cost between those with and without CI. Using administrative healthcare utilisation and cost data linked to the Singapore Chinese Health Study cohort, we estimated regression-adjusted differences in annual healthcare utilisation and costs by CI status determined by modified Mini-Mental State Exam. Estimates were stratified by ex ante mortality risk constructed from out-of-sample Cox model predictions applied to the full sample, with a separate analysis restricted to decedents. These estimates were used to project differential healthcare costs by CI status over 5 years. Results: Patients with CI had 17% higher annual cost compared to those without CI (SGD4870 versus SGD4177, P<0.01). Accounting for the greater mortality risk, individuals with CI cost 9% to 17% more over 5 years, or SGD2500 (95% confidence interval 1000-4200) to SGD3600 (95% confidence interval 1300-6000) more, depending on their age. Higher cost was mainly due to more emergency department visits and subsequent admissions (i.e. unplanned). Differences attenuated in the last year of life when costs increased dramatically for both groups. Conclusion: Ageing populations and higher rates of CI will further strain healthcare resources primarily through greater use of emergency department visits and unplanned admissions. Efforts should be made to identify at risk patients with CI and take appropriate remediation strategies.
Assuntos
Disfunção Cognitiva , Custos de Cuidados de Saúde , Humanos , Singapura/epidemiologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/economia , Idoso , Masculino , Feminino , Pessoa de Meia-Idade , Custos de Cuidados de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/economia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Modelos de Riscos Proporcionais , Estudos de CoortesRESUMO
Background: Alzheimer's disease (AD) and mild cognitive impairment (MCI) have negative quality of life (QoL) and economic impacts on patients and their caregivers and may increase along the disease continuum from MCI to mild, moderate, and severe AD. Objective: To assess how patient and caregiver QoL, indirect and intangible costs are associated with MCI and AD severity. Methods: An on-line survey of physician-identified patient-caregiver dyads living in the United States was conducted from June-October 2022 and included questions to both patients and their caregivers. Dementia Quality of Life Proxy, the Care-related Quality of Life, Work Productivity and Activity Impairment, and Dependence scale were incorporated into the survey. Regression analyses investigated the association between disease severity and QoL and cost outcomes with adjustment for baseline characteristics. Results: One-hundred patient-caregiver dyads were assessed with the survey (MCI, nâ=â27; mild AD, nâ=â27; moderate AD, nâ=â25; severe AD, nâ=â21). Decreased QoL was found with worsening severity in patients (pâ<â0.01) and in unpaid (informal) caregivers (nâ=â79; pâ=â0.02). Dependence increased with disease severity (pâ<â0.01). Advanced disease severity was associated with higher costs to employers (pâ=â0.04), but not with indirect costs to caregivers. Patient and unpaid caregiver intangible costs increased with disease severity (pâ<â0.01). A significant trend of higher summed costs (indirect costs to caregivers, costs to employers, intangible costs to patients and caregivers) in more severe AD was observed (pâ<â0.01). Conclusions: Patient QoL and functional independence and unpaid caregiver QoL decrease as AD severity increases. Intangible costs to patients and summed costs increase with disease severity and are highest in severe AD.
Assuntos
Doença de Alzheimer , Cuidadores , Disfunção Cognitiva , Efeitos Psicossociais da Doença , Qualidade de Vida , Humanos , Doença de Alzheimer/economia , Doença de Alzheimer/psicologia , Qualidade de Vida/psicologia , Feminino , Masculino , Cuidadores/psicologia , Cuidadores/economia , Idoso , Inquéritos e Questionários , Disfunção Cognitiva/economia , Disfunção Cognitiva/psicologia , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Índice de Gravidade de Doença , Estados UnidosRESUMO
BACKGROUND: There is a robust consensus, most recently articulated in the 2020 Lancet Commission, that the roots of dementia can be traced to early life, and that the path to prevention may start there as well. Indeed, a growing body of research demonstrates that early life disadvantage may influence the risk for later life dementia and cognitive decline. A still understudied risk, however, is early life rural residence, a plausible pathway given related economic and educational disadvantages, as well as associations between later life rural living and lower levels of cognitive functioning. OBJECTIVE: We aim to examine whether living in rural environments during early life has long term implications for cognitive health in later life. METHODS: We employed the Wisconsin Longitudinal Study, which tracked 1 in every 3 high school graduates from the class of 1957, from infancy to â¼age 72. The data include a rich array of prospectively collected early life data, unique among existing studies, as well as later life measures of cognitive functioning. RESULTS: We found a robust relationship between early life rural residence, especially living on a farm, and long-term risk for reduced cognitive performance on recall and fluency tasks. Controls for adolescent cognitive functioning, APOEÉ2 and APOEÉ4, as well as childhood and adult factors, ranging from early life socioeconomic conditions to later life health and rural and farm residency, did not alter the findings. CONCLUSION: Rural living in early life is an independent risk for lower levels of cognitive functioning in later life.
Assuntos
Experiências Adversas da Infância/psicologia , Experiências Adversas da Infância/tendências , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Escolaridade , População Rural/tendências , Adolescente , Adulto , Experiências Adversas da Infância/economia , Idoso , Disfunção Cognitiva/economia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Classe Social , Meio Social , Fatores Socioeconômicos , Wisconsin/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Alzheimer's disease and related diseases (ADRD) are a major cause of health-related cost increase. OBJECTIVES: This study aimed to estimate the real medical direct costs of care of patients followed at a memory center, and to investigate potential associations between patients' characteristics and costs. DESIGN: Cross-sectional analyses conducted on matched data between clinical data of a cohort of patients and the claims database of the French Primary Health Insurance Fund. SETTING: Memory center in France. PARTICIPANTS: Patients attending a memory center with subjective cognitive complaint. MEASUREMENTS: Medical or nonmedical direct costs (transportation) reimbursed by the French health insurance during the one year after the first memory visit, and socio-demographic, clinical, cognitive, functional, and behavioral characteristics were analyzed. RESULTS: Among 2,746 patients (mean ± SD age 79.9 ± 8 years, 42.4% of patients with dementia), the total direct cost was on average 9,885 per patient during the year after the first memory visit: 7,897 for patients with subjective cognitive complaint, 9,600 for patients with MCI, and 11,505 for patients with dementia. A higher functional and cognitive impairment, greater behavioral disorders, and a higher caregiver burden were independently associated with a higher total direct cost. A one-point decrease in the Instrumental Activities of Daily Living score was associated with a 1,211 cost increase. The cost was higher in patients with Parkinson's disease, and Lewy body disease compared to patients with AD. Diabetes mellitus, anxiety disorders and number of drugs were also significantly associated with greater costs. CONCLUSIONS: Higher real medical direct costs were independently associated with cognitive, functional, and behavioral impairment, diabetes mellitus, anxiety disorders, number of drugs, etiologies as well as caregiver burden in patients attending a memory center. The identification of factors associated to higher direct costs of care offers additional direct targets to evaluate how interventions conducted in patients with NCD impact direct costs of care.
Assuntos
Doença de Alzheimer , Instituições de Assistência Ambulatorial , Disfunção Cognitiva , Efeitos Psicossociais da Doença , Gastos em Saúde , Atividades Cotidianas , Idoso , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/economia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/economia , Estudos Transversais , Feminino , França , Humanos , Masculino , Doença de Parkinson/economiaRESUMO
OBJECTIVES: This study investigates whether the within-person associations between a recent major financial crisis and deficits in cognitive performance vary across the life course. METHODS: Four waves of data from 7,442 participants (49% men) spanning 12 years and comprising 3 narrow age birth cohorts (baseline age: 20-25, 40-45, and 60-65) were drawn from a representative prospective survey from Canberra, Australia (1999-2014). Cognitive performance was assessed by the California Verbal Learning Test (CVLT) immediate recall trails, Symbol Digit Modalities Test (SDMT), Digit Span Backward (DSB), and Trail Making Test B (TMT-B). A single item from the Threatening Life Experiences Questionnaire assessed self-reported major financial crisis in the past 6 months. Multivariable-adjusted fixed-effect regression models tested the time-dependent association between financial crisis and cognition. RESULTS: A recent financial crisis coincided with contemporaneous declines in CVLT (mean change = -0.14, 95% confidence interval [CI] = -0.262 to -0.025), SDMT (mean change = -0.08, 95% CI = -0.147 to -0.004), and TMT-B (mean change = -0.17, 95% CI = -0.293 to -0.039) for adults in the oldest age group, and these associations were larger than in the younger age groups. In contrast, there was an overall association between financial crisis and deficits in DSB (mean change = -0.06, 95% CI = -0.105 to -0.007), with weak evidence of stronger associations in midlife relative to other age groups. These associations were independent of changes in health and socioeconomic circumstances. DISCUSSION: This study provides important new evidence that financial difficulties in later life are potent stressors associated with occasion-specific deficits in cognitive performance.
Assuntos
Cognição , Disfunção Cognitiva , Estresse Financeiro/psicologia , Estresse Psicológico , Adulto , Fatores Etários , Idoso , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/economia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Estudos de Coortes , Feminino , Humanos , Testes de Inteligência , Acontecimentos que Mudam a Vida , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estresse Psicológico/etiologia , Estresse Psicológico/psicologia , Estados Unidos/epidemiologiaAssuntos
Betacoronavirus , Disfunção Cognitiva/epidemiologia , Infecções por Coronavirus/epidemiologia , Acessibilidade aos Serviços de Saúde , Pneumonia Viral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Disfunção Cognitiva/economia , Disfunção Cognitiva/terapia , Infecções por Coronavirus/economia , Infecções por Coronavirus/terapia , Feminino , Acessibilidade aos Serviços de Saúde/economia , Humanos , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/terapia , SARS-CoV-2RESUMO
OBJECTIVE: To develop a casemix classification to underpin a new funding model for residential aged care in Australia. DESIGN, SETTING: Cross-sectional study of resident characteristics in thirty non-government residential aged care facilities in Melbourne, the Hunter region of New South Wales, and northern Queensland, March 2018 - June 2018. PARTICIPANTS: 1877 aged care residents and 1600 residential aged care staff. MAIN OUTCOME MEASURES: The Australian National Aged Care Classification (AN-ACC), a casemix classification for residential aged care based on the attributes of aged care residents that best predict their need for care: frailty, mobility, motor function, cognition, behaviour, and technical nursing needs. RESULTS: The AN-ACC comprises 13 aged care resident classes reflecting differences in resource use. Apart from the class that included palliative care patients, the primary branches were defined by the capacity for mobility; further classification is based on physical capacity, cognitive function, mental health problems, and behaviour. The statistical performance of the AN-ACC was good, as measured by the reduction in variation statistic (RIV; 0.52) and class-specific coefficients of variation. The statistical performance and clinical acceptability of AN-ACC compare favourably with overseas casemix models, and it is better than the current Australian aged care funding model, the Aged Care Funding Instrument (64 classes; RIV, 0.20). CONCLUSIONS: The care burden associated with frailty, mobility, function, cognition, behaviour and technical nursing needs drives residential aged care resource use. The AN-ACC is sufficiently robust for estimating the funding and staffing requirements of residential aged care facilities in Australia.
Assuntos
Grupos Diagnósticos Relacionados/classificação , Serviços de Saúde para Idosos/economia , Instituição de Longa Permanência para Idosos , Casas de Saúde , Atividades Cotidianas , Austrália , Disfunção Cognitiva/economia , Disfunção Cognitiva/enfermagem , Fragilidade/economia , Fragilidade/enfermagem , Necessidades e Demandas de Serviços de Saúde , Financiamento da Assistência à Saúde , Humanos , Transtornos Mentais/economia , Transtornos Mentais/enfermagem , Limitação da Mobilidade , New South Wales , Serviços de Enfermagem/economia , Queensland , VitóriaRESUMO
BACKGROUND: Costs associated with early stages of Alzheimer's disease (AD; mild cognitive impairment [MCI] and mild dementia [MILD]) are understudied. OBJECTIVE: To compare costs associated with MCI and MILD due to AD in the United States. METHODS: Data included baseline patient/study partner medical history, healthcare resource utilization, and outcome assessments as part of a prospective cohort study. Direct, indirect, and total societal costs were derived by applying standardized unit costs to resources for the 1-month pre-baseline period (USD2017). Costs/month for MCI and MILD cohorts were compared using analysis of variance models. To strengthen the confidence of diagnosis, amyloid-ß (Aß) tests were included and analyses were replicated stratifying within each cohort by amyloid status [+â/-]. RESULTS: Patients (Nâ=â1327) with MILD versus MCI had higher total societal costs/month ($4243 versus $2816; pâ<â0.001). These costs were not significantly different within each severity cohort by amyloid status. The largest fraction of overall costs were informal caregiver costs (45.1%) for the MILD cohort, whereas direct medical patient costs were the largest for the MCI cohort (39.0%). Correspondingly, caregiver time spent on basic activities of daily living (ADLs), instrumental ADLs, and supervision time was twice as high for MILD versus MCI (all pâ<â0.001). CONCLUSION: Early AD poses a financial burden, and despite higher functioning among those with MCI, caregivers were significantly impacted. The major cost driver was the patient's clinical cognitive-functional status and not amyloid status. Differences were primarily due to rising need for caregiver support.
Assuntos
Doença de Alzheimer/economia , Disfunção Cognitiva/economia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Cuidadores , Estudos Transversais , Progressão da Doença , Feminino , Recursos em Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estados UnidosRESUMO
BACKGROUND: Cognitive impairment in older adults causes a high economic and societal burden. This study assesses the cost-effectiveness of the multicomponent, non-pharmacological MAKS treatment vs. "care as usual" in German day care centers (DCCs) for community-dwelling people with mild cognitive impairment (MCI) or mild to moderate dementia over 6 months. METHODS: The analysis was conducted from the societal perspective alongside the cluster-randomized controlled, multicenter, prospective DeTaMAKS-trial with waitlist group design. Outcomes were Mini-Mental Status Examination (MMSE) and Erlangen Test of Activities of Daily Living in Persons with Mild Dementia or Mild Cognitive Impairment (ETAM) of 433 individuals in 32 DCCs. Incremental differences in MMSE and ETAM were calculated via a Gaussian-distributed and incremental cost difference via a Gamma-distributed Generalized Linear Model. Cost-effectiveness was assessed via cost-effectiveness planes and cost-effectiveness acceptability curves (CEAC). RESULTS: At 6 months, MMSE (adjusted mean difference = 0.92; 95% confidence interval (CI): 0.17 to 1.67; p = 0.02) and ETAM (adjusted mean difference = 1.00; CI: 0.14 to 1.85; p = 0.02) were significantly better in the intervention group. The adjusted cost difference was - 938.50 (CI: - 2733.65 to 763.13; p = 0.31). Given the CEAC, MAKS was cost-effective for 78.0% of MMSE and 77.4% for ETAM without a need for additional costs to payers. CONCLUSIONS: MAKS is a cost-effective treatment to stabilize the ability to perform activities of daily living and cognitive abilities of people with MCI or mild to moderate dementia in German DCCs. Thus, MAKS should be implemented in DCCs.
Assuntos
Disfunção Cognitiva/terapia , Hospital Dia/economia , Hospital Dia/estatística & dados numéricos , Demência/terapia , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/economia , Análise Custo-Benefício , Demência/economia , Feminino , Alemanha , Humanos , Vida Independente , Masculino , Testes Neuropsicológicos , Resultado do TratamentoRESUMO
Person-centred care is a relatively new orthodoxy being implemented by modern hospitals across developed nations. Research demonstrating the merits of this style of care for improving patient outcomes, staff morale and organizational efficiency is only just beginning to emerge. In contrast, a significant body of literature exists showing that attainment of person-centred care in the acute care sector particularly, remains largely aspirational, especially for older people with cognitive impairment. In previous articles, we argued that nurses work constantly to reconcile prevailing constructions of time, space, relationships, the body and ethics, to meet expectations that the care they provide is person-centred. In this article, we explore key concepts of neo-liberal thought which forms an important back-story to the articles. Economic concepts, "efficiency" and "freedom" are examined to illustrate how nurses work to reconcile both the repressive and productive effects of economic power. We conclude the article by proposing a new research agenda aimed at building a more nuanced understanding of the messy actualities of nursing practice under the influences of neo-liberalism, that illuminates the compromises and adaptations nurses have had to make in response to economic power.
Assuntos
Disfunção Cognitiva/terapia , Fatores Econômicos , Assistência Centrada no Paciente/métodos , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/economia , Disfunção Cognitiva/psicologia , Geriatria/economia , Geriatria/métodos , Humanos , Assistência Centrada no Paciente/economia , Assistência Centrada no Paciente/tendênciasRESUMO
BACKGROUND: Dementia care management (DCM) aims to provide optimal treatment for people with dementia (PwD). Treatment and care needs are dependent on patients' sociodemographic and clinical characteristics and thus, economic outcomes could depend on such characteristics. OBJECTIVE: To detect important subgroups that benefit most from DCM and for which a significant effect on cost, QALY, and the individual cost-effectiveness could be achieved. METHODS: The analysis was based on 444 participants of the DelpHi-trial. For each subgroup, the probability of DCM being cost-effective was calculated and visualized using cost-effectiveness acceptability curves. The impact of DCM on individual costs and QALYs was assessed by using multivariate regression models with interaction terms. RESULTS: The probability of DCM being cost-effective at a willingness-to-pay of 40,000 /QALY was higher in females (96% versus 16% for males), in those living alone (96% versus 26% for those living not alone), in those being moderately to severely cognitively (100% versus 3% for patients without cognitive impairment) and functionally impaired (97% versus 16% for patients without functional impairment), and in PwD having a high comorbidity (96% versus 26% for patients with a low comorbidity). Multivariate analyses revealed that females (bâ=â-10,873; SEâ=â4,775, pâ=â0.023) who received the intervention had significantly lower healthcare cost. DCM significantly improved QALY for PwD with mild and moderate cognitive (bâ=â+0.232, SEâ=â0.105) and functional deficits (bâ=â+0.200, SEâ=â0.095). CONCLUSION: Patients characteristics significantly affect the cost-effectiveness. Females, patients living alone, patients with a high comorbidity, and those being moderately cognitively and functionally impaired benefit most from DCM. For those subgroups, healthcare payers could gain the highest cost savings and the highest effects on QALYs when DCM will be implemented.
Assuntos
Demência/economia , Demência/terapia , Administração dos Cuidados ao Paciente/economia , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/economia , Disfunção Cognitiva/terapia , Comorbidade , Análise Custo-Benefício , Técnica Delphi , Feminino , Custos de Cuidados de Saúde , Humanos , Vida Independente , Estudos Longitudinais , Masculino , Testes de Estado Mental e Demência , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Fatores Sexuais , Fatores SocioeconômicosRESUMO
Social Security's Representative Payee Program faces a difficult balance with respect to dementia: Many people living with dementia can conduct their finances without a payee if they have help from informal caregivers, but those without help are at risk. To date, it has been unclear what share of retirees with dementia use a payee, what share has help potentially available from another source, and what share has no observed means of assistance. This study finds that while fewer than 10% of retirees with dementia use a payee, only about 8% have no observed means of help.
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Cuidadores , Disfunção Cognitiva , Previdência Social/economia , Idoso , Idoso de 80 Anos ou mais , Cuidadores/economia , Disfunção Cognitiva/economia , Disfunção Cognitiva/epidemiologia , Feminino , Humanos , Masculino , Estados Unidos/epidemiologiaRESUMO
AIM: The purpose of the present study was to investigate the effect of cognitive decline on household spending. METHODS: The panel data covered the years 2007-2009 and were taken from the Japanese Study of Aging and Retirement, with data extracted for 253 participants aged 65 years and over. Sociodemographic characteristics, functional status, depressive symptoms, and monthly household spending excluding spending for shelter (e.g. mortgage) were used in the analysis. Cognitive function was evaluated by delayed recall and serial 7s and represented by the sum of both scores. Changes in spending and cognitive function scores were calculated by subtracting 2007 scores from 2009 scores. Participants were divided into two groups: cognitive decline and no cognitive decline. The effect of cognitive decline on changes in household spending was estimated. RESULTS: Although the cognitive decline group had more severe depressive symptoms than the no cognitive decline group in 2009, cognitive decline was the only factor related to change in household spending. CONCLUSION: The results imply that cognitive decline may cause a decline in household spending in older people. Focusing on changes in household spending behaviour might help detect cognitive impairment in older people.
Assuntos
Atividades Cotidianas/psicologia , Cognição , Disfunção Cognitiva/economia , Comportamento do Consumidor/economia , Características da Família , Idoso , Feminino , Humanos , Japão , MasculinoRESUMO
Objectives: This work examines the clinical utility of the scoring system for the Lichtenberg Financial Decision-making Rating Scale (LFDRS) and its usefulness for decision making capacity and financial exploitation. Objective 1 was to examine the clinical utility of a person centered, empirically supported, financial decision making scale. Objective 2 was to determine whether the risk-scoring system created for this rating scale is sufficiently accurate for the use of cutoff scores in cases of decisional capacity and cases of suspected financial exploitation. Objective 3 was to examine whether cognitive decline and decisional impairment predicted suspected financial exploitation.Methods: Two hundred independently living, non-demented community-dwelling older adults comprised the sample. Participants completed the rating scale and other cognitive measures.Results: Receiver operating characteristic curves were in the good to excellent range for decisional capacity scoring, and in the fair to good range for financial exploitation.Conclusions: Analyses supported the conceptual link between decision making deficits and risk for exploitation, and supported the use of the risk-scoring system in a community-based population.Clinical Implications: This study adds to the empirical evidence supporting the use of the rating scale as a clinical tool assessing risk for financial decisional impairment and/or financial exploitation.
Assuntos
Disfunção Cognitiva/economia , Tomada de Decisões/fisiologia , Abuso de Idosos/economia , Competência Mental/psicologia , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/etnologia , Disfunção Cognitiva/psicologia , Abuso de Idosos/etnologia , Abuso de Idosos/psicologia , Feminino , Administração Financeira/ética , Administração Financeira/estatística & dados numéricos , Humanos , Vida Independente/psicologia , Vida Independente/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Psicometria , Projetos de Pesquisa/estatística & dados numéricos , Medição de Risco , Sensibilidade e EspecificidadeRESUMO
AIM: With the aging population, costs of direct social support for patients with Alzheimer's disease have grown and will continue to increase. The purpose of the present study was to estimate the cost of direct social support for Alzheimer's disease under long-term care insurance in Japan. METHODS: This cross-sectional study included 169 patients with Alzheimer's disease or mild cognitive impairment who visited a memory clinic and were followed over time. Dementia severity, use of care services and costs were analyzed. RESULTS: The use of direct social support and costs increased significantly between patients with mild, moderate and severe dementia (P < 0.001). In particular, the use of day services and short stay services increased with the severity of dementia (P < 0.001). Similar findings were obtained when participants were stratified by long-term care insurance care levels. Of 169 participants, 49 had not applied for long-term care insurance, although their dementia severity was not different from support-need level 1 and care-need level 1. Logistic regression analysis of "did not apply" and "applied and certified" groups showed significant differences not only in dementia severity, but also in age (odds ratio 1.112, 95% confidence interval 1.037-1.193, P = 0.003) and living arrangements (odds ratio 0.257, 95% confidence interval 0.076-0.862, P = 0.028). CONCLUSIONS: As the number of patients with Alzheimer's disease increases, direct social costs will increase. The findings of this study might help standardize the type of direct social support provided after diagnosis of Alzheimer's disease and contribute to the development of cost-effective care for these patients. Geriatr Gerontol Int 2019; 19: 1023-1029.
Assuntos
Doença de Alzheimer/economia , Custos Diretos de Serviços , Índice de Gravidade de Doença , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/epidemiologia , Disfunção Cognitiva/economia , Disfunção Cognitiva/epidemiologia , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Seguro de Assistência de Longo Prazo/economia , Japão , Masculino , Razão de Chances , Apoio SocialRESUMO
INTRODUCTION: We develop a framework to model disease progression across Alzheimer's disease (AD) and to assess the cost-effectiveness of future disease-modifying therapies (DMTs) for people with mild cognitive impairment (MCI) due to AD. METHODS: Using data from the US National Alzheimer's Coordinating Center, we apply survival analysis to estimate transition from predementia to AD dementia and ordered probit regression to estimate transitions across AD dementia stages. We investigate the cost-effectiveness of a hypothetical treatment scenario for people in MCI due to AD. RESULTS: We present an open-access model-based decision-analytic framework. Assuming a modest DMT treatment effect in MCI, we predict extended life expectancy and a reduction in time with AD dementia. DISCUSSION: Any future DMT for AD is expected to pose significant economic challenges across all health-care systems, and decision-analytic modeling will be required to assess costs and outcomes. Further developments are needed to inform these health policy considerations.
Assuntos
Doença de Alzheimer/terapia , Disfunção Cognitiva/terapia , Análise Custo-Benefício , Progressão da Doença , Diagnóstico Precoce , Idoso , Doença de Alzheimer/economia , Disfunção Cognitiva/economia , Feminino , Humanos , Masculino , Modelos EstatísticosRESUMO
The studyClare L, Kudlicka A, Oyebode J R, et al. Goal-oriented cognitive rehabilitation for early-stage Alzheimer's and related dementias: the GREAT RCT. Health Technol Assess 2019;23:1-242.The trial was funded by the NIHR Health Technology Assessment Programme (project number11/15/04).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000767/goal-setting-in-early-stage-dementia-can-improve-function.
Assuntos
Disfunção Cognitiva/economia , Disfunção Cognitiva/reabilitação , Demência/psicologia , Atividades Cotidianas , Disfunção Cognitiva/psicologia , Análise Custo-Benefício , Demência/economia , Demência/epidemiologia , Demência/reabilitação , Objetivos , Humanos , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Autoeficácia , Avaliação da Tecnologia Biomédica , Resultado do Tratamento , Reino UnidoRESUMO
OBJECTIVE: To design, test (pilot) and implement a study to estimate the point prevalence of cognitive impairment (CI) and delirium in a multi-site health service. METHODS: Clinicians were trained to use the 4 A's Test (4AT) to screen for cognitive impairment and delirium, and the 3-minute Diagnostic Interview for the Confusion Assessment Method (3D-CAM) to detect delirium in those with abnormal 4AT results. Outcomes of interest were as follows: (a) rates of cognitive impairment and delirium and (b) feasibility of the approach measured by participation rate, "direct survey activity" time, cost and surveyor preparation. RESULTS: The rates of cognitive impairment and delirium were 43.8% (245/559) and 16.3% (91/559), respectively. 90.5% (563/622) of eligible adult patients from 25 acute and subacute wards were seen. "Direct survey activities" averaged 14 minutes (range 2-45) and cost $11.48 per patient. Training evaluation indicated additional education in the 4AT and 3D-CAM was needed. CONCLUSION: Health services could use this streamlined, inexpensive method to estimate the point prevalence of cognitive impairment and delirium.