The Relationship Between a Dementia Diagnosis, Chronic Illness, Medicare Expenditures, and Hospital Use

Bynum, Julie; Rabins, Peter V.; Weller, Wendy E.; Niefeld, Marlene; Anderson, Gerard F.; Wu, Albert W.

doi:10.1111/j.1532-5415.2004.52054.x

Cited by 358 publications

(397 citation statements)

References 32 publications

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“…Those who were obese or had been hospitalized in the past year were more likely to be cognitively impaired. These results were in line with other studies that found overweight women and obese men to have a higher likelihood of developing dementia (Elias et al, 2003;Gustafson et al, 2003), and dementia to be an important predictor of institutionalization (Bharucha et al, 2004;Bynum et al, 2004). In our study, short or long sleep was also found to be associated not only with cognitive impairment, but also depressive symptoms in elderly Japanese.…”

Section: Discussionsupporting

confidence: 82%

Correlates of cognitive impairment and depressive symptoms among older adults in Korea and Japan

Lee

Shinkai

2005

Int J Geriat Psychiatry

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SUMMARYBackground Cognitive impairment and depressive symptoms impose a heavy burden on the care of the elderly in Japan and Korea, two of the fastest aging nations in Asia. The purpose of this study was to examine and compare factors associated with cognitive impairment and depressive symptoms among older persons in the two countries. Methods In 2002, representative samples of community-dwelling people aged 65 and older were selected among residents in Anyang, Korea and Yoita, Japan. Mini-Mental State Examination and Geriatric Depression Scale were used to assess the elderly's mental status. Sociodemographics, physical function, chronic conditions, social support, and health behaviors were examined to identify significant associations. Results The prevalence of cognitive impairment in older adults was 17.0% in Anyang and 14.6% in Yoita. The rates for depressive symptoms were 15.2% and 19.8%, respectively. Overall, functional capacity was the universal factor significantly associated with mental conditions. Self-rated health and social support were also found to be independently associated with depressive symptoms in the study subjects. Differences in the patterns of association by community, however, were notable for other characteristics. For example, in factors associated with cognitive impairment, sociodemographic factors such as age, gender, and education were significant among Koreans, whereas socio-behavioral factors such as obesity, social support and hospitalization experience were found to be significant for older Japanese residents. Conclusions Similarities in the patterns of association indicate the need for joint explorations into the role these factors play in affecting the mental health of older persons. Socioeconomic and regional differentials, however, may account for the disparity in the associations observed, suggesting the importance of developing mental health programs sensitive to the older individual's culture.

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Section: Discussionsupporting

confidence: 82%

Correlates of cognitive impairment and depressive symptoms among older adults in Korea and Japan

Lee

Shinkai

2005

Int J Geriat Psychiatry

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“…[19][20][21][22][23] AHRQ-CCS disease categories have been widely used in numerous publications to identify comorbidities and outcomes, [24][25][26][27][28][29] predict mortality, 30,31 and estimate utilization and costs. [32][33][34][35] AHRQ-CCS disease categories are recognized by the Department of Defense Military Health System and are incorporated into Tricare data as an industry standard. 13 AHRQ-CCS category 49 (diabetes without complication) and category 50 (diabetes with complications) have been used in clinical research 36,37 and to generate reports on utilization and cost statistics in relation to diabetes and diabetic complications in various health care settings.…”

Section: Discussionmentioning

confidence: 99%

Statins and New-Onset Diabetes Mellitus and Diabetic Complications: A Retrospective Cohort Study of US Healthy Adults

et al. 2015

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BACKGROUND: Statin use is associated with increased incidence of diabetes and possibly with increased body weight and reduced exercise capacity. Data on the longterm effects of these associations in healthy adults, however, are very limited. In addition, the relationship between these effects and diabetic complications has not been adequately studied. OBJECTIVE: To examine the association between statin use and new-onset diabetes, diabetic complications, and overweight/obesity in a cohort of healthy adults. RESEARCH DESIGN: This was a retrospective cohort study. PARTICIPANTS: Subjects were Tricare beneficiaries who were evaluated between October 1, 2003 and March 1, 2012. Patients were divided into statin users and nonusers. INTERVENTION: We excluded patients who, at baseline, had a preexisting disease indicative of cardiovascular diseases, any positive element of the Charlson comorbidity index (including diabetes mellitus), or life-limiting chronic diseases. Using 42 baseline characteristics, we generated a propensity score to match statin users and nonusers. MAIN MEASURES: Outcomes assessed included newonset diabetes, diabetic complications, and overweight/ obesity. KEY RESULTS: A total of 25,970 patients (3982 statin users and 21,988 nonusers) were identified as healthy adults at baseline. Of these, 3351 statins users and 3351 nonusers were propensity score-matched. Statin users had higher odds of new-onset diabetes (odds ratio [OR] 1.87; 95 % confidence interval [95 % CI] 1.67-2.01), diabetes with complications (OR 2.50; 95 % CI 1.88-3.32), and overweight/obesity (OR 1.14; 95 % CI 1.04-1.25). Secondary and sensitivity analyses demonstrated similar findings. CONCLUSIONS: Diabetes, diabetic complications, and overweight/obesity were more commonly diagnosed among statin-users than similar nonusers in a healthy cohort of adults. This study demonstrates that short-term clinical trials might not fully describe the risk/benefit of long-term statin use for primary prevention.

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“…Cognitive impairment increases with aging. About 17 % of individuals with dementia reported association with COPD in the US Medicare database [66] and there is evidence that the occurrence of cognitive impairment is Fig. 1 Proposed factors influencing the choice of an inhaled corticosteroid (ICS) in elderly patients.…”

Section: Practical Considerations For Elderly Patients On Long-term Dmentioning

confidence: 99%

Erratum to: Safety Considerations of Inhaled Corticosteroids in the Elderly

et al. 2015

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Inhaled corticosteroids (ICSs) are widely used in the treatment of patients with chronic obstructive pulmonary diseases. However, high-dose regimens and longterm use of ICSs have the potential to cause a variety of local and systemic side effects such as candidiasis, cataracts, glaucoma, and osteoporosis. The use of ICSs can also be associated with the risk of bone fractures, diabetes mellitus and pneumonia. These ICS-related side effects are of particular importance in elderly patients due to the presence of comorbidities and age-related behavioral, cognitive, and psychological problems, which can all interact with inhaled treatment. We reviewed the available literature on the clinically relevant side effects of ICSs in the elderly to provide practical measures to properly monitor and manage the risk of ICSs in the geriatric population. Inspection of the mouth, monitoring of ocular pressure, and use of bone-protective drugs may be necessary in patients on prolonged ICS therapy. Above all, the use of the lowest possible ICS dose and a careful re-assessment of the inhalation procedure should be recommended. Taken together, these observations suggest that physicians should use ICSs appropriately for those patients in whom the benefit will outweigh the risk, especially chronic obstructive pulmonary disease (COPD) patients with previous frequent exacerbations. Given the paucity of information on the topic and the need to extrapolate the results from studies with broader age ranges, we strongly encourage the design of specifically tailored clinical studies in the elderly. Key PointsAsthma and chronic obstructive pulmonary disease (COPD) are inflammatory disorders of the airways. The pharmacological management of these chronic diseases is based on persistent and long-term use of inhaled corticosteroids (ICSs).Asthma and COPD are among the most common chronic diseases in clinical settings, and physicians are expected to diagnose and manage those diseases in the geriatric population on a daily basis. The management of chronic obstructive respiratory diseases in the geriatric population is complicated by the increased occurrence of comorbidities and associated treatment, and by age-associated physiological and structural changes of the lung.The chronic use of ICSs in the elderly is associated with the increased risk of local and systemic side effects such as candidiasis, cataract, glaucoma, diabetes mellitus, bone fractures, and pneumonia. Physicians should be aware of this in order to select those patients in whom the benefits will outweigh the risks.The online version of the original article can be found under

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The Relationship Between a Dementia Diagnosis, Chronic Illness, Medicare Expenditures, and Hospital Use

Cited by 358 publications

References 32 publications

Correlates of cognitive impairment and depressive symptoms among older adults in Korea and Japan

Correlates of cognitive impairment and depressive symptoms among older adults in Korea and Japan

Statins and New-Onset Diabetes Mellitus and Diabetic Complications: A Retrospective Cohort Study of US Healthy Adults

Erratum to: Safety Considerations of Inhaled Corticosteroids in the Elderly

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