Low-value care: antipsychotic medication use among community-dwelling medicare beneficiaries with Alzheimer’s disease and related dementias and without severe mental illness

Mona Nili, Chan Shen, Usha Sambamoorthi

Research output: Contribution to journalArticle

Abstract

Background: Antipsychotic medication use among elderly with Alzheimer’s disease and related dementias (ADRD) and without severe mental illness is considered as low-value care. Our objective was to assess the factors associated with this inappropriate use of antipsychotic medications among community-dwelling Medicare beneficiaries with ADRD and without severe mental illness. Methods: This study used a retrospective cross-sectional design. Data for this study were derived from the nationally representative Medicare Current Beneficiary Survey (MCBS) and linked Medicare claims. Logistic regression models were used to examine factors associated with low-value care. Results: Overall 8.5% had low-value care. In the final adjusted logistic regression model, race other than Hispanic or Non-Hispanic White (AOR =0.54, 95% CI = [0.30,0.98]), individuals over 80 years of age (AOR =0.53, 95% CI = [0.36,0.76]), and obese individuals (AOR =0.55, 95% CI = [0.35,0.85]) had significantly lower odds of receiving low-value care. Those with depression (AOR =1.71, 95% CI = [1.21, 2.43]), who lived in the Midwest (AOR =1.7, 95% CI = [1.08,2.68]), and with a higher number of ADL limitations (AOR =1.28, 95% CI = [1.19,1.38]) had significantly higher odds of low-value care. Conclusions: There were subgroup differences in low-value care. Interventions may target these subgroups to reduce low-value care.

Original languageEnglish (US)
JournalAging and Mental Health
DOIs
StateAccepted/In press - Jan 1 2018

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Independent Living
Medicare
Antipsychotic Agents
Dementia
Alzheimer Disease
Logistic Models
Activities of Daily Living
Hispanic Americans
Depression

All Science Journal Classification (ASJC) codes

  • Phychiatric Mental Health
  • Gerontology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health

Cite this

@article{74e48dc61f4645f0a990b6deeb4e25ba,
title = "Low-value care: antipsychotic medication use among community-dwelling medicare beneficiaries with Alzheimer’s disease and related dementias and without severe mental illness",
abstract = "Background: Antipsychotic medication use among elderly with Alzheimer’s disease and related dementias (ADRD) and without severe mental illness is considered as low-value care. Our objective was to assess the factors associated with this inappropriate use of antipsychotic medications among community-dwelling Medicare beneficiaries with ADRD and without severe mental illness. Methods: This study used a retrospective cross-sectional design. Data for this study were derived from the nationally representative Medicare Current Beneficiary Survey (MCBS) and linked Medicare claims. Logistic regression models were used to examine factors associated with low-value care. Results: Overall 8.5{\%} had low-value care. In the final adjusted logistic regression model, race other than Hispanic or Non-Hispanic White (AOR =0.54, 95{\%} CI = [0.30,0.98]), individuals over 80 years of age (AOR =0.53, 95{\%} CI = [0.36,0.76]), and obese individuals (AOR =0.55, 95{\%} CI = [0.35,0.85]) had significantly lower odds of receiving low-value care. Those with depression (AOR =1.71, 95{\%} CI = [1.21, 2.43]), who lived in the Midwest (AOR =1.7, 95{\%} CI = [1.08,2.68]), and with a higher number of ADL limitations (AOR =1.28, 95{\%} CI = [1.19,1.38]) had significantly higher odds of low-value care. Conclusions: There were subgroup differences in low-value care. Interventions may target these subgroups to reduce low-value care.",
author = "Mona Nili and Chan Shen and Usha Sambamoorthi",
year = "2018",
month = "1",
day = "1",
doi = "10.1080/13607863.2018.1544211",
language = "English (US)",
journal = "Aging and Mental Health",
issn = "1360-7863",
publisher = "Taylor and Francis Ltd.",

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TY - JOUR

T1 - Low-value care

T2 - antipsychotic medication use among community-dwelling medicare beneficiaries with Alzheimer’s disease and related dementias and without severe mental illness

AU - Nili, Mona

AU - Shen, Chan

AU - Sambamoorthi, Usha

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Antipsychotic medication use among elderly with Alzheimer’s disease and related dementias (ADRD) and without severe mental illness is considered as low-value care. Our objective was to assess the factors associated with this inappropriate use of antipsychotic medications among community-dwelling Medicare beneficiaries with ADRD and without severe mental illness. Methods: This study used a retrospective cross-sectional design. Data for this study were derived from the nationally representative Medicare Current Beneficiary Survey (MCBS) and linked Medicare claims. Logistic regression models were used to examine factors associated with low-value care. Results: Overall 8.5% had low-value care. In the final adjusted logistic regression model, race other than Hispanic or Non-Hispanic White (AOR =0.54, 95% CI = [0.30,0.98]), individuals over 80 years of age (AOR =0.53, 95% CI = [0.36,0.76]), and obese individuals (AOR =0.55, 95% CI = [0.35,0.85]) had significantly lower odds of receiving low-value care. Those with depression (AOR =1.71, 95% CI = [1.21, 2.43]), who lived in the Midwest (AOR =1.7, 95% CI = [1.08,2.68]), and with a higher number of ADL limitations (AOR =1.28, 95% CI = [1.19,1.38]) had significantly higher odds of low-value care. Conclusions: There were subgroup differences in low-value care. Interventions may target these subgroups to reduce low-value care.

AB - Background: Antipsychotic medication use among elderly with Alzheimer’s disease and related dementias (ADRD) and without severe mental illness is considered as low-value care. Our objective was to assess the factors associated with this inappropriate use of antipsychotic medications among community-dwelling Medicare beneficiaries with ADRD and without severe mental illness. Methods: This study used a retrospective cross-sectional design. Data for this study were derived from the nationally representative Medicare Current Beneficiary Survey (MCBS) and linked Medicare claims. Logistic regression models were used to examine factors associated with low-value care. Results: Overall 8.5% had low-value care. In the final adjusted logistic regression model, race other than Hispanic or Non-Hispanic White (AOR =0.54, 95% CI = [0.30,0.98]), individuals over 80 years of age (AOR =0.53, 95% CI = [0.36,0.76]), and obese individuals (AOR =0.55, 95% CI = [0.35,0.85]) had significantly lower odds of receiving low-value care. Those with depression (AOR =1.71, 95% CI = [1.21, 2.43]), who lived in the Midwest (AOR =1.7, 95% CI = [1.08,2.68]), and with a higher number of ADL limitations (AOR =1.28, 95% CI = [1.19,1.38]) had significantly higher odds of low-value care. Conclusions: There were subgroup differences in low-value care. Interventions may target these subgroups to reduce low-value care.

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