scholarly journals Prescriber continuity and medication availability in older adults with cardiometabolic conditions

2018 ◽  
Vol 6 ◽  
pp. 205031211875738 ◽  
Author(s):  
Matthew L Maciejewski ◽  
Bradley G Hammill ◽  
Corrine I Voils ◽  
Laura Ding ◽  
Elizabeth A Bayliss ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Conditions ◽  
Medicare Beneficiaries ◽  
Coordination Problems ◽  
Complex Patients ◽  
Medicare Program ◽  
The Us ◽  
Care Fragmentation ◽  
Incremental Addition ◽  
Multiple Conditions

Background: Many older adults have multiple conditions and see multiple providers, which may impact their use of essential medications. Objective: We examined whether the number of prescribers of these medications was associated with the availability of medications, a surrogate for adherence, to manage diabetes, hypertension or dyslipidemia. Methods: A retrospective cohort of 383,145 older adults with diabetes, hypertension or dyslipidemia in the US Medicare program living in 10 states. The association between the number of prescribers of cardiometabolic medications in 2010 and medication availability (proportion of days with medication on hand) in 2011 was estimated via logistic regression, controlling for patient demographic characteristics and chronic conditions. Results: Medicare beneficiaries with diabetes, hypertension and/or dyslipidemia had an average of five chronic conditions overall, obtained 10–12 medications for all conditions and most often had one prescriber of cardiometabolic medications. In adjusted analyses, the number of prescribers was not significantly associated with availability of oral diabetes agents but having more prescribers is associated with increased medication availability in older Medicare beneficiaries with dyslipidemia or hypertension. Conclusion: The incremental addition of new prescribers may be clinically reasonable for complex patients but creates the potential for coordination problems and informational discontinuity over time. Health systems may want to identify complex patients with multiple prescribers to minimize care fragmentation.

scholarly journals COST-BENEFIT ANALYSIS OF HEARING CARE SERVICES AMONG MEDICARE BENEFICIARIES WITH HEARING AIDS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S43-S44
Author(s):  
Amber Willink ◽  
Amber Willink ◽  
Nicholas S Reed ◽  
Frank R Lin
Keyword(s):  
Older Adults ◽  
Hearing Aids ◽  
Cost Benefit Analysis ◽  
Skilled Nursing Facility ◽  
Medicare Beneficiaries ◽  
Cross Sectional ◽  
Care Services ◽  
Medicare Program ◽  
The Impact ◽  
Medicare Spending

Abstract Hearing care services for older adults with hearing aids are underutilized and are not covered by the Medicare program. Little information exists to the value of hearing care services for older adults with hearing aids. Using the Medicare Current Beneficiary Survey 2013, we conducted a cross-sectional analysis of the impact of hearing care services use on Medicare spending among those with hearing aids. Older Medicare beneficiaries with hearing aids that received hearing care services in the previous 12 months were propensity score matched to those who did not receive services. Average annual Medicare spending was $8196 (CI:$6670-$9723) among Medicare beneficiaries who used hearing care services and $10,709 (CI:$8878-12541) among matched controls. Spending differences were driven by higher skilled nursing facility and home health spending among matched controls. Increasing access to hearing care services among Medicare beneficiaries with hearing aids may provide value to the health care system and Medicare program.

scholarly journals Failing to Plan Is Planning to Fail: Utilization of Advance Care Directives in Older Adults Living With HIV

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 221-221
Author(s):  
Annie Nguyen ◽  
Anna Egbert ◽  
Mark Brennan-Ing ◽  
Stephen Karpiak ◽  
Paul Nash
Keyword(s):  
Older Adults ◽  
Chronic Conditions ◽  
Significant Relationships ◽  
Sexuality And Gender ◽  
The Us ◽  
Advance Care Directives ◽  
Advance Care ◽  
And Gender ◽  
Living With Hiv ◽  
The Impact

Abstract Advance Care Planning (ACP) makes up an integral part of the care continuum, especially for those living with chronic conditions such as HIV. Little research exists to understand how intersections of race, gender, sexuality and gender identity combine to influence the choices made by older adults living with HIV regarding ACP. The Research on Older Adults with HIV (ROAH) 2 study collected data from across the US and investigated the incidence and range of ACP amongst those 50+ living with HIV. Correlational analysis indicated that being White was significantly related to having at least one directive (R=0.070, p=0.035) where being African American correlated negatively with several forms of ACP. Additionally, there were also significant relationships between being Transgender, being gay, and being a woman as to the engagement with ACP options. Further analysis explored the impact of finance, self-rated health and social support networks.

scholarly journals Physical Activity: Exploring Views of Older Russian-Speaking Slavic Immigrants

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Janet Purath ◽  
Catherine Van Son ◽  
Cynthia F. Corbett
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Older Adults ◽  
Chronic Conditions ◽  
Environmental Safety ◽  
Future Research ◽  
Culturally Appropriate ◽  
Focus Group Interviews ◽  
The Us ◽  
Group Interviews

Many of the 1.3 million Russian-speaking immigrants in the US have chronic conditions such as cardiovascular disease, diabetes, obesity, and depression. They engage in physical activity less often than other groups, and little is known about their views of physical activity. This qualitative study explored physical activity attitudes, beliefs, motivators, and barriers among older Russian-speaking immigrants. In four focus group interviews, 23 participants discussed physical activity. “Movement is life” was a theme throughout all interviews. Walking was the most frequently mentioned activity. Increased energy and decreased pain were described as health benefits. Motivators for physical activity were maintaining function, improved health, and the support of God and family. Barriers included poor health and environmental safety concerns. Participants suggested community walking groups and church-supported programs as useful methods to promote physical activity. Future research includes developing culturally appropriate interventions that utilize physical activity to prevent and manage chronic illness with ethnic minority older adults.

scholarly journals Emergency Department and Inpatient Utilization among U.S. Older Adults with Multiple Chronic Conditions: A Post-Reform Update

2020 ◽  
Author(s):  
SangNam Ahn ◽  
Mustafa Hussein ◽  
Asos Mahmood ◽  
Matthew Lee Smith
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Low Income ◽  
Chronic Conditions ◽  
Medical Expenditure Panel Survey ◽  
Medical Expenditure ◽  
Multiple Chronic Conditions ◽  
Medicare Beneficiaries ◽  
Percentage Points ◽  
Ed Visits

Abstract Background. The Affordable Care Act (ACA) was enacted to enhance access to care primarily among nonelderly and low-income populations; however, several provisions addressed key determinants of emergency department (ED) and inpatient visits among Medicare beneficiaries over age 65 years. We take stock of the overall changes in these visits among older Medicare beneficiaries, focusing on those with multiple chronic conditions (MCCs), and provide a nationally representative post-reform update. Methods. We analyzed a sample of 32,919 older adults (65+) on Medicare from the 2006-2015 Medical Expenditure Panel Survey (MEPS). Using a survey-weighted two-part model, we examined changes in ED visits, inpatient visits, and length of stay (LOS) by MCC status, before (2006-2010), during (2011-2013), and after the ACA (2014-2015). Results. Prior to the ACA, 18.1% of Medicare older adults had ≥1 ED visit, whereas 17.1% had ≥1 inpatient visits, with an average of 5.1 nights/visit. Following ACA reforms, among those with 2+ chronic conditions, the rate of ever having an ED visit increased by 4.3 percentage points [95% confidence intervals [CI]: 2.5, 6.1, p < 0.01], whereas the rate of inpatient visits decreased by 1.4 percentage points [95%CI: -2.9, 0.2, p < 0.1], after multivariable adjustment. Conclusions. We found sizable increases in ED visits and nontrivial decreases in inpatient visits among older Medicare beneficiaries with MCCs, underscoring the continuing need for improving access to and quality of care among older adults with MCCs to decrease reliance on the ED and reduce preventable hospitalizations.

scholarly journals Multimorbidity patterns and their relationship to mortality in the US older adult population

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245053
Author(s):  
D. Diane Zheng ◽  
David A. Loewenstein ◽  
Sharon L. Christ ◽  
Daniel J. Feaster ◽  
Byron L. Lam ◽  
...  
Keyword(s):  
Older Adults ◽  
Older Adult ◽  
Chronic Conditions ◽  
Latent Class ◽  
Adult Population ◽  
Cognitively Impaired ◽  
Cross Sectional ◽  
Respiratory Condition ◽  
The Us ◽  
Older Adult Population

Background Understanding patterns of multimorbidity in the US older adult population and their relationship with mortality is important for reducing healthcare utilization and improving health. Previous investigations measured multimorbidity as counts of conditions rather than specific combination of conditions. Methods This cross-sectional study with longitudinal mortality follow-up employed latent class analysis (LCA) to develop clinically meaningful subgroups of participants aged 50 and older with different combinations of 13 chronic conditions from the National Health Interview Survey 2002–2014. Mortality linkage with National Death Index was performed through December 2015 for 166,126 participants. Survival analyses were conducted to assess the relationships between LCA classes and all-cause mortality and cause specific mortalities. Results LCA identified five multimorbidity groups with primary characteristics: “healthy” (51.5%), “age-associated chronic conditions” (33.6%), “respiratory conditions” (7.3%), “cognitively impaired” (4.3%) and “complex cardiometabolic” (3.2%). Covariate-adjusted survival analysis indicated “complex cardiometabolic” class had the highest mortality with a Hazard Ratio (HR) of 5.30, 99.5% CI [4.52, 6.22]; followed by “cognitively impaired” class (3.34 [2.93, 3.81]); “respiratory condition” class (2.14 [1.87, 2.46]); and “age-associated chronic conditions” class (1.81 [1.66, 1.98]). Patterns of multimorbidity classes were strongly associated with the primary underlying cause of death. The “cognitively impaired” class reported similar number of conditions compared to the “respiratory condition” class but had significantly higher mortality (3.8 vs 3.7 conditions, HR = 1.56 [1.32, 1.85]). Conclusion We demonstrated that LCA method is effective in classifying clinically meaningful multimorbidity subgroup. Specific combinations of conditions including cognitive impairment and depressive symptoms have a substantial detrimental impact on the mortality of older adults. The numbers of chronic conditions experienced by older adults is not always proportional to mortality risk. Our findings provide valuable information for identifying high risk older adults with multimorbidity to facilitate early intervention to treat chronic conditions and reduce mortality.

scholarly journals Emergency Department and Inpatient Utilization among U.S. Older Adults with Multiple Chronic Conditions: A Post-Reform Update

2019 ◽  
Author(s):  
SangNam Ahn ◽  
Mustafa Hussein ◽  
Asos Mahmood ◽  
Matthew Lee Smith
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Low Income ◽  
Chronic Conditions ◽  
Medical Expenditure Panel Survey ◽  
Medical Expenditure ◽  
Multiple Chronic Conditions ◽  
Medicare Beneficiaries ◽  
Percentage Points ◽  
Ed Visits

Abstract Background The Affordable Care Act (ACA) was enacted to enhance access to care primarily among nonelderly and low-income populations; however, several provisions addressed key determinants of emergency department (ED) and inpatient visits among Medicare beneficiaries over age 65 years. We take stock of the overall changes in these visits among older Medicare beneficiaries, focusing on those with multiple chronic conditions (MCCs), and provide a nationally representative post-reform update. Methods We analyzed a sample of 32,919 older adults (65+) on Medicare from the 2006-2015 Medical Expenditure Panel Survey (MEPS). Using survey-weighted logistic regression, we examined changes in ED visits, inpatient visits, and length of stay (LOS) by MCC status, before (2006-2010), during (2011-2013), and after the ACA (2014-2015). Results Prior to the ACA, 18.1% of Medicare older adults had ≥1 ED visit, whereas 17.1% had ≥1 inpatient visits, with an average of 5.1 nights/visit. Following ACA reforms, among those with 2+ chronic conditions, the rate of ever having an ED visit increased by 4.3 percentage points [95% confidence intervals [CI]: 2.5, 6.1, p < 0.01], whereas the rate of inpatient visits decreased by 1.4 percentage points [95%CI: -2.9, 0.2, p < 0.1], after multivariable adjustment. Conclusions We found sizable increases in ED visits and nontrivial decreases in inpatient visits among older Medicare beneficiaries with MCCs, underscoring the continuing need for improving access to and quality of care among older adults with MCCs to decrease reliance on the ED and reduce preventable hospitalizations.

scholarly journals Emergency Department and Inpatient Utilization among U.S. Older Adults with Multiple Chronic Conditions: A Post-Reform Update

2019 ◽  
Author(s):  
SangNam Ahn ◽  
Mustafa Hussein ◽  
Asos Mahmood ◽  
Matthew Lee Smith
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Low Income ◽  
Chronic Conditions ◽  
Medical Expenditure Panel Survey ◽  
Medical Expenditure ◽  
Multiple Chronic Conditions ◽  
Medicare Beneficiaries ◽  
Percentage Points ◽  
Ed Visits

Abstract Background. The Affordable Care Act (ACA) was enacted to enhance access to care primarily among nonelderly and low-income populations; however, several provisions addressed key determinants of emergency department (ED) and inpatient visits among Medicare beneficiaries over age 65 years. We take stock of the overall changes in these visits among older Medicare beneficiaries, focusing on those with multiple chronic conditions (MCCs), and provide a nationally representative post-reform update. Methods. We analyzed a sample of 32,919 older adults (65+) on Medicare from the 2006-2015 Medical Expenditure Panel Survey (MEPS). Using a survey-weighted two-part model, we examined changes in ED visits, inpatient visits, and length of stay (LOS) by MCC status, before (2006-2010), during (2011-2013), and after the ACA (2014-2015). Results. Prior to the ACA, 18.1% of Medicare older adults had ≥1 ED visit, whereas 17.1% had ≥1 inpatient visits, with an average of 5.1 nights/visit. Following ACA reforms, among those with 2+ chronic conditions, the rate of ever having an ED visit increased by 4.3 percentage points [95% confidence intervals [CI]: 2.5, 6.1, p < 0.01], whereas the rate of inpatient visits decreased by 1.4 percentage points [95%CI: -2.9, 0.2, p < 0.1], after multivariable adjustment. Conclusions. We found sizable increases in ED visits and nontrivial decreases in inpatient visits among older Medicare beneficiaries with MCCs, underscoring the continuing need for improving access to and quality of care among older adults with MCCs to decrease reliance on the ED and reduce preventable hospitalizations.

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