scholarly journals The Impact of Tai Chi Exercise on Health Care Utilization and Imputed Cost in Residents of Low-Income Senior Housing

2021 ◽  
Vol 10 ◽  
pp. 216495612098547
Author(s):  
Jennifer Perloff ◽  
Cindy Parks Thomas ◽  
Eric Macklin ◽  
Peggy Gagnon ◽  
Timothy Tsai ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Low Income ◽  
Tai Chi ◽  
Statistical Significance ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
P Value ◽  
Senior Housing ◽  
The Impact

Background/Objectives This study was designed to test the impact of Tai Chi (TC) on healthcare utilization and cost in older adults living in low-income senior housing. We hypothesized that TC would improve overall health enough to reduce the use of emergency department (ED) and inpatient services. Design Cluster randomized controlled trial with randomization at the housing site level. Setting Greater Boston, Massachusetts. Participants The study includes 6 sites with 75 individuals in the TC treatment condition and 6 sites with 67 individuals in the health education control condition. Intervention Members of the treatment group received up to a year-long intervention with twice weekly, in-person TC exercise sessions along with video-directed exercises that could be done independently at home. The comparison group received monthly, in-person healthy aging education classes (HE). Study recruitment took place between August, 2015 and October, 2017. Key outcomes included acute care utilization (inpatient stays, observation stays and emergency department visits). In addition, the cost of utilization was estimated using the age, sex and race adjusted allowed amount from Medicare claims for a geographically similar population aged ≥ 65. Results The results suggested a possible reduction in the rate of ED visits in the TC group vs. controls (rate ratio = 0.476, p-value = 0.06), but no findings achieved statistical significance. Adjusted estimates of imputed costs of ED and hospital care were similar between TC and HE, averaging approximately $3,000 in each group. Conclusion ED utilization tended to be lower over 6 to 12 months of TC exercises compared to HE in older adults living in low-income housing, although estimated costs of care were similar.

Reducing emergency department visits among older adults

2019 ◽  
Vol 27 (1) ◽  
pp. 37-49
Author(s):  
Daniel Chen ◽  
Alex M. Torstrick ◽  
Robert Crupi ◽  
Joseph E. Schwartz ◽  
Ira Frankel ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Integrated Care ◽  
Low Income ◽  
Medical Center ◽  
Emergency Department Visits ◽  
Control Group ◽  
Content Type ◽  
Low Intensity ◽  
The Impact

Purpose There is mixed evidence regarding the efficacy of low-intensity integrated care interventions in reducing the use of emergency services and costs of care. The purpose of this paper is to examine the effects of a low-intensity intervention formulated for older adults and delivered in an urban medical center serving low-income individuals. Design/methodology/approach The intervention included an initial evaluation of stress, psychiatric symptomatology and health habits; potential referrals for lifestyle management and psychiatric treatment; and training for physicians about the impact of lifestyle change in older adults. Participants included older adults (at or above 50 years of age) seen as outpatients in an urban medical center serving a low-income community (n=945). Participants were entered into the intervention at any point during this two-year period. Mixed models analyses examined all visits for all enrolled individuals over a two-year period, comparing visits before the individual received the initial intervention evaluation to those received after this evaluation. Outcomes included total health care costs incurred, average cost per visit, and emergency department (ED) usage within the facility. Findings The intervention was associated with reduced likelihood of emergency department use and reduced costs per visit following the intervention. These effects were seen across all participants. Research limitations/implications Limitations of the study include the lack of control group. Practical implications This program is easy to disseminate and could improve the quality of care and costs. Originality/value This study is among the few available to document a decrease in medical costs, as well as decreased ED utilization following a low-intensity integrated care intervention.

scholarly journals PEER TO PEER SUPPORT AND HEALTH CARE UTILIZATION AMONG COMMUNITY-DWELLING OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S857-S857
Author(s):  
Elizabeth A Jacobs ◽  
Rebecca Schwei ◽  
Scott Hetzel ◽  
Jane Mahoney ◽  
KyungMann Kim
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Emergency Department ◽  
Health Care Utilization ◽  
Peer Support ◽  
Peer Group ◽  
Peer To Peer ◽  
Emergency Department Visits ◽  
Urgent Care ◽  
Care Utilization

Abstract The majority of older adults want to live and age in their communities. Some community-based organizations (CBOs) have initiated peer-to-peer support services to promote aging in place but the effectiveness of these programs is not clear. Our objective was to compare the effectiveness of a community-designed and implemented peer-to-peer support program vs. access to standard community services, in promoting health and wellness in vulnerable older adult populations. We partnered with three CBOs, one each in California, Florida, and New York, to enroll adults 65 > years of age who received peer support and matched control participants (on age, gender, and race/ethnicity) in an observational study. We followed participants over 12 months, collecting data on self-reported urgent care and emergency department visits and hospitalizations. In order to account for the lack of randomization, we used a propensity score method to compare outcomes between the two groups. We enrolled 222 older adults in the peer-to-peer group and 234 in the control group. After adjustment, we found no differences between the groups in the incidence of hospitalization, urgent and emergency department visits, and composite outcome of any health care utilization. The incidence of urgent care visits was statistically significantly greater in the standard community service group than in the peer-to-peer group. Given that the majority of older adults and their families want them to age in place, the question of how to do this is highly relevant. Peer-to-peer services may provide some benefit to older adults in regard to their health care utilization.

Aging in Place of Vulnerable Older Adults: Person–Environment Fit Perspective

2015 ◽  
Vol 36 (11) ◽  
pp. 1327-1350 ◽  
Author(s):  
Sojung Park ◽  
Yoonsun Han ◽  
BoRin Kim ◽  
Ruth E. Dunkle
Keyword(s):  
Older Adults ◽  
Low Income ◽  
Research Effort ◽  
Aging In Place ◽  
Positive Health ◽  
Senior Housing ◽  
Supportive Environment ◽  
Person Environment Fit ◽  
Poverty Status ◽  
The Impact

Based on the premise that the experience of aging in place is different for vulnerable subgroups of older adults compared with less vulnerable subgroups, we focus on low-income older adults as a vulnerable subgroup and senior housing as an alternative to a conventional, private home environment. Using the 2008 and 2010 waves of the Health Retirement Study, regression models determined the impact of person–environment (P-E) fit between poverty status and residence in senior housing on self-rated health. Consistent with the environmental docility hypothesis, findings show that, among low-income individuals, the supportive environment of senior housing plays a pronounced compensating role and may be a key to successful adaptation in aging. As the first research effort to empirically demonstrate the positive health effects of senior housing among socioeconomically vulnerable elders, our findings provide a much-needed theoretical and practical underpinning for policy-making efforts regarding vulnerable elders.

scholarly journals The Impact of Expanded Insurance Coverage of Dental Prosthetic Services on Dental Care Utilization Among Older Adults in South Korea: Based on the Korean Health Panel Survey.

2020 ◽  
Author(s):  
Jin-Sun Choi ◽  
Se-Hwan Jung
Keyword(s):  
Older Adults ◽  
Dental Implants ◽  
Dental Implant ◽  
Dental Care ◽  
Statistical Significance ◽  
Insurance Coverage ◽  
Care Utilization ◽  
Sociodemographic Characteristics ◽  
Dental Care Utilization ◽  
The Impact

Abstract Background: In Korea, the National Health Insurance Service (NHIS) began its coverage of dentures and dental implants for older people in 2012 and 2014, respectively. This study aimed to investigate the impact of these policies on dental care utilization among people aged 65 years or older according to their sociodemographic characteristics. Methods: Data was collected from the Korea Health Panel (KHP; years 2012 and 2015). The statistical significance of the relationships between sociodemographic characteristics and use of outpatient dental care, denture, and dental implant were analyzed. Results: Results showed an increase of 5.7%, 1.4%, and 2.8% for use of outpatient dental care, denture, and dental implant, respectively, over the course of three years. Including dentures increased its use by 2.5–3.7 times among people aged 70 years or older. Including dental implants alleviated the disparities among age groups and duration of education, except among uneducated people; however, it caused inequity according to household income. Conclusions: Thus, some Korean older adults remain neglected from the benefits of the expanded NHIS; the NHIS should aim for the provision of universal health coverage, and older adults’ access to dental care should be enhanced by the implementation of policies to promote oral health care utilization, Dental prosthetic services, Older adults, Insurance coverage

scholarly journals Emergency Department Utilization Patterns Among Physical Elder Abuse Victims in Comparison to Other Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 151-152
Author(s):  
Tony Rosen ◽  
Katherine Wen ◽  
Sunday Clark ◽  
Alyssa Elman ◽  
Philip Jeng ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Elder Abuse ◽  
Statistical Significance ◽  
Preliminary Evidence ◽  
Emergency Department Utilization ◽  
Care Utilization ◽  
Control Subjects ◽  
Patterns Of Utilization ◽  
Utilization Patterns

Abstract Background Physical elder abuse is common and has serious health consequences. Little is known, however, about the patterns of health care utilization among these victims, including whether opportunities may exist for earlier identification and intervention. Our goal was to describe Emergency Department (ED) utilization known physical elder abuse victims compared with non-victims. Methods We used Medicare insurance claims to examine ED utilization patterns among a well-characterized cohort of 139 known physical elder abuse victims in the year before abuse was identified and compared this to control subjects matched on age, sex, race, and residential zip code. Results Physical elder abuse victims were significantly more likely than control subjects to visit the ED (47.5% vs. 35.9%, p=0.01) during the year before identification and to have at least one visit for an injury-related complaint (14.4% vs. 8.3%, p=0.03). Victims were also more likely to have multiple visits (18.7% vs. 14.6%, p=0.24), visit multiple EDs (7.9% vs. 6.7%, p=0.63), or be high frequency utilizers (≥4 visits, 3.6% vs. 2.7%, p=0.58), but differences did not reach statistical significance. The most common diagnoses in ED visits among victims were: open wound of knee/ankle, exacerbation of chronic bronchitis, pneumonia, and chest pain. Conclusion This work provides preliminary evidence that physical elder abuse victims use the ED more frequently and potentially have different patterns of utilization than other older adults. We plan to further characterize these different patterns to potentially to use them to develop tools for earlier identification.

Outpatient Visits, Hospitalizations and Emergency Department Visits Among Patients with Sickle Cell Disease On Medicaid: Trends in 14 USA States, 2006–2007.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3181-3181
Author(s):  
Benjamin Ansa ◽  
Tom Adamkiewicz ◽  
Yvonne Fry-Johnson ◽  
Gregory Strayhorn ◽  
Barbara Moore ◽  
...  
Keyword(s):  
Emergency Department ◽  
Medical Care ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
P Value ◽  
Age Group ◽  
Cell Disease ◽  
Medical Care Utilization ◽  
Outpatient Visits ◽  
Yearly Rate

Abstract Abstract 3181 Sickle cell disease (SCD) is an inherited hematological disorder affecting 90,000–100,000 Americans. Public insurance accounts for the major method of reimbursement for medical care utilization in this population. Few published population-based studies describe outpatient visits, hospitalizations and emergency department visits together. This study examined rates of hospitalizations, outpatient visits (OPV) and emergency department visits (EDV) among children and adults with SCD across fourteen states of the United States, using a relational claims database, to determine any differences across age groups, genders and states (Medicaid Analytic eXtract [MAX] files, of the Center for Medicare and Medicaid Services). Visits information was extracted using ICD-9-CM codes for SCD, as well as procedure codes (cpt) to determine OPV and EDV. All SCD cases with 24 months continuous Medicaid eligibility for the period under study (2006 to 2007) were identified, and the pattern of medical care utilization was examined. A total of 19,168 pediatric and adult SCD patients were identified to have enrolled in Medicaid with eligibility for the years 2006 and 2007. The mean age was 22.06 years; range: <1year-93years; males and females accounted for 7,402(38.6%) and 11,763(61.4%) respectively with 3 cases of unknown gender. The highest number of cases (2,353[12.3%]) presented in Florida, while Georgia and Louisiana followed with 2,130(11.1%) and 1,883(9.8%) patients respectively (other states included Alabama, Arkansas, Kentucky, Maryland, Missouri, Mississippi, North & South Carolina, Tennessee, Texas and Virginia). The <1–10 years age group represented 25.2% of cases, and majority of the cases were 11–20 years old (27.4%), with a decline in the number of cases as the age increased. Patients identified as Blacks/African Americans made up 80.5% of the SCD population. After the age of 21 years, there were considerably more female SCD patients enrolled in Medicaid, compared to males. There were 94,891 OPV recorded within the two year period, 61,762 hospitalizations and 146,163 EDV. The yearly rate for OPV ranged from 0.5–15.1 per 1000 visits, for hospitalization, 0.4–8.9 per 1000 visits, and for EDV, 2–22.9 per 1000 visits. Patients that were in the <1–10 years age group had the most OPV (15.1 per 1,000 visits yearly rate), and those over 50 years had the least OPV (2.1 per 1000 visits yearly). Hospitalization and EDV rates were highest among patients that were between 21 and 30 years old (8.9 and 22.9 per 1,000 visits yearly, respectively), and lowest for the over 50 years group (1.5 and 2.0 per 1000 visits yearly). In summary, patterns medical service utilization in patients with SCD on Medicaid, representing approximately 1/5 to 1/4 of the estimated USA patient population. Utilization of care changed significantly as children transitioned into adulthood: OPV decreased, while hospitalization and, in particular, EDV increased and peaked in young adults. The emergency department, as the commonest place for service among young adults with SCD, may be a strategic focal point for promoting disease prevention programs. Medical Care Utilization by SCD Patients by Age (years) and Gender, 2006–2007 (MAX)* Age (years) Total # of SCD Patients N=19168 (100%) Total OPV N=94891 (100%) Yearly rate of OPV/1000 Total EDV N=146163 (100%) Yearly rate of EDV/1000 Total Hosp. N=61762 (100%) Yearly rate of Hosp./1000 <1–10 4825 (25.2%) 30193 (31.8%) 15.1 6043 (4.1%) 3.0 10564 (17.1%) 5.3 11–20 5247 (27.4%) 27990 (29.5%) 14 35599 (24.4%) 17.8 15942 (25.8%) 8.0 21–30 4480 (23.4%) 16552 (17.4%) 8.3 45820 (31.3%) 22.9 17735 (28.7%) 8.9 31–40 2166 (11.3%) 9315 (9.8%) 4.7 23418 (16.0%) 11.7 9101 (14.7%) 4.6 41–50 1444 (7.5%) 6657 (7.0%) 3.3 11780 (8.1%) 5.9 5428 (8.8%) 2.7 51–60 683 (3.6%) 3255 (3.4%) 1.6 4097 (2.8%) 2.0 2182 (3.5%) 1.1 >60 323 (1.7%) 929 (1.0%) 0.5 19406 (13.3%) 9.7 810 (1.3%) 0.4 p value (Age) 0.0001 0.0001 0.0001 Gender Female 11763 (61.4%) 57297 (60.4%) 28.6 88811 (60.8%) 44.4 37633 (60.9%) 18.8 Male 7402 (38.6%) 37582 (39.6%) 18.8 57346 (39.2%) 28.7 24125 (39.1%) 12.1 Unknown 3 (0%) 12 (0%) 6 (0%) 4 (0%) p value (Gender) 0.0001 0.0001 0.0001 Yearly Rate of Medical Care Utilization by SCD Patients by Age (years)/1000 visits (MAX)* *MAX: Medicaid Analytic eXtract files 2006–2007 Disclosures: No relevant conflicts of interest to declare.

Association of Memorial Sloan Kettering-Frailty Index with the postoperative intensive and specialized advanced care units admission among older adults with cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18606-e18606
Author(s):  
Timothy J Donoghue ◽  
Amy L. Tin ◽  
Armin Shahrokni
Keyword(s):  
Older Adults ◽  
Frailty Index ◽  
Vulnerable Population ◽  
Care Utilization ◽  
P Value ◽  
Icu Admission ◽  
Postoperative Intensive Care ◽  
Point Increase ◽  
Increased Risk ◽  
The Impact

e18606 Background: Understanding factors associated with poor surgical outcomes of older adults with cancer is necessary in identifying high risk patients and finding ways to mitigate poor outcomes following surgery. In this study, we evaluated whether frailty is associated with intensive postoperative healthcare utilization for this vulnerable population. Methods: This was a single hospital, retrospective cohort study, using the Memorial Sloan Kettering Frailty Index (MSK-FI) to define frailty, with higher MSK-FI corresponding to increased frailty. Multivariable logistic regression with random intercept models were used to assess the association between frailty and 30-day postoperative Intensive Care Unit (ICU) admission, and Specialized Advanced Care Unit (SACU) admission, separately. Covariates included surgical department, age, sex, surgical stress score, preoperative albumin level, and whether patients took a Beers criteria medication prior to surgery. Results: We identified 4417 patients over the age of 65 undergoing elective surgery between January 2015 and December 2018 at our institution and had a length of stay of at least one day. A quarter of patients had an MSK-FI score of 3 or greater. Among our patients, 3.8% (95% CI 3.2%, 4.4%), and 5.4% (95% CI 4.8%, 6.1%) were admitted to the ICU, and the SACU, respectively. We found evidence of an association between greater frailty and increased risk of ICU admission (OR per one-point increase in MSK-FI 1.44; 95% CI 1.31, 1.59; p-value < 0.001), and SACU admission (OR per one point increase in MSK-FI 1.46; 95% CI 1.33, 1.60; p-value < 0.001). For example, for a patient with an MSK-FI score of 2, the predicted risk of ICU admission is 2.2% and SACU admission is 1.1%, compared to 4.5% and 2.2%, respectively, for a patient with an MSK-FI score of 4, when all continuous covariates are set to the mean and the categorical covariates are set to the mode. Conclusions: Frailty based on the MSK-FI is associated with intensive postoperative care utilization in this population of older adults with cancer. Future studies should assess the impact of this information on surgery decision making for this vulnerable population.

scholarly journals A Novel Approach to Developing a Discordance Index for Older Adults With Chronic Kidney Disease

2019 ◽  
Vol 75 (3) ◽  
pp. 522-528 ◽  
Author(s):  
Rasheeda K Hall ◽  
Hui Zhou ◽  
Kristi Reynolds ◽  
Teresa N Harrison ◽  
C Barrett Bowling
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Emergency Department ◽  
Kidney Disease ◽  
Cox Regression ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Ulcer Disease

Abstract Background Older adults with chronic kidney disease (CKD)-discordant conditions (comorbid conditions with treatment recommendations that potentially complicate CKD management) have higher risk of hospitalization and death. Our goal is to develop a CKD-Discordance Index using electronic health records to improve recognition of discordance. Methods This retrospective cohort study included Kaiser Permanente Southern California patients aged ≥65 years and older with incident CKD (N = 30,932). To guide inclusion of conditions in the Index and weight each condition, we first developed a prediction model for 1-year hospitalization risk using Cox regression. Points were assigned proportional to regression coefficients derived from the model. Next, the CKD-Discordance Index was calculated as an individual’s total points divided by the maximum possible discordance points. The association between CKD-Discordance Index and hospitalizations, emergency department visits, and mortality was accessed using multivariable-adjusted Cox regression model. Results Overall, mean (SD) age was 77.9 (7.6) years, 55% of participants were female, 59.3% were white, and 32% (n = 9,869) had ≥1 hospitalization during 1 year of follow-up. The CKD-Discordance Index included the following variables: heart failure, gastroesophageal reflux disease/peptic ulcer disease, osteoarthritis, dementia, depression, cancer, chronic obstructive pulmonary disease/asthma, and having four or more prescribers. Compared to those with a CKD-Discordance Index of 0, adjusted hazard ratios (95% confidence interval) for hospitalization were 1.39 (1.27–1.51) and 1.81 (1.64–2.01) for those with a CKD-Discordance Index of 0.001–0.24 and ≥0.25, respectively (ptrend &lt; .001). A graded pattern of risk was seen for emergency department visits and all-cause mortality. Conclusion A data-driven approach identified CKD-discordant indicators for a CKD-Discordance Index. Higher CKD-Discordance Index was associated with health care utilization and mortality.

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