National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (4)
- Adverse Events (2)
- Behavioral Health (1)
- Blood Pressure (1)
- Comparative Effectiveness (2)
- (-) Dementia (21)
- Diabetes (1)
- Education: Continuing Medical Education (1)
- Elderly (16)
- Evidence-Based Practice (2)
- Falls (1)
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- Medicare (1)
- (-) Medication (21)
- Medication: Safety (1)
- Mortality (2)
- Neurological Disorders (8)
- Nursing Homes (9)
- Opioids (1)
- Outcomes (1)
- Patient-Centered Outcomes Research (2)
- Patient Adherence/Compliance (2)
- Patient and Family Engagement (1)
- Patient Safety (1)
- Prevention (1)
- Public Reporting (1)
- Quality Improvement (1)
- Quality of Care (1)
- Risk (1)
- Shared Decision Making (2)
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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 21 of 21 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
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
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
Rosenthal M, Poling J, Wec A
"Medication is just one piece of the whole puzzle": how nursing homes change their use of antipsychotic medications.
This article investigated health professionals’ experiences with decision-making during changes under the National Partnership to Improve Dementia Care in Nursing Homes and its companion coalitions. These programs were introduced in 2012 for the purpose of encouraging reductions in antipsychotic use and increasing use of nonpharmacological treatments for dementia. Interviews were conducted with 40 nursing home physicians and staff in seven states. The authors found that reducing antipsychotics is more time and resource-intensive than relying on medication. However, respondents supported reductions in antipsychotic use. They indicated that with supported staffing, effective communications, and training, they could create or implement individualized treatments.
AHRQ-funded; HS023464.
Citation: Rosenthal M, Poling J, Wec A .
"Medication is just one piece of the whole puzzle": how nursing homes change their use of antipsychotic medications.
J Appl Gerontol 2022 Jan;41(1):62-72. doi: 10.1177/0733464820958919..
Keywords: Elderly, Medication, Nursing Homes, Dementia, Neurological Disorders, Long-Term Care, Shared Decision Making
Abrahamson K, Davila H, Kirk L
Can a nursing home psychotropic reduction project be successfully implemented in assisted living?
This study’s objective was to compare implementation of a psychotropic medication reduction project across nursing homes (NH) and assisted living (AL) facilities. Fifteen NHs and 14 AL facilities within a single corporate chain participated. In-person and telephone interviews with 62 staff members from participating NH and AL facilities were conducted to investigate project implementation experience. Implementation at nursing homes made more dramatic changes in residents’ lives and medication use than at assisted living facilities. AL staff identified numerous barriers to implementation.
AHRQ-funded; HS018464.
Citation: Abrahamson K, Davila H, Kirk L .
Can a nursing home psychotropic reduction project be successfully implemented in assisted living?
J Appl Gerontol 2021 Sep;40(9):1071-79. doi: 10.1177/0733464820948328..
Keywords: Elderly, Nursing Homes, Long-Term Care, Medication, Dementia
van Dalen JW, Marcum ZA, Gray SL
Association of angiotensin II-stimulating antihypertensive use and dementia risk: post hoc analysis of the PreDIVA trial.
The purpose of this study was to assess whether angiotensin II-stimulating antihypertensives (thiazides, dihydropyridine calcium channel blockers, and angiotensin I receptor blockers) convey a lower risk of incident dementia compared to angiotensin II-inhibiting antihypertensives (angiotensin-converting enzyme inhibitors, β-blockers, and nondihydropyridine calcium channel blockers), in accordance with the "angiotensin hypothesis." The investigators concluded that users of angiotensin II-stimulating antihypertensives had lower dementia rates compared to angiotensin II-inhibiting antihypertensive users, supporting the angiotensin hypothesis.
AHRQ-funded; HS022982.
Citation: van Dalen JW, Marcum ZA, Gray SL .
Association of angiotensin II-stimulating antihypertensive use and dementia risk: post hoc analysis of the PreDIVA trial.
Neurology 2021 Jan 5;96(1):e67-e80. doi: 10.1212/wnl.0000000000010996.
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Keywords: Medication, Dementia, Blood Pressure
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, 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
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
Marcum ZA, Walker RL, Jones BL
Patterns of antihypertensive and statin adherence prior to dementia: findings from the adult changes in thought study.
Using the hypothesis that changes in medication adherence might represent an early sign of cognitive impairment, this study examined antihypertensive and statin adherence trajectories in community-dwelling older adults to compare which went on to develop dementia and which did not. Data from Adult Changes in Thought (ACT), a population-based cohort study, was analyzed; 4368 participants aged 65 years or older who had at least one follow-up visit were selected, included on the basis of whether they were prevalent users of either a statin or antihypertensive medication on the first day of follow up. Research-quality dementia diagnoses were used to identify cases. Non-dementia control visits were matched by age, sex, and study cohort that occurred at similar follow-up time as the selected case dementia onset. The authors conclude that the patterns of medication adherence that emerged may be useful to identify people with higher likelihood of developing dementia.
AHRQ-funded; HS022982.
Citation: Marcum ZA, Walker RL, Jones BL .
Patterns of antihypertensive and statin adherence prior to dementia: findings from the adult changes in thought study.
BMC Geriatr 2019 Feb 14;19(1):41. doi: 10.1186/s12877-019-1058-6..
Keywords: Dementia, Elderly, Medication, Neurological Disorders, Patient Adherence/Compliance
Carnahan RM, Daly JM, Minion S
A needs assessment of family physicians to inform development of educational resources on antipsychotic use in dementia.
The authors assessed the needs and preferred resources of Iowa physicians to inform the development of educational resources for best practice dementia care and compared the responses of nursing home medical directors with nonmedical directors. They found that medical directors and nonmedical directors had similar preferences for resources used and information needs, with preference for online resources, pocket guides, a handbook, consulting pharmacists, and facility in-services being the most commonly preferred sources of new information. Medical directors were significantly more aware of the FDA warning on antipsychotic use in dementia and treated more nursing home patients. No differences were observed between groups related to confidence in and use of nondrug strategies instead of antipsychotics to manage behavioral symptoms of dementia.
AHRQ-funded; HS019355.
Citation: Carnahan RM, Daly JM, Minion S .
A needs assessment of family physicians to inform development of educational resources on antipsychotic use in dementia.
J Prim Care Community Health 2019 Jan-Dec;10:2150132719840113. doi: 10.1177/2150132719840113..
Keywords: Education: Continuing Medical Education, Medication, Dementia, Neurological Disorders, Elderly, Evidence-Based Practice, Guidelines, Long-Term Care
Fink HA, Jutkowitz E, McCarten JR
Pharmacologic interventions to prevent cognitive decline, mild cognitive impairment, and clinical Alzheimer-type dementia: a systematic review.
This review summarized current evidence on the efficacy and harms of pharmacologic interventions to prevent or delay cognitive decline, mild cognitive impairment (MCI), or dementia in adults with normal cognition or MCI. It concluded that evidence does not support use of the studied pharmacologic treatments for cognitive protection in persons with normal cognition or MCI.
AHRQ-funded; 290201500008I.
Citation: Fink HA, Jutkowitz E, McCarten JR .
Pharmacologic interventions to prevent cognitive decline, mild cognitive impairment, and clinical Alzheimer-type dementia: a systematic review.
Ann Intern Med 2018 Jan 2;168(1):39-51. doi: 10.7326/m17-1529.
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Keywords: Comparative Effectiveness, Dementia, Medication, Patient-Centered Outcomes Research, Prevention
Sarkar U, Lyles C, Steinman M
Changes in medication use after dementia diagnosis in an observational cohort of individuals with diabetes mellitus.
The researchers assessed changes in medication use after a diagnosis of dementia in individuals with type 2 diabetes mellitus. After adjustment, the number of chronic medications and the subset of cardiovascular medications declined after a dementia diagnosis in the overall cohort and in age-, sex-, and time-matched reference individuals, but the decline was significantly greater in the group with dementia.
AHRQ-funded; HS023558.
Citation: Sarkar U, Lyles C, Steinman M .
Changes in medication use after dementia diagnosis in an observational cohort of individuals with diabetes mellitus.
J Am Geriatr Soc 2017 Jan;65(1):77-82. doi: 10.1111/jgs.14429.
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Keywords: Medication, Diabetes, Dementia, Elderly, Healthcare Utilization
Tjia J, Lemay CA, Bonner A
Informed family member involvement to improve the quality of dementia care in nursing homes.
Researchers described the extent to which nursing homes engaged families in antipsychotic initiation decisions in the year before surveyor guidance revisions were implemented. Under existing federal regulations but before guidance revisions were implemented in 2013, more than 40 percent of families reported being involved in nonpharmacological behavior management of family members, but fewer than one in four reported being involved throughout the entire antipsychotic prescribing process.
AHRQ-funded; HS019351.
Citation: Tjia J, Lemay CA, Bonner A .
Informed family member involvement to improve the quality of dementia care in nursing homes.
J Am Geriatr Soc 2017 Jan;65(1):59-65. doi: 10.1111/jgs.14299.
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Keywords: Shared Decision Making, Dementia, Medication, Nursing Homes, Patient and Family Engagement
Chatterjee S, Bali V, Carnahan RM
Anticholinergic medication use and risk of dementia among elderly nursing home residents with depression.
The purpose of this study was to examine the risk of dementia with anticholinergic use among elderly nursing home residents with depression. The study concluded that use of clinically significant anticholinergic medications was associated with a 26% increase in risk of dementia among elderly nursing home residents with depression. With increasing safety concerns, there is a significant need to optimize anticholinergic use, especially for those who are at risk for dementia.
AHRQ-funded; HS021264.
Citation: Chatterjee S, Bali V, Carnahan RM .
Anticholinergic medication use and risk of dementia among elderly nursing home residents with depression.
Am J Geriatr Psychiatry 2016 Jun;24(6):485-95. doi: 10.1016/j.jagp.2015.12.011..
Keywords: Adverse Drug Events (ADE), Dementia, Elderly, Medication, Nursing Homes
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
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
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
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
Konetzka RT, Brauner DJ, Shega J
The effects of public reporting on physical restraints and antipsychotic use in nursing home residents with severe cognitive impairment.
The purpose of this paper was to assess whether reductions in physical restraint use associated with quality reporting may have had the unintended consequence of increasing antipsychotic use in nursing home (NH) residents with severe cognitive impairment. Physical restraint use declined significantly from 1999 to 2008 in NH residents with severe cognitive impairment. Correspondingly, antipsychotic use in the same residents increased more in NHs that were subject to public reporting. This analysis suggests that public reporting of physical restraint use had the unintended consequence of increasing use of antipsychotics in NH residents with severe cognitive impairment.
AHRQ-funded; HS018718.
Citation: Konetzka RT, Brauner DJ, Shega J .
The effects of public reporting on physical restraints and antipsychotic use in nursing home residents with severe cognitive impairment.
J Am Geriatr Soc 2014 Mar;62(3):454-61. doi: 10.1111/jgs.12711.
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Keywords: Dementia, Elderly, Medication, Nursing Homes, Public Reporting