Geriatrics

Alzheimer's disease and related dementias increase costs of comorbidities in managed Medicare.

by John R Lloyd

Hill JW, Futterman R, Duttagupta S, Mastey V, Lloyd JR, Fillit H. Neurology. 2002 Jan 8;58(1):62-70.

OBJECTIVES: To analyze the relationship between comorbid conditions and costs for patients with AD and related... more OBJECTIVES: To analyze the relationship between comorbid conditions and costs for patients with AD and related dementias (ADRD) in a Medicare managed care organization (MCO). To derive implications for improving management of patients with ADRD.

METHODS: Retrospective analysis was carried out on administrative data for 3,934 patients with ADRD and 19,300 age/sex-matched control subjects enrolled in a large Medicare MCO. Patients with ADRD were identified from diagnoses on medical claims and encounter data for a 2-year period. Control subjects were selected from health plan members without dementia. Comorbid conditions were based on the diagnostic classifications from the Charlson comorbidity index. Health care costs and utilization for MCO-covered services for cases were compared with those of control subjects.

RESULTS: Prevalence of ADRD was 4.4%, substantially higher than reported in previous studies of Medicare managed care and similar to population-based estimates. After controlling for comorbid conditions, age, and sex, annual costs were $4,134 higher for ADRD patients, resulting in excess costs of $16 million to the MCO. For the 10 most prevalent comorbidities in ADRD patients, adjusted costs were higher for ADRD patients compared with control subjects with the same condition. Higher costs were attributable to higher inpatient and skilled nursing facility utilization.

CONCLUSIONS: In this study, prevalence rates for ADRD mirrored population estimates. Costs for patients with ADRD in this Medicare MCO varied considerably by comorbid condition and were substantially higher for patients with both AD and comorbid diseases commonly targeted for disease management, indicating that AD increases costs through effects on the management of comorbid illnesses. These findings indicate that better treatment and care management of AD could reduce the costs of comorbid illnesses commonly experienced by the frail elderly.

Treatment of Alzheimer's Disease Patients in a Managed Care Organization: A Descriptive Study of Costs and Utilization. Drug Benefit Trends. Vol. 12, No. 3 March 2000

by John R Lloyd

Drug Benefit Trends. Vol. 12, No. 3 March 2000 Karen W. Linkins, PhD, John R. Lloyd, BS

This paper explores issues related to the cost and financing of Alzheimer’s disease (AD) care, especially as they... more This paper explores issues related to the cost and financing of Alzheimer’s disease (AD) care, especially as they concern managed care organizations. Illustrative cost analyses are presented for a sample of AD patients and a matched control
group served in a large managed care organization. Findings are consistent with other studies, indicating that AD patients consistently used nearly twice as many resources for all categories considered. This disproportionate spending on
AD translates into approximately 3.6% of health care costs to service just 0.55% of the health care plan’s population.

Physical activity and physical function in older adults: The 45 and Up Study

by Ric Rosenkranz

Yorston, L.C, Kolt, G.S., & Rosenkranz, R.R. (2012). Journal of the American Geriatrics Society, 60:719-725.

Objectives
To determine the strength of the relationship between physical activity and physical function in older... more Objectives
To determine the strength of the relationship between physical activity and physical function in older adults.

Design
Cross-sectional.

Setting
The 45 and Up Study baseline questionnaire, New South Wales, Australia.

Participants
Ninety-one thousand three hundred seventy-five Australian men and women aged 65 and older from the 45 and Up Study.

Measurements
Physical activity engagement (Active Australia Survey), physical function (Medical Outcomes Study Physical Functioning), psychological distress (Kessler-10), and self-reported age, smoking history, education, height, and weight were all measured.

Results
Higher levels of physical activity were associated with better physical function in older adults (correlation coefficient = 0.166, P < .001). Participants engaging in higher levels of physical activity had progressively lower likelihoods of functional limitation (middle tertile: odds ratio (OR) = 0.39, 95% confidence interval (CI) = 0.38–0.41; highest tertile: OR = 0.28, 95% CI = 0.27–0.29). This relationship remained significant, but weakened slightly, when adjusted for age, sex, body mass index, smoking history, psychological distress, and educational attainment (middle tertile: adjusted OR (AOR) = 0.48, 95% CI = 0.46–0.50; highest tertile: AOR = 0.36, 95% CI = 0.34–0.37).

Conclusion
There is a significant, positive relationship between physical activity and physical function in older adults, with older adults who are more physically active being less likely to experience functional limitation than their more-sedentary counterparts. Level of engagement in physical activity is an important predictor of physical function in older adults.

Relationship of erythrocyte superoxide dismutase, serum lipid peroxides and age

by Vinod Bhagwat

Geriatric medicine in Egypt-Wikipedia

by Ahmed Mohammedin

Dale W, Mohile S, Hurria A, Biological, Clinical, and Psychosocial Correlates at the Interface of Cancer and Aging Research (U13), JNCI 2012

by William Dale

Remaining life expectancy measurement and PSA screening of older men

by William Dale

Co-authored with Supriya Mohile and Ashwin Kotwal.

Alain MONTANDON (UBP; Institut Universitaire de France) Préface 7 Jean-Marc TALPIN (Université Lyon II) Lire le vieillir avec l'Ecclésiaste: le bilan de vie entre …

by antonio dominguez leiva

Hurria, Mohile, Dale, Research Priorities in Geriatric Oncology, JNCCN, 2012

by William Dale

Shega et al, The Relationship of Pain and Cognitive Impairment with Social Vulnerability, Pain Medicine, 2012

by William Dale

Predictors of Hospitalization in Italian Nursing Home Residents: The ULISSE Project.

by Paolo Eusebi

Cherubini A, Eusebi P, Dell'aquila G, Landi F, Gasperini B, Bacuccoli R, Menculini G, Bernabei R, Lattanzio F, Ruggiero C.
J Am Med Dir Assoc. 2012 Jan;13(1):84.e5-84.e10. Epub 2011 May 31.

Rationale of Combining More than One Antipsychotic in a LTC/Nursing Home Patient at Same Time

by Dr. Joel Lamoure

Lamoure J.  Rationale of Combining More than One Antipsychotic in a LTC/Nursing Home Patient at Same Time .... more Lamoure J.  Rationale of Combining More than One Antipsychotic in a LTC/Nursing Home Patient at Same Time . Canadian Healthcare Network ATE Panel. October, 2011. http://www.canadianhealthcarenetwork.ca/pharmacists/discussions/the-experts/mental-health

Psychometric properties of the extended Care Dependency Scale for older persons in Egypt

by Ahmed Mohammedin

Psychometric properties of the extended Care Dependency Scale for older persons in Egypt

by Ahmed Mohammedin

Oral Care for Frail Elders: Knowledge, Attitudes, and Practices of Long-Term Care Staff

by Shafik Dharamsi

A longitudinal study of bereavement phenomena in recently widowed elderly men

by Gerard Byrne

Psychometric properties and health correlates of the Geriatric Anxiety Inventory in Australian community-residing older women

by Gerard Byrne

Objective: To assess the psychometric properties and health correlates of the Geriatric Anxiety Inventory (GAI) in a... more Objective: To assess the psychometric properties and health correlates of the Geriatric Anxiety Inventory (GAI) in a cohort of Australian community-residing older women.
Method: Cross-sectional study of a population-based cohort of women aged 60 years and over (N 1⁄4 286). Results: The GAI exhibited sound internal consistency and demonstrated good concurrent validity against the state half of the Spielberger State Trait Anxiety Inventory and the neuroticism domain of the NEO five-factor inventory. GAI score was significantly associated with self-reported sleep difficulties and perceived memory impairment, but not with age or cognitive function. Women with current DSM-IV Generalized Anxiety Disorder (GAD) had significantly higher GAI scores than women without such a history. In this cohort, the optimal cut-point to detect current GAD was 8/9. Although the GAI was designed to have few somatic items, women with a greater number of general medical problems or who rated their general health as worse had higher GAI scores.
Conclusion: The GAI is a new scale designed specifically to measure anxiety in older people. In this Australian cohort of older women, the instrument had sound psychometric properties.

The fitness for the Ageing Brain Study II (FABS II): protocol for a randomized controlled clinical trial evaluating the effect of physical activity on cognitive function …

by Gerard Byrne

Development of the Geriatric Anxiety Inventory (GAI)

by Gerard Byrne

Psychiatric drug prescribing in elderly Australians: Time for action

by Gerard Byrne

Recent epidemiological studies have revealed very high ratres of antipsychotic, antidepressant and anxiolytic and... more Recent epidemiological studies have revealed very high ratres of antipsychotic, antidepressant and anxiolytic and sedative-hypnotic drug use among Australians. These large-scale analyses supplement previous data across a number of settings demonstrating higher rates of use in those over 60 years, with the highest rates in those 80-95 years of age. This issue is of growing concern, given the increasing size of the elderly population and the greater vulnerability of older people to adverse effects of drugs and to interactions among the multiple the multiple drugs often prescribed. On the basis of these new data and significant previous findings, we argue for the urgent need to review psychotropic prescribing among the elderly on the grounds of safety and cost.