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End-of-Life Healthcare Utilization of Older Mexican Americans With and Without a Diagnosis of Alzheimer's Disease and Related Dementias.

ABSTRACT: BACKGROUND:Little is known about the patterns of end-of-life health care for older Mexican Americans with or without a diagnosis of Alzheimer's disease and related dementias (ADRD). Our objective was to investigate the frequency of acute hospital admissions, intensive care unit use, and ventilator use during the last 30 days of life for deceased older Mexican American Medicare beneficiaries with and without an ADRD diagnosis. METHODS:We used Medicare claims data linked with survey information from 1,090 participants (mean age of death 85.1 years) of the Hispanic Established Populations for the Epidemiologic Studies of the Elderly. Multivariable logistic regression models were used to estimate the odds for hospitalization, intensive care unit use, and ventilator use in the last 30 days of life for decedents with ADRD than those without ADRD. Generalized linear models were used to estimate the risk ratio (RR) for length of stay in hospital. RESULTS:Within the last 30 days of life, 64.5% decedents had an acute hospitalization (59.1% ADRD, 68.3% no ADRD), 33.9% had an intensive care unit stay (31.3% ADRD, 35.8% no ADRD), and 17.2% used a ventilator (14.9% ADRD, 18.8% no ADRD). ADRD was associated with significantly lower hospitalizations (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.50-0.89) and shorter length of stay in hospital (RR = 0.77, 95% CI = 0.65-0.90). CONCLUSION:Hospitalization, intensive care unit stay, and ventilator use are common at the end of life for older Mexican Americans. The lower hospitalization and shorter length of stay in hospital of decedents with ADRD indicate a modest reduction in acute care use. Future research should investigate the impact of end-of-life planning on acute-care use and quality of life in terminally ill Mexican American older adults.

SUBMITTER: Nguyen C

PROVIDER: S-EPMC7176060 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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End-of-Life Healthcare Utilization of Older Mexican Americans With and Without a Diagnosis of Alzheimer's Disease and Related Dementias.

Nguyen Christine C Downer Brian B Chou Lin-Na LN Kuo Yong-Fang YF Raji Mukaila M

The journals of gerontology. Series A, Biological sciences and medical sciences 20200101 2

<h4>Background</h4>Little is known about the patterns of end-of-life health care for older Mexican Americans with or without a diagnosis of Alzheimer's disease and related dementias (ADRD). Our objective was to investigate the frequency of acute hospital admissions, intensive care unit use, and ventilator use during the last 30 days of life for deceased older Mexican American Medicare beneficiaries with and without an ADRD diagnosis.<h4>Methods</h4>We used Medicare claims data linked with survey ...[more]

PMID: 30855070

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Project description:BACKGROUND:Little is known regarding the impact of transitions in frailty on healthcare use and payment in older Mexican Americans. We address this gap in knowledge by investigating the effect of early transitions in physical frailty on the use of healthcare services and Medicare payments involving older Mexican Americans. METHODS:Longitudinal analyses were conducted using the Hispanic Established Populations for the Epidemiological Study of the Elderly (Hispanic-EPESE) survey data from five Southwest states linked to the Medicare claims files from the Centers for Medicare and Medicaid Services. Seven hundred and eighty-eight community-dwelling Mexican Americans 72?years and older in 2000/01 were studied. We used a modified Frailty Phenotype (unintentional weight loss, weakness, self-reported exhaustion and slow walking speed) to classify frailty status (non-frail, pre-frail or frail). Each participant was placed into one of 5 frailty transition groups: 1) remain non-frail, 2) remain pre-frail, 3) remain frail, 4) improve (pre-frail to non-frail, frail to non-frail, frail to pre-frail) and 5) worse (non-frail to pre-frail, non-frail to frail, pre-frail to frail). The outcomes for the one-year follow-up period (2000-2001) were: (a) healthcare use (hospitalization, emergency room [ER] admission and physician visit); and (b) Medicare payments (total payment and outpatient payment). RESULTS:Mean age was 78.8 (SD?=?5.1) years and 60.3% were female in 1998/99. Males who remained pre-frail (Odds Ratio [OR]?=?3.49, 1.13-10.8, remained frail OR?=?6.92, 1.61-29.7) and transitioned to worse frail status (OR?=?4.49, 1.74-11.6) had significantly higher hospitalization risk compared to individuals who remained non-frail. Males in the 'worsened' groups, and females in the 'improved' groups, had significantly higher Medicare payments than individuals who remained non-frail (Cost Ratio [CR]?=?2.00, 1.30-3.09; CR?=?1.53, 1.12-2.09, respectively]. CONCLUSIONS:Healthcare use and Medicare payments differed by frailty transition status. The differences varied by sex. Research is necessary to elucidate the relationship between frailty transitions and outcomes, sex difference and Medicare payment for older Mexican Americans living in the community.

Project description:ObjectivesDevelop and validate a modified frailty phenotype measure for older Mexican Americans participating in the Hispanic Established Populations for the Epidemiological Study of the Elderly (H-EPESE) and related studies.DesignExpert-based panel evaluation of content validity, cross-sectional analysis of construct validity, and longitudinal analysis of criterion validity for a modified version of the frailty phenotype measure.SettingFive southwestern states.ParticipantsA total of 1833 community-dwelling Mexican Americans aged 67 years or older.MeasurementsFrailty was assessed using the frailty phenotype measure (weight loss, weakness, exhaustion, slowness, and low physical activity) and a modified frailty phenotype measure (replacing "low physical activity" with "limitations in walking half a mile"). Each individual was classified as non-frail, pre-frail, or frail based on both frailty measures (original vs modified). Expert panel consensus was used to examine content validity. Spearman correlation, κ, weighted κ, and bootstrapping κ examined construct validity (n = 1833). Generalized linear mixed models, odds ratios, Cox proportional regression models, hazard ratios, and C statistics were used to analyze criterion validity (n = 1446) across four outcomes: hospitalization, physician visits, disability, and mortality from wave 3 (1998-99) through wave 8 (2012-13).ResultsThe original and modified frailty phenotype measures had a strong correlation (r = .89; P < .000) and agreement (κ = .84; 95% confidence interval [CI] = .81-.86; weighted κ = .86; 95% CI = .84-.88; bootstrap κ = .84; 95% CI = .81-.86; bootstrap-weighted κ = .86; 95% CI = .84-.88 with 1000 bootstrapping samples). Four outcome models showed similar risk predictions for both frailty measures, with the exception of physician visits for frail participants.Conclusion"Limitations in walking half a mile" can be used as a substitute criterion for "low physical activity" in assessing frailty. The modified frailty phenotype measure was comparable with the original frailty phenotype measure in H-EPESE participants over time. Our results indicate the modified frailty phenotype is a useful longitudinally frailty measure for community-dwelling older Mexican Americans. J Am Geriatr Soc 67:2393-2397, 2019.

Dataset Information

End-of-Life Healthcare Utilization of Older Mexican Americans With and Without a Diagnosis of Alzheimer's Disease and Related Dementias.

Publications

End-of-Life Healthcare Utilization of Older Mexican Americans With and Without a Diagnosis of Alzheimer's Disease and Related Dementias.

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