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Cho K.,Massachusetts Veterans Epidemiology Research and Information Center | Cho K.,Harvard University | Gagnon D.R.,Massachusetts Veterans Epidemiology Research and Information Center | Gagnon D.R.,Boston University | And 9 more authors.
International Journal of Alzheimer's Disease | Year: 2014

Growing evidence suggests that Alzheimer's disease and other types of dementia are underdiagnosed and poorly documented. In our study, we describe patterns of dementia coding and treatment in the Veteran's Administration New England Healthcare System. We conducted a retrospective cohort study with new outpatient ICD-9 codes for several types of dementia between 2002 and 2009. We examined healthcare utilization, medication use, initial dementia diagnoses, and changes in diagnoses over time by provider type. 8,999 veterans received new dementia diagnoses during the study period. Only 18.3% received a code for cognitive impairment other than dementia, most often "memory loss" (65.2%) prior to dementia diagnosis. Two-thirds of patients received their initial code from a PCP. The etiology of dementia was often never specified by ICD-9 code, even by specialists. Patients followed up exclusively by PCPs had lower rates of neuroimaging and were less likely to receive dementia medication. Emergency room visits and hospitalizations were frequent in all patients but highest in those seen by dementia specialists. Dementia medications are commonly used off-label. Our results suggest that, for the majority the patients, no prodrome of the dementia syndrome is documented with diagnostic code, and patients who do not see dementia specialists have less extensive diagnostic assessment and treatment. © 2014 Kelly Cho et al.

Schepker C.A.,Spaulding Rehabilitation Hospital | Schepker C.A.,Harvard University | Schepker C.A.,Touro College | Leveille S.G.,University of Massachusetts Boston | And 13 more authors.
Journal of the American Geriatrics Society | Year: 2016

Objectives To examine the effect of pain and mild cognitive impairment (MCI) - together and separately - on performance-based and self-reported mobility outcomes in older adults in primary care with mild to moderate self-reported mobility limitations. Design Cross-sectional analysis. Setting Academic community outpatient clinic. Participants Individuals aged 65 and older in primary care enrolled in the Boston Rehabilitative Impairment Study in the Elderly who were at risk of mobility decline (N = 430). Measurements Participants with an average score greater than three on the Brief Pain Inventory (BPI) were defined as having pain. MCI was defined using age-adjusted scores on a neuropsychological battery. Multivariable linear regression models assessed associations between pain and MCI, together and separately, and mobility performance (habitual gait speed, Short Physical Performance Battery), and self-reports of function and disability in various day-to-day activities (Late Life Function and Disability Instrument). Results The prevalence of pain was 34% and of MCI was 42%; 17% had pain only, 25% had MCI only, 17% had pain and MCI, and 41% had neither. Participants with pain and MCI performed significantly worse than all others on all mobility outcomes (P <.001). Participants with MCI only or pain only also performed significantly worse on all mobility outcomes than those with neither (P <.001). Conclusion Mild to moderate pain and MCI were independently associated with poor mobility, and the presence of both comorbidities was associated with the poorest status. Primary care practitioners who encounter older adults in need of mobility rehabilitation should consider screening them for pain and MCI to better inform subsequent therapeutic interventions. © 2016, the Authors Journal compilation.

Horvath K.J.,New England Geriatric Research Education and Clinical Center | Horvath K.J.,Edith Nourse Rogers Memorial Veterans Hospital | Horvath K.J.,Boston University | Horvath K.J.,Center for Health Quality Outcomes and Economics Research | And 8 more authors.
International Journal of Alzheimer's Disease | Year: 2013

This randomized clinical trial tested a new self-directed educational intervention to improve caregiver competence to create a safer home environment for persons with dementia living in the community. The sample included 108 patient/caregiver dyads: the intervention group (n = 60) received the Home Safety Toolkit (HST), including a new booklet based on health literacy principles, and sample safety items to enhance self-efficacy to make home safety modifications. The control group (n = 48) received customary care. Participants completed measures at baseline and at twelve-week follow-up. Multivariate Analysis of Covariance (MANCOVA) was used to test for significant group differences. All caregiver outcome variables improved in the intervention group more than in the control. Home safety was significant at P ≤ 0.001, caregiver strain at P ≤ 0.001, and caregiver self-efficacy at P = 0.002. Similarly, the care receiver outcome of risky behaviors and accidents was lower in the intervention group (P ≤ 0.001). The self-directed use of this Home Safety Toolkit activated the primary family caregiver to make the home safer for the person with dementia of Alzheimer's type (DAT) or related disorder. Improving the competence of informal caregivers is especially important for patients with DAT in light of all stakeholders reliance on their unpaid care. © 2013 Kathy J. Horvath et al.

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