Temporal and Geographic Variation in the Incidence of Alzheimer's Disease Diagnosis in the US between 2007 and 2014 - American Geriatric Society

OBJECTIVES

Our aim was to describe the incidence of Alzheimer's disease (AD) in the United States, overall and by geographic region.

DESIGN

We conducted retrospective analyses of administrative claims data for a 5% random sample of US Medicare beneficiaries aged 65 years or older. AD incidence, defined as a diagnosis for AD (International Classification of Disease, Ninth Revision, Clinical Modification code 331.0×) in a given year, with no AD diagnosis in the beneficiary's entire medical history, was estimated for each calendar year between 2007 and 2014. Beneficiaries were required to be enrolled in Medicare for the calendar year of evaluation as well as the preceding 12 months. In addition, a cross‐sectional assessment of geographic variation in AD incidence was conducted for 2014. For each population area (specifically, core‐based statistical area, as defined by the US Census Bureau), AD incidence was estimated overall, as well as adjusted for differences in underlying patient demographics and metrics of access to care and quality of care. Changes in AD incidence from 2007 were also estimated.

SETTING

US fee‐for‐service Medicare.

Participants

US Medicare beneficiaries aged 65 years or older with no history of AD.

RESULTS

Overall, the diagnosed incidence of AD decreased over time, from 1.53% in 2007 to 1.09% in 2014; trends were similar for most population areas. In 2014, the rates of AD incidence ranged from 0% to more than 3% across population areas, with the highest observed incidence rates in areas of the Midwest and the South. Statistical models explain little of the geographic variation, although following adjustment, the incidence rates increased the most (in relative terms) in rural areas of western states.

CONCLUSION

Our findings are consistent with previously reported estimates of incidence of AD in the United States and its recent declining trend. Additionally, the study highlights the considerable geographic variation in the incidence of AD in the United States and suggests that further research is needed to better understand the determinants of this geographic variation.

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Risks and Benefits of Screening for Dementia in Primary Care: The Indiana University Cognitive Health Outcomes Investigation of the Comparative Effectiveness of Dementia Screening (IU CHOICE)Trial - American Geriatric Society

BACKGROUND/OBJECTIVE

The benefits and harms of screening of Alzheimer disease and related dementias (ADRDs) are unknown. This study addressed the question of whether the benefits outweigh the harms of screening for ADRDs among older adults in primary care.

DESIGN, SETTING, AND PARTICIPANTS

Single‐blinded, two‐arm, randomized controlled trial (October 2012‐September 2016) in urban, suburban, and rural primary care settings in Indiana. A total of 4005 primary care patients (aged ≥65 years) were randomized to ADRD screening (n = 2008) or control (n = 1997).

INTERVENTION

Patients were screened using the Memory Impairment Screen or the Mini‐Cog and referred for a voluntary follow‐up diagnostic assessment if they screened positive on either or both screening tests.

MEASUREMENTS

Primary measures were health‐related quality of life (HRQOL; Health Utilities Index) at 12 months, depressive symptoms (Patient Health Questionnaire‐9), and anxiety symptoms (Generalized Anxiety Disorder seven‐item scale) at 1 month.

RESULTS

The mean age was 74.2 years (SD = 6.9 years); 2257 (66%) were female and 2301 (67%) were white. At 12 months, we were unable to detect differences in HRQOL between the groups (effect size = 0.009 [95% confidence interval {CI} = −0.063 to 0.080]; P = .81). At 1 month, differences in mean depressive symptoms (mean difference = −0.23 [90% CI = −0.42 to ‐0.039]) and anxiety symptoms (mean difference = −0.087 [90% CI = −0.246 to 0.072]) were within prespecified equivalency range. Scores for depressive and anxiety symptoms were similar between the groups at all time points. No differences in healthcare utilization, advance care planning, and ADRD recognition by physicians were detected at 12 months.

CONCLUSION

We were unable to detect a difference in HRQOL for screening for ADRD among older adults. We found no harm from screening measured by symptoms of depression or anxiety. Missing data, low rates of dementia detection, and high rate of refusal for follow‐up diagnostic assessments after a positive screen may explain these findings.

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GP‐Led Deprescribing in Community‐Living Older Australians: An Exploratory Controlled Trial - American Geriatric Society

OBJECTIVE

To assess feasibility, effectiveness, and safety of a multifaceted general practitioner (GP) led intervention to reduce potentially inappropriate polypharmacy in community‐living older people.

DESIGN

Pragmatic, controlled, pre‐post design.

SETTING

Five general practices in southeast Queensland, Australia.

PARTICIPANTS

Ten GPs from three practices, two pharmacists, and 78 patients comprised the intervention group, and 10 GPs from two practices and 67 patients comprised the usual care group. Patients were aged 65 years or older, receiving five or more regularly prescribed medicines, and capable of participating in telephone interviews in English.

INTERVENTION

A 5‐hour interactive deprescribing training workshop for clinicians; an extended deprescribing consultation between GPs and enrolled patients, entailing a comprehensive review of their medicines using a standardized software template codesigned by GPs; and comprehensive medicine review by a pharmacist, at the GP's discretion.

OUTCOME MEASURES

Primary outcome was mean difference in number of regular medicines deprescribed (ie, ceased or dose reduced) per patient over an 18‐week follow‐up period. Medicine‐specific and patient‐reported outcomes, safety, and process measures were also evaluated.

RESULTS

At study completion, mean (SD) number of regular medicines deprescribed per patient was 0.99 (1.23) in the intervention group vs 0.43 (0.84) in the usual care group, equaling a mean difference of 0.55 (95% confidence interval = −0.90 to −0.21; P = .002). Crude totals showed 77 of 649 (11.9%) vs 29 of 571 (5.1%) regular medicines deprescribed in intervention and usual care groups, respectively (P < .001). Supplements, gastric acid suppressants, statins, oral hypoglycemics, and diuretics were medicine classes more frequently deprescribed. There were no statistically significant between‐group differences in numbers of medicines commenced, self‐reported unplanned hospitalizations, or worsened health‐related quality of life. A subset of intervention patients reported greater certainty in the necessity and appropriateness of their medicines at study end.

CONCLUSION

The deprescribing intervention appears feasible, was modestly effective, and was not associated with any major safety events.

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MoCA Test Mandatory Training and Certification: What Is the Purpose? - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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Reply to: MoCA Test Mandatory Training and Certification: What Is the Purpose? - American Geriatric Society

Journal of the American Geriatrics Society, EarlyView.

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AGS and NIA Bench‐to Bedside Conference Summary: Osteoporosis and Soft Tissue (Muscle and Fat) Disorders - American Geriatric Society

This report summarizes the presentations and recommendations of the eleventh annual American Geriatrics Society and National Institute on Aging research conference, “Osteoporosis and Soft Tissue (Muscle/Fat) Disorders,” on March 11‐12, 2019, in Bethesda, Maryland. Falls, fractures, and sarcopenia have a major impact on health in older adults, and they are interconnected by known risk factors. The link between osteoporosis, which is common in older adults, and the risk of falls is well known. Sarcopenia, the age‐related decline in skeletal muscle mass and function, is also associated with an increased risk of falls and fractures because it reduces strength and leads to functional limitations. In addition to increasing the risk of falls, sarcopenia and osteoporosis can lead to frailty, reduced quality of life, morbidity, and mortality. The conference highlighted the impact of bone and soft tissue disorders on quality of life, morbidity, and mortality in older adults. Presenters described factors that contribute to these disorders; health disparities experienced by various subpopulations; and promising biological, pharmacologic, and behavioral interventions to prevent or treat these disorders. The workshop identified many research gaps and questions along with research recommendations that have the potential to enhance the prospect of healthy aging and improved quality of life for older adults.

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Results From a Survey of American Geriatrics Society Members' Views on Physician‐Assisted Suicide - American Geriatric Society

BACKGROUND

Physician‐assisted suicide (PAS) is a controversial practice, currently legal in nine states and the District of Columbia. No prior study explores the views of the American Geriatrics Society (AGS) membership on PAS.

DESIGN

We surveyed 1488 randomly selected AGS members via email.

PARTICIPANTS

A total of 369 AGS members completed the survey (24.8% response rate).

ANALYSIS

We conducted bivariate correlation analyses of beliefs related to support for PAS. We also conducted qualitative analysis of open‐ended responses.

RESULTS

There was no consensus regarding the acceptability of PAS, with 47% supporting and 52% opposing this practice. PAS being legal in the respondent's state, belief that respect for autonomy alone is sufficient to justify PAS, and intent to prescribe or support requests for PAS if legal in state of practice all correlated with support for PAS. There was no consensus on whether the AGS should oppose, support, or adopt a neutral stance on PAS. Most respondents believed that PAS is more complex among patients with low health literacy, low English proficiency, disability, dependency, or frailty. Most respondents supported mandatory palliative care consultation and independent assessments from two physicians. Themes identified from qualitative analysis include role of the medical profession, uncertainty of the role of professional organizations, potential unintended consequences, autonomy, and ethical and moral considerations.

CONCLUSION

There was no consensus among respondents regarding the acceptability of PAS. Respondents expressed concern about vulnerable older populations and the need for safeguards when responding to requests for PAS. Ethical, legal, and policy discussions regarding PAS should consider vulnerable populations.

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