 |
The 130th Annual Meeting of APHA |
|
The 130th Annual Meeting of APHA |
Steven M. Albert, PhD, MSc1, Sherry A Glied, PhD2, Howard Andrews, PhD3, Y Stern, PhD1, and R Mayeux, MD, MSc1. (1) Gertrude H. Sergievsky Center, Columbia University, PH-19, 630 West 168th St., New York, NY 07666, 212-305-2503, sma10@columbia.edu, (2) Division of Health Policy and Management, Mailman School of Public Health, Columbia University, 600 West 168th St., 6th Floor, New York, NY 10032, (3) New York State Psychiatric Institute, 1051 Riverside Drive, Box 47, New York, NY 10032
It is unclear if older people with early declines in cognitive abilities use medical services and other forms of supportive care to a greater extent than elders without cognitive deficits. We were able to investigate this question in a longitudinal study of a population-based sample of Medicare enrollees in northern Manhattan, NYC. We identified 250 people who did not meet criteria for dementia at an early assessment but who later went on to meet criteria for the first time. These people were considered incident cases. 230 met criteria for mild Alzheimer’s disease (AD). We examined the following outcomes in this group, comparing incident cases to non-demented and prevalent AD cases: (1) mortality (follow-up, National Death Index), (2) dementia progression (follow-up), (3) hospitalization (HCFA standard analytic files), and (4) Medicaid-reimbursed personal assistance care (NYC Human Resources Administration data). Mean age at diagnosis was 78.6. Annual mortality was 15.3% (57 deaths/372.5 person-years of follow-up), significantly higher than rates in non-demented people of the same age. Mortality experience did not differ by gender, race, or education. Having 2+ medical co-morbidities and an APOE- 4 allele were significantly associated with elevated risk of death. The incidence of progression to more advanced dementia was 5.9% per year (22/372.5 person-years of follow-up). Risk of progression was significantly related to age, education, and both memory performance and motor status at the incidence date. Primary care costs and hospital use were significantly higher in the incident AD group than in non-demented elders. For example, 16.4% of the incident AD group had a hospitalization, compared to 11.9% in non-demented elders. Finally, 38% of the incident AD groups used personal assistance care services, compared to 12.9% in non-demented elders. These findings suggest that even early Alzheimer’s disease entails severe medical and personal care demands.
Learning Objectives:
Keywords: Outcomes Research, Personal Assistance
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.