National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- Caregiving (7)
- Case Study (1)
- Chronic Conditions (1)
- Clinical Decision Support (CDS) (1)
- COVID-19 (1)
- Cultural Competence (1)
- (-) Dementia (23)
- Diagnostic Safety and Quality (4)
- Education: Patient and Caregiver (1)
- Elderly (15)
- Electronic Health Records (EHRs) (2)
- Evidence-Based Practice (6)
- Guidelines (2)
- Healthcare Costs (2)
- Health Information Technology (HIT) (4)
- Health Insurance (1)
- Hospital Discharge (1)
- Hospitalization (1)
- Imaging (1)
- Long-Term Care (2)
- Low-Income (1)
- Medicare (2)
- Medication (6)
- Mortality (1)
- Neurological Disorders (18)
- Nursing Homes (2)
- Opioids (1)
- Outcomes (1)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (3)
- Patient Adherence/Compliance (1)
- Patient and Family Engagement (1)
- Prevention (2)
- Primary Care (1)
- Quality Improvement (1)
- Quality of Care (1)
- Quality of Life (1)
- Racial and Ethnic Minorities (3)
- Research Methodologies (1)
- Screening (2)
- Shared Decision Making (1)
- Telehealth (2)
- Treatments (1)
- U.S. Preventive Services Task Force (USPSTF) (2)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 23 of 23 Research Studies DisplayedDeardorff WJ, Jing B, Growdon ME
Medication misuse and overuse in community-dwelling persons with dementia.
This study sought to characterize a broad spectrum of medication misuse and overuse among community-dwelling persons with dementia (PWD). The authors included community-dwelling adults aged ≥66 in the Health and Retirement Study from 2008 to 2018 linked to Medicare and classified as having dementia using a validated algorithm. Potentially problematic medications were identified as: (1) medication overuse including over-aggressive treatment of diabetes/hypertension (e.g., insulin/sulfonylurea with hemoglobin A1c < 7.5%) and medications inappropriate near end of life based on STOPPFrail and (2) medication misuse including medications that negatively affect cognition and medications from 2019 Beers and STOPP Version 2 criteria. To contextualize, they compared medication use to people without dementia through a propensity-matched cohort by age, sex, comorbidities, and interview year. Among 1441 PWD, median age was 84, 67% female, and 14% Black. Overall, 73% of PWD were prescribed ≥1 potentially problematic medication with a mean of 2.09 per individual in the prior year. This was notable across several domains, as 41% were prescribed ≥1 medications that negatively affects cognition. Frequently prescribed problematic medications identified included proton pump inhibitors (PPIs), non-steroidal anti-inflammatory drugs (NSAIDs), opioids, antihypertensives, and antidiabetic agents. Problematic medication use was higher among PWD compared to those without dementia with 73% versus 67% prescribed ≥1 problematic medication and a mean of 2.09 versus 1.62, respectively.
AHRQ-funded; HS02638.
Citation: Deardorff WJ, Jing B, Growdon ME .
Medication misuse and overuse in community-dwelling persons with dementia.
J Am Geriatr Soc 2023 Oct; 71(10):3086-98. doi: 10.1111/jgs.18463..
Keywords: Medication, Dementia, Elderly
Ramirez M, Duran MC, Penfold RB
STAR-Caregivers Virtual Training and Follow-up: a cultural adaptation for Latino caregivers of people with dementia.
This paper describes what is needed to adapt the STAR-Caregivers Virtual Training and Follow-up (STAR-VTF), an evidence-based intervention that teaches family caregivers how to manage behavioral and psychological symptoms of dementia to Latino caregivers. This qualitative research study interviewed Spanish- and English-speaking caregivers of people with dementia who self-identify as Hispanic/Latino (N = 30) and healthcare and social service providers of older Latino clients and/or Latino family caregivers (N = 14). The authors identified three themes: (i) there was a need to increase awareness about dementia and decrease stigma; (ii) semantics mattered as certain words and phrases could be stigmatizing, offensive, or culturally inappropriate; and (iii) there was a need to incorporate into program materials the traditional family structure and nature of caregiving in Latino families. Based on findings, STAR-VTF was adapted to expand content to improve understanding of dementia, language was revised that was viewed as problematic, and cultural examples were added to reflect the range of family involvement in caring for people living with dementia and multigenerational living.
AHRQ-funded; HS026369.
Citation: Ramirez M, Duran MC, Penfold RB .
STAR-Caregivers Virtual Training and Follow-up: a cultural adaptation for Latino caregivers of people with dementia.
Transl Behav Med 2023 Sep 12; 13(9):625-34. doi: 10.1093/tbm/ibad028..
Keywords: Education: Patient and Caregiver, Cultural Competence, Racial and Ethnic Minorities, Dementia, Neurological Disorders
Ramirez M, De Anda S, Jin H
Health information-seeking behavior of Latino caregivers of people living with dementia: a mixed-methods study.
This study examined the health information-seeking behavior of Latino caregivers of people living with dementia. This mixed-methods study used a structured survey and semi-structured interviews with 21 Latino caregivers in Los Angeles, California. Semi-structured interviews were also conducted with six healthcare and social service providers. The results showed that caregivers sought information on what changes to expect as dementia progresses to be better prepared. The most common action they used was to search the Internet. However, those who did were concerned about the quality of information.
AHRQ-funded; HS00046,HS026369.
Citation: Ramirez M, De Anda S, Jin H .
Health information-seeking behavior of Latino caregivers of people living with dementia: a mixed-methods study.
J Appl Gerontol 2023 Aug; 42(8):1738-48. doi: 10.1177/07334648231163430..
Keywords: Caregiving, Dementia, Neurological Disorders, Racial and Ethnic Minorities
Hua Y, Temkin-Greener H, Cai S
Primary care telemedicine use among assisted living residents with dementia during COVID-19: race and dual enrollment status.
The purpose of this study was to explore primary care telemedicine use among Medicare beneficiaries with Alzheimer’s disease and related dementias (ADRD) who resided in Assisted Living Facilities (Als) during the early stage of the COVID-19 pandemic, with a focus on possible racial and socioeconomic differences. The study found that at the start of the pandemic in quarter 2 of 2020, Black residents were less likely to have telemedicine visits than their White counterparts. In the following two quarters, Black residents were more likely to receive primary care via telemedicine than White residents; a similar difference was observed between Hispanic and White residents, but with smaller effect sizes. Compared with nondual residents, dual residents were more likely to receive primary care via telemedicine in Q3. In addition, residents in AL communities with a higher proportion of dual residents, compared with those in low-dual ALs, were less likely to receive primary care via telemedicine throughout the study period. However, the difference in telemedicine use between higher vs lower dual ALs narrowed over time.
AHRQ-funded; HS026893.
Citation: Hua Y, Temkin-Greener H, Cai S .
Primary care telemedicine use among assisted living residents with dementia during COVID-19: race and dual enrollment status.
J Am Med Dir Assoc 2023 Aug; 24(8):1157-58.e3. doi: 10.1016/j.jamda.2023.05.005..
Keywords: COVID-19, Primary Care, Telehealth, Health Information Technology (HIT), Nursing Homes, Long-Term Care, Dementia, Neurological Disorders, Racial and Ethnic Minorities, Elderly
Sideman AB, Gilissen J, Harrison KL
Caregiver experiences navigating the diagnostic journey in a rapidly progressing dementia.
This mixed-methods study examined the diagnostic journey experience from the perspective of caregivers of people who died from sporadic Creutzfeldt-Jakob Disease (sCJD). Qualitative data were drawn from interviews with former caregivers of 12 people who had died from sCJD. Four overarching themes were identified, as well as 4 phases along the diagnostic journey. Findings suggested that more work was needed to improve clinician diagnostic knowledge and communication practices. The authors also noted that caregivers need better support during the diagnostic journey and concluded that lessons learned from studying sCJD and other rapidly progressive dementias is likely to be applicable to more common dementias.
AHRQ-funded; HS022241.
Citation: Sideman AB, Gilissen J, Harrison KL .
Caregiver experiences navigating the diagnostic journey in a rapidly progressing dementia.
J Geriatr Psychiatry Neurol 2023 Jul; 36(4):282-94. doi: 10.1177/08919887221135552..
Keywords: Caregiving, Dementia, Neurological Disorders
Growdon ME, Gan S, Yaffe K
New psychotropic medication use among Medicare beneficiaries with dementia after hospital discharge.
Hospital stays often trigger behavioral shifts in people with dementia (PWD), potentially leading to the prescription of psychotropic drugs despite their limited effectiveness and potential for harmful side-effects. The purpose of this study was to ascertain the prevalence of new psychotropic drug prescriptions in PWD living in the community after their discharge from the hospital, and within these new users, the percentage who continued their use for an extended duration. The researchers conducted a retrospective cohort study, utilizing a random selection of Medicare claims from 2017. The study included PWD hospital patients who were 68 years or older and covered by traditional and Part D Medicare. The primary outcome was the event of prescribing at the time of discharge psychotropic drugs including antipsychotics, sedative-hypnotics, antiepileptics, and antidepressants. The initiation was characterized as new prescriptions (from classes not utilized in the 180 days preceding admission) filled within a week of discharge from the hospital or skilled nursing facility. Extended use was defined as the percentage of new users who continued to refill the newly prescribed medications for more than 90 days post-discharge. The study population consisted of 117,022 hospitalized PWD with an average age of 81 years, with 63% being female. The study found that prior to admission, 63% were already using at least one psychotropic drug; 10% were using drugs from three or more psychotropic classes. These classes included antidepressants (44% pre-admission), antiepileptics (29%), sedative-hypnotics (21%), and antipsychotics (11%). The percentage of PWD discharged with new psychotropic prescriptions ranged from 1.9% (antipsychotics) to 2.9% (antiepileptics); 6.6% had at least one new class initiated. Among these new users, prolonged use varied from 36% (sedative-hypnotics) to 63% (antidepressants); across drug classes, prolonged use was observed in 51%. Factors associated with the initiation of new psychotropics included duration of hospital stay and delirium.
AHRQ-funded; HS026383.
Citation: Growdon ME, Gan S, Yaffe K .
New psychotropic medication use among Medicare beneficiaries with dementia after hospital discharge.
J Am Geriatr Soc 2023 Apr; 71(4):1134-44. doi: 10.1111/jgs.18161..
Keywords: Elderly, Medication, Medicare, Dementia, Neurological Disorders, Hospitalization
Couch E, Belanger E, Gadbois EA
"I know that my role is going to change": a mixed-methods study of the relationship between amyloid-β PET scan results and caregiver burden.
The purpose of this study was to clarify the relationship between amyloid scan results and subjective and objective indicators of burden. The researchers utilized a parallel mixed-methods design using survey data from 1,338 care partners of persons with mild cognitive impairment (MCI) and dementia who received an amyloid scan from the CARE-IDEAS study, and semi-structured interviews with a subsample of 62 care partners. The study found that amyloid was not associated with burden. However, the scan result influenced participants' perceptions of their caregiving role and coping strategies. Care partners to persons with elevated amyloid expected increasing responsibility, while partners to persons without elevated amyloid and mild cognitive impairment did not anticipate changes to their role. Care partners to persons with elevated amyloid reported using knowledge gained from the scan to develop coping strategies. All care partners described needing practical and emotional support.
AHRQ-funded; HS000011.
Citation: Couch E, Belanger E, Gadbois EA .
"I know that my role is going to change": a mixed-methods study of the relationship between amyloid-β PET scan results and caregiver burden.
Aging Clin Exp Res 2023 Feb; 35(2):387-97. doi: 10.1007/s40520-022-02314-6..
Keywords: Caregiving, Dementia
Coley RY, Smith JJ, Karliner L RY, Smith JJ, Karliner L
External validation of the eRADAR risk score for detecting undiagnosed dementia in two real-world healthcare systems.
Drupal date: Feb, 2023
It is estimated that half of the individuals with dementia remain undiagnosed. The electronic health record (EHR) Risk of Alzheimer's and Dementia Assessment Rule (eRADAR) was designed to detect older adults at risk of undiagnosed dementia using routinely gathered clinical information. The purpose of this retrospective cohort study was to externally validate eRADAR in two real-world healthcare systems, examining its performance over time and across race/ethnicity. The study found a total of 7631 dementia diagnoses were observed at KPWA and 216 at UCSF. The area under the curve was 0.84 (95% confidence interval: 0.84-0.85) at KPWA and 0.79 (0.76-0.82) at UCSF. Using the 90th percentile as the cut point for identifying high-risk patients, sensitivity was 54% (53-56%) at KPWA and 44% (38-51%) at UCSF. Performance was consistent over time, including across the transition from International Classification of Diseases, version 9 (ICD-9) to ICD-10 codes, and across racial/ethnic groups (although small samples limited precision in some groups). The study concluded that eRADAR demonstrated strong external validity for identifying undiagnosed dementia in two healthcare systems with diverse patient populations and varying availability of external healthcare data for risk calculations. This study showed that eRADAR is generalizable from a research sample to real-world clinical populations, transportable across health systems, resilient to temporal changes in healthcare, and exhibits similar performance across major racial/ethnic groups.
It is estimated that half of the individuals with dementia remain undiagnosed. The electronic health record (EHR) Risk of Alzheimer's and Dementia Assessment Rule (eRADAR) was designed to detect older adults at risk of undiagnosed dementia using routinely gathered clinical information. The purpose of this retrospective cohort study was to externally validate eRADAR in two real-world healthcare systems, examining its performance over time and across race/ethnicity. The study found a total of 7631 dementia diagnoses were observed at KPWA and 216 at UCSF. The area under the curve was 0.84 (95% confidence interval: 0.84-0.85) at KPWA and 0.79 (0.76-0.82) at UCSF. Using the 90th percentile as the cut point for identifying high-risk patients, sensitivity was 54% (53-56%) at KPWA and 44% (38-51%) at UCSF. Performance was consistent over time, including across the transition from International Classification of Diseases, version 9 (ICD-9) to ICD-10 codes, and across racial/ethnic groups (although small samples limited precision in some groups). The study concluded that eRADAR demonstrated strong external validity for identifying undiagnosed dementia in two healthcare systems with diverse patient populations and varying availability of external healthcare data for risk calculations. This study showed that eRADAR is generalizable from a research sample to real-world clinical populations, transportable across health systems, resilient to temporal changes in healthcare, and exhibits similar performance across major racial/ethnic groups.
AHRQ-funded; HS026369.
Citation: Coley RY, Smith JJ, Karliner L RY, Smith JJ, Karliner L .
External validation of the eRADAR risk score for detecting undiagnosed dementia in two real-world healthcare systems.
J Gen Intern Med 2023 Feb; 38(2):351-60. doi: 10.1007/s11606-022-07736-6..
Keywords: Dementia, Neurological Disorders, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT)
Goodhope NR, Anderson TS, Jung Y
Initiation of psychotropic and opioid medications after hospital discharge in older adults with dementia.
Despite the high number of people suffering from opioid addiction in the USA, access to treatment remains limited, with only a fraction of those in need receiving life-saving medications for opioid use disorder (MOUD). The current healthcare system and policies create unnecessary barriers to care, exacerbating treatment and illness burdens. This study proposes the use of a minimally disruptive medicine (MDM) framework to reduce disruptions in patients' lives, improve healthcare quality and delivery, and save lives. To achieve this, the authors suggest policy changes that expand MOUD to all healthcare settings, promote flexible and patient-centered medication choices, reduce treatment requirements, and address systemic disparities and inequities. By adopting an MDM approach, clinicians, health systems, and policymakers can create a more patient-centered and accessible care system for those battling opioid addiction.
AHRQ-funded; HS026216.
Citation: Goodhope NR, Anderson TS, Jung Y .
Initiation of psychotropic and opioid medications after hospital discharge in older adults with dementia.
J Gen Intern Med 2023 Feb; 38(3):824-27. doi: 10.1007/s11606-022-07874-x..
Keywords: Elderly, Opioids, Medication, Dementia, Hospital Discharge
Bajaj JS, Duarte-Rojo A, Xie JJ
Minimal hepatic encephalopathy and mild cognitive impairment worsen quality of life in elderly patients with cirrhosis.
Researchers investigated the performance of elderly patients with cirrhosis on tests for minimal hepatic encephalopathy (MHE) and predementia mild cognitive impairment (MCI) and their effects on quality of life (QOL). They found that, in a multicenter study of elderly patients with cirrhosis and controls, the presence of MHE, regardless of MCI, was associated with poor cognition and QOL. They created adjusted norms that defined the high sensitivity of EncephalApp for the detection of MHE in older individuals and validated it in a separate cohort.
AHRQ-funded; HS025412.
Citation: Bajaj JS, Duarte-Rojo A, Xie JJ .
Minimal hepatic encephalopathy and mild cognitive impairment worsen quality of life in elderly patients with cirrhosis.
Clin Gastroenterol Hepatol 2020 Dec;18(13):3008-16.e2. doi: 10.1016/j.cgh.2020.03.033..
Keywords: Elderly, Chronic Conditions, Quality of Life, Dementia, Neurological Disorders
Roberts ET, McGarry BE, Glynn A
Cognition and take-up of the Medicare Savings Programs.
In this study, the investigators examined the association between cognition and Medicare Savings Program (MSP) enrollment among elderly Medicare beneficiaries who qualified for these programs. They also examined enrollment in the Low-Income Subsidy (LIS), a separate program that provides premium and cost-sharing assistance in Medicare Part D that Medicare beneficiaries automatically received if they are enrolled in an MSP.
AHRQ-funded; HS026727.
Citation: Roberts ET, McGarry BE, Glynn A .
Cognition and take-up of the Medicare Savings Programs.
JAMA Intern Med 2020 Nov;180(11):1529-31. doi: 10.1001/jamainternmed.2020.2783..
Keywords: Elderly, Medicare, Health Insurance, Healthcare Costs, Low-Income, Dementia, Neurological Disorders
Armstrong MJ, Gamez N, Alliance S
Research priorities of caregivers and individuals with dementia with Lewy bodies: an interview study.
The authors investigated the research priorities of individuals and caregivers living with dementia with Lewy bodies (DLB). Through telephone interviews, they found that individuals with DLB and caregivers identified research needs and highlighted DLB symptoms needing additional research. They recommended that funding be informed by the priorities of all relevant stakeholders and support research investigating causes, natural history, biomarkers, and treatment in addition to research targeting themes regarding living with disease.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Gamez N, Alliance S .
Research priorities of caregivers and individuals with dementia with Lewy bodies: an interview study.
PLoS One 2020 Oct 7;15(10):e0239279. doi: 10.1371/journal.pone.0239279..
Keywords: Caregiving, Dementia, Neurological Disorders, Patient and Family Engagement, Elderly, Research Methodologies
Merrilees JJ, Bernstein A, Dulaney S
The Care Ecosystem: promoting self-efficacy among dementia family caregivers.
The authors illustrated specific psychosocial interventions aimed at improving self-efficacy among family caregivers enrolled in the Care Ecosystem, a model of navigated care designed to support persons with dementia and their primary caregivers. They identified three categories of Care Team Navigator intervention: emotional, informational, and instrumental support, which are consistent with a psychosocial approach to building self-efficacy. They concluded that their findings demonstrated how a model of navigated care can positively impact self-efficacy among dementia family caregivers.
AHRQ-funded; HS022241.
Citation: Merrilees JJ, Bernstein A, Dulaney S .
The Care Ecosystem: promoting self-efficacy among dementia family caregivers.
Dementia 2020 Aug;19(6):1955-73. doi: 10.1177/1471301218814121..
Keywords: Elderly, Caregiving, Dementia
H H, Caton Gilstrap L
AHRQ Author: Tracer H
Screening for cognitive impairment in older adults.
This evidence-based approach paper focuses on putting prevention into action. It discusses screening for cognitive impairment in older adults. It provides case study, case study questions and a discussion.
AHRQ-authored.
Citation: H H, Caton Gilstrap L .
Screening for cognitive impairment in older adults.
Am Fam Physician 2020 Jun 15;101(12):753-54..
Keywords: U.S. Preventive Services Task Force (USPSTF), Dementia, Neurological Disorders, Elderly, Screening, Prevention, Case Study, Evidence-Based Practice, Guidelines
Crystal S, Jarrín OF, Rosenthal M
National partnership to improve dementia care in nursing homes campaign: state and facility strategies, impact, and antipsychotic reduction outcomes.
This study examines the success of the national partnership campaign to reduce prescription of antipsychotic medications to elderly nursing home residents with dementia. Antipsychotic medications have been shown to increase mortality. Use of these medications had increased 23.9% in dementia patients by 2011. The campaign reduced use by 40.1% to 14.3% by the second quarter of 2019. The campaign measured progress with public reporting of quality measures, increased regulatory scrutiny, and accompanying state and facility initiatives. Sedative-hypnotic medication use also decreased in tandem with antipsychotic reduction suggesting that the campaign increased attention to the use of other risky psychotropic medications.
AHRQ-funded; HS023464; HS022406; HS023258; HS021112.
Citation: Crystal S, Jarrín OF, Rosenthal M .
National partnership to improve dementia care in nursing homes campaign: state and facility strategies, impact, and antipsychotic reduction outcomes.
Innov Aging 2020 Jun 2;4(3):igaa018. doi: 10.1093/geroni/igaa018..
Keywords: Elderly, Nursing Homes, Long-Term Care, Dementia, Neurological Disorders, Quality Improvement, Quality of Care, Medication, Mortality
Fink HA, Linskens EJ, Silverman PC
Accuracy of biomarker testing for neuropathologically defined Alzheimer disease in older adults with dementia
This study is a systematic review of biomarker and test accuracy for identification of Alzheimer Disease (AD) in older adults. Studies with low or medium risk of bias were analyzed, and two reviewers rated risk of bias. Fifteen brain imaging studies and 9 cerebrospinal fluid (CSF) studies met analysis criteria and were included. The meta-analysis found that in methodologically heterogeneous studies of uncertain applicability to typical clinical settings, the biomarkers amyloid PET, 18F-FDG proton emission tomography (PET), and magnetic resonance imaging (MRI) were highly sensitive for neuropathologic AD. Single studies suggested that adding amyloid PET, 18F-FDG PET, and CSF test combinations may add accuracy to clinical evaluation.
AHRQ-funded; 290201500008I.
Citation: Fink HA, Linskens EJ, Silverman PC .
Accuracy of biomarker testing for neuropathologically defined Alzheimer disease in older adults with dementia
Ann Intern Med 2020 May 19;172(10):669-77. doi: 10.7326/m19-3888..
Keywords: Elderly, Dementia, Neurological Disorders, Imaging, Diagnostic Safety and Quality, Patient-Centered Outcomes Research, Evidence-Based Practice
Fink HA, Linskens EJ, MacDonald R
Benefits and harms of prescription drugs and supplements for treatment of clinical Alzheimer-type dementia
This is a systematic review and meta-analysis of the benefits and harms of prescription drugs and supplements for treatment of clinical Alzheimer-type dementia (CATD). Studies with low or medium risk of bias (ROB) were analyzed and rated. The analysis concluded there was a slight reduction in short-term cognitive decline with cholinesterase inhibitors and memantime, and cholinesterase inhibitors slightly reduced reported functional decline. There was mostly insufficient evidence on drug treatment of behavioral and psychological symptoms of dementia and on supplements for all outcomes.
AHRQ-funded; 290201500008I.
Citation: Fink HA, Linskens EJ, MacDonald R .
Benefits and harms of prescription drugs and supplements for treatment of clinical Alzheimer-type dementia
Ann Intern Med 2020 May 19;172(10):656-68. doi: 10.7326/m19-3887..
Keywords: Elderly, Dementia, Neurological Disorders, Medication, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes, Adverse Drug Events (ADE), Adverse Events, Treatments
Hemmy LS, Linskens EJ, Silverman PC
Brief cognitive tests for distinguishing clinical Alzheimer-type dementia from mild cognitive impairment or normal cognition in older adults with suspected cognitive impairment.
Researchers summarized evidence on accuracy and harms of brief cognitive tests for clinical Alzheimer-type dementia (CATD) in older adults with suspected cognitive impairment. They encountered the following limitations: small studies, few test metrics being evaluated by multiple studies, and few studies directly comparing different tests, scores, cut points, or test combinations. They concluded that many brief, single cognitive tests accurately distinguish CATD from normal cognition in older adults but are less accurate in distinguishing mild CATD from normal cognition or CATD from mild cognitive impairment.
AHRQ-funded; 290201500008I.
Citation: Hemmy LS, Linskens EJ, Silverman PC .
Brief cognitive tests for distinguishing clinical Alzheimer-type dementia from mild cognitive impairment or normal cognition in older adults with suspected cognitive impairment.
Ann Intern Med 2020 May 19;172(10):678-87. doi: 10.7326/m19-3889..
Keywords: Dementia, Neurological Disorders, Diagnostic Safety and Quality, Elderly, Evidence-Based Practice, Patient-Centered Outcomes Research
Reynolds EL, JF JF, Banerjee M
Association of out-of-pocket costs on adherence to common neurologic medications.
The objective of this training was to determine the association between out-of-pocket costs and medication adherence in 3 common neurologic diseases. The investigators concluded that higher out-of-pocket costs were associated with lower medication adherence in 3 common neurologic conditions. The investigators also observed racial/ethnic disparities and recommended that minority populations receive additional focus in future intervention efforts to improve adherence.
AHRQ-funded; HS017690; HS022258.
Citation: Reynolds EL, JF JF, Banerjee M .
Association of out-of-pocket costs on adherence to common neurologic medications.
Neurology 2020 Mar 31;94(13):e1415-e26. doi: 10.1212/wnl.0000000000009039..
Keywords: Medication, Healthcare Costs, Patient Adherence/Compliance, Neurological Disorders, Dementia
Patnode CD, Perdue LA, Rossom RC
Screening for cognitive impairment in older adults: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to systematically review the test accuracy of cognitive screening instruments and benefits and harms of interventions to treat cognitive impairment in older adults (>/=65 years) to inform the US Preventive Services Task Force. The investigators concluded that screening instruments could adequately detect cognitive impairment. They indicated that there was no empirical evidence, however, that screening for cognitive impairment improved patient or caregiver outcomes or causes harm.
AHRQ-funded; 290201500007I.
Citation: Patnode CD, Perdue LA, Rossom RC .
Screening for cognitive impairment in older adults: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2020 Feb 25;323(8):764-85. doi: 10.1001/jama.2019.22258..
Keywords: U.S. Preventive Services Task Force (USPSTF), Dementia, Neurological Disorders, Elderly, Guidelines, Screening, Prevention, Evidence-Based Practice
Mitchell LL, Peterson CM, Rud SR
"It's like a cyber-security blanket": the utility of remote activity monitoring in family dementia care.
Technologies have emerged that aim to help older persons with Alzheimer's disease and related dementias (ADRDs) remain at home while also supporting their caregiving family members. The current study evaluated the acceptability and utility of an in-home remote activity monitoring (RAM) system for 30 family caregivers of persons with ADRD via quantitative survey data collected over a 6-month period and qualitative survey and interview data collected for up to 18 months.
AHRQ-funded; HS022836.
Citation: Mitchell LL, Peterson CM, Rud SR .
"It's like a cyber-security blanket": the utility of remote activity monitoring in family dementia care.
J Appl Gerontol 2020 Jan;39(1):86-98. doi: 10.1177/0733464818760238..
Keywords: Elderly, Dementia, Caregiving, Telehealth, Health Information Technology (HIT)
Barnes DE, Zhou J, Walker RL
Development and validation of eRADAR: a tool using EHR Data to detect unrecognized dementia.
The goal of this retrospective cohort study was to develop and validate an electronic health record (EHR)-based tool to help detect patients with unrecognized dementia. The tool was named EHR Risk of Alzheimer’s and Dementia Assessment Rule (eRADAR). This study was conducted at Kaiser Permanente Washington (KPWA) using participants in the Adult Changes in Thought (ACT) study who undergo comprehensive testing every 2 years to detect and diagnose dementia and have linked KPWA EHR data. Overall, 1015 ACT visits resulted in a diagnosis of incident dementia, of which 49% were previously unrecognized in the EHR. The final 31-predictor model included markers of dementia-related symptoms, healthcare utilization patterns, and dementia risk factors. The study showed good discrimination in the development interval and validation samples.
AHRQ-funded; HS022982.
Citation: Barnes DE, Zhou J, Walker RL .
Development and validation of eRADAR: a tool using EHR Data to detect unrecognized dementia.
J Am Geriatr Soc 2020 Jan;68(1):103-11. doi: 10.1111/jgs.16182..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Dementia, Neurological Disorders, Diagnostic Safety and Quality, Clinical Decision Support (CDS), Shared Decision Making
Hao Z, Ruggiano N
Family-centeredness in dementia care: what is the evidence?
In this systematic review, the authors identified and evaluated intervention studies examining family-centered care in Alzheimer’s disease and related dementias. They discussed further implications for research and practice.
AHRQ-funded; HS026571.
Citation: Hao Z, Ruggiano N .
Family-centeredness in dementia care: what is the evidence?
Soc Work Health Care 2020 Jan;59(1):1-19. doi: 10.1080/00981389.2019.1690089..
Keywords: Dementia, Neurological Disorders, Evidence-Based Practice, Patient-Centered Healthcare, Caregiving