National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (2)
- Adverse Events (1)
- Behavioral Health (1)
- Caregiving (3)
- Comparative Effectiveness (1)
- COVID-19 (1)
- Cultural Competence (1)
- (-) Dementia (18)
- Diagnostic Safety and Quality (1)
- Education: Patient and Caregiver (1)
- Elderly (10)
- Electronic Health Records (EHRs) (1)
- Falls (1)
- Health Information Technology (HIT) (2)
- Hospital Discharge (1)
- Hospitalization (2)
- Injuries and Wounds (1)
- Long-Term Care (3)
- Medicare (1)
- Medication (8)
- Medication: Safety (1)
- Mortality (1)
- Neurological Disorders (7)
- Nursing (1)
- Nursing Homes (6)
- Opioids (1)
- Patient Safety (1)
- Primary Care (1)
- Quality Measures (1)
- Racial and Ethnic Minorities (4)
- Risk (1)
- Telehealth (1)
- Vitamins and Supplements (1)
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 18 of 18 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
Bali V, Chatterjee S, Carnahan RM
Risk of dementia among elderly nursing home patients using paroxetine and other selective serotonin reuptake inhibitors.
This study evaluated the comparative risk of dementia associated with use of paroxetine and other selective serotonin reuptake inhibitors (SSRIs) among elderly nursing home patients. It found that compared with use of other SSRIs, use of paroxetine was not associated with higher risk of dementia among elderly nursing home patients with depression.
AHRQ-funded; HS021264.
Citation: Bali V, Chatterjee S, Carnahan RM .
Risk of dementia among elderly nursing home patients using paroxetine and other selective serotonin reuptake inhibitors.
Psychiatr Serv 2015 Dec;66(12):1333-40. doi: 10.1176/appi.ps.201500011.
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Keywords: Adverse Drug Events (ADE), Dementia, Elderly, Nursing Homes, Medication
Konetzka RT, Brauner DJ, Coca Perraillon M
The role of severe dementia in nursing home report cards.
This article examined the intended and unintended effects of quality reporting for nursing home residents with severe dementia relative to other residents, using a difference-in-differences design to examine selected reported and unreported quality measures. The results indicate that prior to public reporting, nursing home residents with severe dementia were at significantly higher risk of poor outcomes on most reported quality measures.
AHRQ-funded; HS018718.
Citation: Konetzka RT, Brauner DJ, Coca Perraillon M .
The role of severe dementia in nursing home report cards.
Med Care Res Rev 2015 Oct;72(5):562-79. doi: 10.1177/1077558715588436.
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Keywords: Dementia, Nursing Homes, Long-Term Care, Quality Measures
Gerhard T, Devanand DP, Huang C
Lithium treatment and risk for dementia in adults with bipolar disorder: population-based cohort study.
This study examined the association of lithium and dementia risk in a large claims-based US cohort of publicly insured older adults with bipolar disorder. It found that compared with non-use, 301–365 days of lithium exposure was associated with significantly reduced dementia risk. No corresponding association was observed for shorter lithium exposures.
AHRQ-funded; HS021112.
Citation: Gerhard T, Devanand DP, Huang C .
Lithium treatment and risk for dementia in adults with bipolar disorder: population-based cohort study.
Br J Psychiatry 2015 Jul;207(1):46-51. doi: 10.1192/bjp.bp.114.154047..
Keywords: Dementia, Risk, Behavioral Health, Medication
Daly JM, Bay CP, Levy BT
Caring for people with dementia and challenging behaviors in nursing homes: a needs assessment geriatric nursing.
The authors conducted a needs assessment of directors of nursing (DON) in Iowa nursing homes in relation to caring for patients with Behavioral and Psychological Symptoms of Dementia. They found that facilities with a larger proportion of patients with challenging behaviors being treated with non-drug approaches instead of antipsychotics had DONs who were more likely to be confident in non-drug management strategies and have knowledge about the FDA antipsychotic medications risks.
AHRQ-funded; HS019355.
Citation: Daly JM, Bay CP, Levy BT .
Caring for people with dementia and challenging behaviors in nursing homes: a needs assessment geriatric nursing.
Geriatr Nurs 2015 May-Jun;36(3):182-91. doi: 10.1016/j.gerinurse.2015.01.001.
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Keywords: Elderly, Dementia, Nursing Homes, Long-Term Care, Nursing
Park Y, Franklin JM, Schneeweiss S
Antipsychotics and mortality: adjusting for mortality risk scores to address confounding by terminal illness.
The researchers sought to determine whether adjustment for prognostic indices specifically developed for nursing home populations affect the magnitude of previously observed associations between mortality and conventional and atypical antipsychotics. They concluded that although causality cannot be proven based on nonrandomized studies, this study adds to the body of evidence rejecting explanations other than causality for the greater mortality risk associated with conventional antipsychotics than with atypical antipsychotics.
AHRQ-funded; HS017918; HS02112.
Citation: Park Y, Franklin JM, Schneeweiss S .
Antipsychotics and mortality: adjusting for mortality risk scores to address confounding by terminal illness.
J Am Geriatr Soc 2015 Mar;63(3):516-23. doi: 10.1111/jgs.13326..
Keywords: Nursing Homes, Mortality, Medication, Elderly, Dementia
Daiello LA, Gongvatana A, Dunsiger S
Association of fish oil supplement use with preservation of brain volume and cognitive function.
The aim of this study was to investigate whether the use of fish oil supplements (FOSs) is associated with concomitant reduction in cognitive decline and brain atrophy in older adults. It found that FOS use during follow-up was associated with significantly lower mean cognitive subscale of the Alzheimer’s Disease Assessment Scale and higher Mini-Mental State Examination scores among those with normal cognition.
AHRQ-funded; HS017735.
Citation: Daiello LA, Gongvatana A, Dunsiger S .
Association of fish oil supplement use with preservation of brain volume and cognitive function.
Alzheimers Dement 2015 Feb;11(2):226-35. doi: 10.1016/j.jalz.2014.02.005..
Keywords: Dementia, Elderly, Vitamins and Supplements
Campbell NL, Skaar TC, Perkins AJ
Characterization of hepatic enzyme activity in older adults with dementia: potential impact on personalizing pharmacotherapy.
The purpose of this study was to determine the frequency of pharmacogenomic variants and concurrent medications that may alter the efficacy and tolerability of acetylcholinesterase inhibitors (AChEIs). Its results indicate that both pharmacogenomic variants and concomitant medications may affect the pharmacokinetics and ultimately the efficacy and tolerability of Alzheimer’s disease medications.
AHRQ-funded; HS019818.
Citation: Campbell NL, Skaar TC, Perkins AJ .
Characterization of hepatic enzyme activity in older adults with dementia: potential impact on personalizing pharmacotherapy.
Clin Interv Aging 2015 Jan 14;10:269-75. doi: 10.2147/cia.s65980..
Keywords: Elderly, Dementia, Comparative Effectiveness, Medication
Aspinall SL, Zhao X, Semia TP
Epidemiology of drug-disease interactions in older veteran nursing home residents.
The objective of this study was to assess the prevalence of and factors associated with potentially inappropriate drug– disease combinations according to the AGS 2012 Beers criteria that are clinically important in elderly adults residing in Veterans Affairs Community Living Centers. It found that drug-disease interactions were common in older residents with dementia or cognitive impairment or a history of falls or hip fracture.
AHRQ-funded; HS018721.
Citation: Aspinall SL, Zhao X, Semia TP .
Epidemiology of drug-disease interactions in older veteran nursing home residents.
J Am Geriatr Soc 2015 Jan;63(1):77-84. doi: 10.1111/jgs.13197..
Keywords: Adverse Drug Events (ADE), Adverse Events, Dementia, Elderly, Falls, Injuries and Wounds, Medication, Medication: Safety, Neurological Disorders, Nursing Homes, Patient Safety
Sentell TL, Valcour N, Ahn HJ
High rates of Native Hawaiian and older Japanese adults hospitalized with dementia in Hawaii.
This study compared rates of inpatients with a dementia diagnosis for disaggregated Asian and Pacific Islanders (Native Hawaiian, Chinese, Japanese, Filipino) with those of whites according to age for all adults hospitalized in Hawaii; Native Hawaiians with dementia were significantly more likely to be hospitalized and to be hospitalized at younger ages than individuals of other races and ethnicities.
AHRQ-funded; HS019990.
Citation: Sentell TL, Valcour N, Ahn HJ .
High rates of Native Hawaiian and older Japanese adults hospitalized with dementia in Hawaii.
J Am Geriatr Soc 2015 Jan;63(1):158-64. doi: 10.1111/jgs.13182..
Keywords: Dementia, Racial and Ethnic Minorities, Hospitalization