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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 24 of 24 Research Studies DisplayedArmstrong MJ, Gamez N, Alliance S
Clinical care and unmet needs of individuals with dementia with Lewy bodies and caregivers: an interview study.
Investigators researched the clinical care preferences of individuals living with dementia and caregivers, particularly dementia with Lewy bodies (DLB). Twenty individuals with DLB and 25 caregivers were interviewed via a semistructured questionnaire. The investigators concluded that improving care for individuals with DLB and their families will require a multipronged strategy including education for non-specialist care providers, increasing specialty care access, improved clinical care services, research to support disease prognosis and treatment decisions, and local and national strategies for enhanced caregiver support.
Citation: Armstrong MJ, Gamez N, Alliance S .
Clinical care and unmet needs of individuals with dementia with Lewy bodies and caregivers: an interview study.
Alzheimer Dis Assoc Disord 2021 Oct-Dec;35(4):327-34. doi: 10.1097/wad.0000000000000459..
Keywords: Dementia, Caregiving, Chronic Conditions, Neurological Disorders, Patient Experience
Ma C, McDonald MV, Feldman PH
Continuity of nursing care in home health: impact on rehospitalization among older adults with dementia.
The objective of this retrospective cohort study was to examine the association between continuity of nursing care in home health care (HHC) and rehospitalization among persons with dementia (PWD). Multiple years of HHC assessment, administrative, and human resources data from a large urban not-for-profit home health agency was used. Findings showed that wide variations exist in continuity of nursing care to PWD. Consistency in nurse staff when providing HHC visits to PWD is critical for preventing rehospitalizations.
AHRQ-funded; HS023593.
Citation: Ma C, McDonald MV, Feldman PH .
Continuity of nursing care in home health: impact on rehospitalization among older adults with dementia.
Med Care 2021 Oct;59(10):913-20. doi: 10.1097/mlr.0000000000001599..
Keywords: Elderly, Home Healthcare, Dementia, Neurological Disorders, Hospital Readmissions
Hua CL, Thomas KS, Bunker J
Changes in the agreement between the Minimum Data Set and hospital Medicare claims measures of dementia.
The objective of this study was to examine the agreement between a clinical Minimum Data Set measure of dementia and a diagnosis of dementia documented on a hospital claim across three points in time. A second objective was to examine the extent to which the agreement varied by age, sex, and race/ethnicity. Findings showed that hospital claims for patients aged 66–75 were less likely to be accurate than those for other age groups and suggests that physicians do not always look for signs of dementia in younger adults. Additionally, Asian patients were less likely to have a diagnosis of dementia documented during hospitalization, which could be related to language barriers between patients and clinicians.
AHRQ-funded; HS000011.
Citation: Hua CL, Thomas KS, Bunker J .
Changes in the agreement between the Minimum Data Set and hospital Medicare claims measures of dementia.
J Am Geriatr Soc 2021 Sep;69(9):2672-75. doi: 10.1111/jgs.17201..
Keywords: Elderly, Dementia, Neurological Disorders, Diagnostic Safety and Quality, Medicare
Shepard V, Chou LN, Kuo YF, et al.
Characteristics associated with feeding tube placement: retrospective cohort study of Texas nursing home residents with advanced dementia.
The purpose of this retrospective cohort study was to investigate resident-level, provider-type, nursing home (NH), and regional factors associated with feeding tube (FT) placement in advanced dementia. The investigators concluded that regional, race, and ethnic variations in prevalence of FT use among NH residents suggested opportunities for clinicians and policy makers to improve the quality of end-of-life care by especially considering other palliative care measures for minorities living in border towns.
AHRQ-funded; HS020642.
Citation: Shepard V, Chou LN, Kuo YF, et al..
Characteristics associated with feeding tube placement: retrospective cohort study of Texas nursing home residents with advanced dementia.
J Am Med Dir Assoc 2021 Jul;22(7):1471-76.e4. doi: 10.1016/j.jamda.2020.10.033..
Keywords: Elderly, Nursing Homes, Long-Term Care, Dementia, Neurological Disorders
Armstrong Armstrong, Irwin DJ, Leverenz JB
Biomarker use for dementia with Lewy body diagnosis: survey of US experts.
Researchers investigated clinical practice patterns of dementia with Lewy body (DLB) diagnostic criteria. An anonymous survey was sent to 38 center of excellence investigators inquiring about clinical use of diagnostic tests/biomarkers. They found that neuropsychological testing and MRI remained the most widely used diagnostic tests by DLB specialists. Other tests, particularly, indicative biomarkers, are used only selectively. They recommended research to validate existing potential DLB biomarkers, to develop new biomarkers, and to investigate mechanisms to improve DLB diagnosis.
Citation: Armstrong Armstrong, Irwin DJ, Leverenz JB .
Biomarker use for dementia with Lewy body diagnosis: survey of US experts.
Alzheimer Dis Assoc Disord 2021 Jan-Mar;35(1):55-61. doi: 10.1097/wad.0000000000000414..
Keywords: Dementia, Neurological Disorders, Diagnostic Safety and Quality
Zmora R, Zmora LL, Bustamante G
Dementia caregivers' experiences and reactions to remote activity monitoring system alerts.
Technology-based tools, including remote activity monitoring (RAM) systems, have been proposed as valuable aids for family caregivers of people with dementia. Previous analyses have shown limited effects of these systems and highlighted a number of barriers, including false alarms. In this study, the investigators used data from an ongoing embedded mixed method randomized controlled intervention to describe patterns of alerts and their association with receipt of the RAM system and caregiver outcomes.
AHRQ-funded; HS022836.
Citation: Zmora R, Zmora LL, Bustamante G .
Dementia caregivers' experiences and reactions to remote activity monitoring system alerts.
J Gerontol Nurs 2021 Jan;47(1):13-20. doi: 10.3928/00989134-20201208-03.
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Keywords: Elderly, Dementia, Neurological Disorders, Caregiving, Telehealth
McCreedy E, Ogarek JA, Thomas KS
The minimum data set agitated and reactive behavior scale: measuring behaviors in nursing home residents with dementia.
Researchers in this study test the internal consistency and construct validity of the Agitated and Reactive Behavior Scale (ARBS), a measure created to measure agitated and aggressive behaviors in dementia residents at nursing homes (NHs). This cross-sectional study used data from the 2016 national sample of 15,326 Centers for Medicare and Medicaid Services-certified NHs. The sample included 489,854 new admissions and 765,367 long-stay residents (defined as 90 days or more) all diagnosed with dementia. The ARBS is a composite measure of physical and verbal agitation or aggressiveness towards other people; other behavioral symptoms not directed at other people; and rejection of care. The study found that 1) the ARBS score has borderline-adequate internal consistency in the national population of NH residents with dementia; 2) only 18% of new admissions, and 21% of long-stay residents with dementia displayed any aggressive or agitated behaviors in the previous week; and 3) the ARBS demonstrated good construct validity. Conclusions were that nationally available MDS data may significantly underestimate the prevalence of agitated and aggressive behaviors among NH dementia patients.
AHRQ-funded; HS000011.
Citation: McCreedy E, Ogarek JA, Thomas KS .
The minimum data set agitated and reactive behavior scale: measuring behaviors in nursing home residents with dementia.
J Am Med Dir Assoc 2019 Dec;20(12):1548-52. doi: 10.1016/j.jamda.2019.08.030..
Keywords: Elderly, Dementia, Neurological Disorders, Nursing Homes, Long-Term Care, Behavioral Health
Possin KL, Merrilees JJ, Dulaney S
Effect of collaborative dementia care via telephone and internet on quality of life, caregiver well-being, and health care use: the Care Ecosystem randomized clinical trial.
Few health systems have adopted effective dementia care management programs. The Care Ecosystem is a model for delivering care from centralized hubs across broad geographic areas to caregivers and persons with dementia (PWDs) independently of their health system affiliations. The purpose of this study was to determine whether the Care Ecosystem was effective in improving outcomes important to PWDs, their caregivers, and payers beyond those achieved with usual care.
AHRQ-funded; HS022241.
Citation: Possin KL, Merrilees JJ, Dulaney S .
Effect of collaborative dementia care via telephone and internet on quality of life, caregiver well-being, and health care use: the Care Ecosystem randomized clinical trial.
JAMA Intern Med 2019 Sep 30;179(12):1658-67. doi: 10.1001/jamainternmed.2019.4101..
Keywords: Dementia, Neurological Disorders, Telehealth, Health Information Technology (HIT), Care Management, Healthcare Delivery, Caregiving, Quality of Life
Bernstein A, Rogers KM, Possin KL
Primary care provider attitudes and practices evaluating and managing patients with neurocognitive disorders.
The prevalence of dementia, a neurocognitive disorder (NCD), is expected to triple in the next 30 years. In this study, the investigators surveyed a national sample of primary care physicians to characterize their attitudes and practices with respect to the evaluation and management of NCDs.
AHRQ-funded; HS022241.
Citation: Bernstein A, Rogers KM, Possin KL .
Primary care provider attitudes and practices evaluating and managing patients with neurocognitive disorders.
J Gen Intern Med 2019 Sep;34(9):1691-92. doi: 10.1007/s11606-019-05013-7..
Keywords: Dementia, Neurological Disorders, Provider: Physician, Provider: Clinician, Provider, Primary Care
Gillespie SM, Wasserman EB, Wood NE
High-intensity telemedicine reduces emergency department use by older adults with dementia in senior living communities.
Individuals with dementia have high rates of emergency department (ED) use for acute illnesses. In this study, the investigators evaluated the effect of a high-intensity telemedicine program that delivered care for acute illnesses on ED use rates for individuals with dementia residing in senior living communities (SLCs; independent and assisted living).
AHRQ-funded; HS018047.
Citation: Gillespie SM, Wasserman EB, Wood NE .
High-intensity telemedicine reduces emergency department use by older adults with dementia in senior living communities.
J Am Med Dir Assoc 2019 Aug;20(8):942-46. doi: 10.1016/j.jamda.2019.03.024..
Keywords: Elderly, Telehealth, Health Information Technology (HIT), Dementia, Neurological Disorders, Healthcare Delivery, Chronic Conditions, Emergency Department, Healthcare Utilization
Spears CC, Besharat A, Monari EH
Causes and outcomes of hospitalization in Lewy body dementia: a retrospective cohort study.
Understanding hospitalization in Lewy body dementia (LBD) is a known knowledge gap. In this study, the authors aimed to identify common causes, medication profiles, complications, and outcomes of hospitalization in LBD. The investigators concluded that the most common reasons for hospitalization in LBD are potentially modifiable. They indicated that opportunities for improved care include increased involvement of neurological and psychiatric services, delirium prevention strategies, and reduced antipsychotic use.
AHRQ-funded; HS024159.
Citation: Spears CC, Besharat A, Monari EH .
Causes and outcomes of hospitalization in Lewy body dementia: a retrospective cohort study.
Parkinsonism Relat Disord 2019 Jul;64:106-11. doi: 10.1016/j.parkreldis.2019.03.014..
Keywords: Dementia, Neurological Disorders, Hospitalization
Armstrong MJ, Gronseth GS, Day GS
Patient stakeholder versus physician preferences regarding amyloid PET testing.
Patient and caregiver perspectives on amyloid positron emission tomography (PET) use are largely unexplored, particularly as compared with clinician views. In this study, the investigators surveyed clinicians, patients, caregivers, and dementia advocates on topics relating to an evidence-based guideline on amyloid PET use. They found that patients and caregivers emphasized the importance of having a dementia diagnosis and placed more value on testing and outcomes for asymptomatic populations than clinicians.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Gronseth GS, Day GS .
Patient stakeholder versus physician preferences regarding amyloid PET testing.
Alzheimer Dis Assoc Disord 2019 Jul-Sep;33(3):246-53. doi: 10.1097/wad.0000000000000311..
Keywords: Decision Making, Dementia, Diagnostic Safety and Quality, Evidence-Based Practice, Guidelines, Imaging, Neurological Disorders, Patient-Centered Outcomes Research, Provider, Provider: Physician
Schiltz NK, Warner DF, Sun J
The influence of multimorbidity on leading causes of death in older adults with cognitive impairment.
The aim of this study was to evaluate the relationship of leading causes of death with gradients of cognitive impairment and multimorbidity. The authors found that multimorbidity was common in the study population. Heart disease was the leading cause in all groups, but with a larger percentage of deaths in the mild and moderate/severe cognitively impaired groups than among the noncognitively impaired. The different "paths" down the regression trees showed that the distribution of causes of death changed with different combinations of multimorbidity.
AHRQ-funded; HS023113.
Citation: Schiltz NK, Warner DF, Sun J .
The influence of multimorbidity on leading causes of death in older adults with cognitive impairment.
J Aging Health 2019 Jul;31(6):1025-42. doi: 10.1177/0898264317751946..
Keywords: Elderly, Dementia, Neurological Disorders, Chronic Conditions, Mortality
Armstrong MJ, Alliance S, Taylor A
End-of-life experiences in dementia with Lewy bodies: qualitative interviews with former caregivers.
This study examined the knowledge of former caregivers of patients with dementia with Lewy bodies (DLB) and the patients’ end of life (EOL) experiences. Telephone interviews were conducted with a total of 30 caregivers and family members of individuals who died with DLB in the last 5 years. The interviews revealed a lack of knowledge regarding what to expect, EOL time course, advance care planning, medications at the end of life, approaching end of life, and the death experience itself.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Alliance S, Taylor A .
End-of-life experiences in dementia with Lewy bodies: qualitative interviews with former caregivers.
PLoS One 2019 May 30;14(5):e0217039. doi: 10.1371/journal.pone.0217039..
Keywords: Palliative Care, Dementia, Neurological Disorders, Caregiving
Albrecht JS, Hanna M, Randall RL
An algorithm to characterize a dementia population by disease subtype.
The purpose of this study was to develop a method of categorizing Alzheimer disease and related dementias (ADRD) cases by subtype and to characterize and compare subtype populations by demographic and other characteristics. Cases of ADRD occurring 2008 to 2014 were identified from the OptumLabs Database a categorization algorithm using temporal sequencing of diagnoses and provider type developed. The algorithm identified six dementia subtypes as well as three additional categories that represent unique diagnostic patterns in the data. The authors conclude that the differences and similarities between these groups provide support for their algorithmic approach and offer a unique insight into ADRD subtype characteristics.
AHRQ-funded; HS024560.
Citation: Albrecht JS, Hanna M, Randall RL .
An algorithm to characterize a dementia population by disease subtype.
An algorithm to characterize a dementia population by disease subtype..
Keywords: Dementia, Neurological Disorders
Hong M, Casado BL, Lee SE
The intention to discuss advance care planning in the context of Alzheimer's disease among Korean Americans.
The authors examined the intention to discuss advance care planning (ACP) for a family member with Alzheimer's disease among Korean Americans. Path analyses were conducted on a cross-sectional convenience sample; age, gender, education, and knowledge about Alzheimer's disease and ACP were included as covariates. From their findings, the authors recommended promoting ACP among this population and designing educational interventions to address positive attitudes and subjective norms toward ACP.
AHRQ-funded; HS022947.
Citation: Hong M, Casado BL, Lee SE .
The intention to discuss advance care planning in the context of Alzheimer's disease among Korean Americans.
Gerontologist 2019 Mar 14;59(2):347-55. doi: 10.1093/geront/gnx211..
Keywords: Elderly, Dementia, Neurological Disorders, Decision Making, Racial and Ethnic Minorities
Simon KC, Yucus C, Castle J
Building of EMR tools to support quality and research in a memory disorders clinic.
This article describes the development of a customized EMR toolkit that standardizes patient data collection with hundreds of discrete fields, supports Best Practices for treating patients with memory disorders, and also supports practice-based research. The toolkit was successfully implemented to support Best Practices in the care of patients with memory disorders. Applications are also discussed. Data collection is ongoing, but the authors anticipate that the toolkit will generate data that allows for descriptive and hypothesis-driven research as well as quality improvement among patients seen in memory clinics.
AHRQ-funded; HS024057.
Citation: Simon KC, Yucus C, Castle J .
Building of EMR tools to support quality and research in a memory disorders clinic.
Front Neurol 2019 Mar 7;10:161. doi: 10.3389/fneur.2019.00161..
Keywords: Dementia, Electronic Health Records (EHRs), Health Information Technology (HIT), Neurological Disorders, Quality of Care, Quality Improvement, Tools & Toolkits
Marcum ZA, Hohl SD, Gray SL
Brain health and dementia prevention: a mixed-method analysis.
This study examined perceptions on the ability to prevent Alzheimer’s disease and related dementias (ADRD) by improving brain health. A web-based survey was conducted on a sample 1661 patients in Washington State from February-March 2018. Most respondents were female, aged 51-70, and white. Most agreed that it may be possible to improve brain health to reduce ADRD risk, one-third lacked confidence that they could take personal action to reduce the risk.
AHRQ-funded; HS022982.
Citation: Marcum ZA, Hohl SD, Gray SL .
Brain health and dementia prevention: a mixed-method analysis.
Am J Health Behav 2019 Mar 1;43(2):300-10. doi: 10.5993/ajhb.43.2.7..
Keywords: Dementia, Neurological Disorders, Prevention
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
Sterling MR, Jannat-Khah D, Bryan J
The prevalence of cognitive impairment among adults with incident heart failure: the "Reasons for Geographic and Racial Differences in Stroke" (REGARDS) study.
The REGARDS study determined the prevalence of cognitive impairment (CI) among adults aged 45 and older with incident heart failure (HF) in order to improve understanding of cognition in HF. Cognitive function was assessed using the Six-Item Screener, and the prevalence of CI among those with incident HF was compared with the prevalence of CI among a matching cohort without HF. The study results indicated that 14.9 percent of the adults with incident HF had CI, suggesting that the majority of cognitive decline occurs after HF diagnosis. The authors suggest that increased awareness of CI among newly diagnosed patients and ways to mitigate it in the context of HF management are warranted.
AHRQ-funded; HS000066.
Citation: Sterling MR, Jannat-Khah D, Bryan J .
The prevalence of cognitive impairment among adults with incident heart failure: the "Reasons for Geographic and Racial Differences in Stroke" (REGARDS) study.
J Card Fail 2019 Feb;25(2):130-36. doi: 10.1016/j.cardfail.2018.12.006..
Keywords: Cardiovascular Conditions, Dementia, Heart Disease and Health, Neurological Disorders
Gaugler JE, Zmora R, Mitchell LL
Six-month effectiveness of remote activity monitoring for persons living with dementia and their family caregivers: an experimental mixed methods study.
This paper describes a pilot study conducted to evaluate the effectiveness of remote activity monitoring (RAM) for persons living with Alzheimer’s disease or a related dementia (ADRD) and their family caregivers. An experimental mixed methods study of 132 persons living with ADRD was conducted for six months. There were mixed results as the early months spent calibrating and modifying the RAM system was challenging for families. For families who care for ADRD patients with less severe cognitive impairment and difficulty navigating around the most there was a statistically significant increase in competence and self-sufficiency. However, it may not be as effective for patients with more severe cognitive impairment.
AHRQ-funded; HS022836.
Citation: Gaugler JE, Zmora R, Mitchell LL .
Six-month effectiveness of remote activity monitoring for persons living with dementia and their family caregivers: an experimental mixed methods study.
Gerontologist 2019 Jan 9;59(1):78-89. doi: 10.1093/geront/gny078..
Keywords: Caregiving, Dementia, Elderly, Health Information Technology (HIT), Neurological Disorders, Quality of Care, Quality Improvement
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
Armstrong MJ, Alliance S, Corsentino P
Cause of death and end-of-life experiences in individuals with dementia with Lewy bodies.
Researchers investigate the natural history, cause of death, and end-of-life experiences of individuals diagnosed with dementia with Lewy bodies (DLB). In the 20-question survey, respondents indicated that physicians rarely discussed what to expect at the end of life and that the caregiver usually initiated such conversations. Failure to thrive was the most common cause of death, followed by pneumonia and swallowing difficulties, other medical conditions, and complications from falling. The researchers conclude that the study results highlight a critical need for better prognostic counseling and education for persons and families living with DLB, and they recommended further study.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Alliance S, Corsentino P .
Cause of death and end-of-life experiences in individuals with dementia with Lewy bodies.
J Am Geriatr Soc 2019 Jan;67(1):67-73. doi: 10.1111/jgs.15608..
Keywords: Dementia, Neurological Disorders, Patient Experience, Palliative Care, Mortality, Elderly
McCarron HR, Finlay JM, Sims T
Stakeholder engagement to enhance interventions for family caregivers of people with dementia: a case study of care to plan.
This study discusses a case study that uses a community advisory board (CAB) to help interventions for family caregivers of people with dementia. The intervention used is an online dementia caregiver resource called Care to Plan. Transcripts of seven CAB meetings over a 3-year period were reviewed. They looked at: how meetings were conducted and issues that arose; and Care to Plan improvements, how CAB members provided key stakeholder perspectives that resulted in changes in language, functionality, substance and dissemination.
AHRQ-funded; HS022445.
Citation: McCarron HR, Finlay JM, Sims T .
Stakeholder engagement to enhance interventions for family caregivers of people with dementia: a case study of care to plan.
J Gerontol Soc Work 2019 Jan;62(1):29-47. doi: 10.1080/01634372.2018.1505797..
Keywords: Caregiving, Dementia, Neurological Disorders, Patient and Family Engagement