Continuity of Care and Functional Decline among Older Adults with Alzheimer’s Disease and Related Dementias Open Access

Xue, Zheng (Ashley) (Spring 2020)

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Alzheimer’s disease and related dementias (ADRD) are debilitating conditions that impair cognitive and functional health among older adults. As ADRD progresses, older patients with ADRD need increasingly more help with activities of daily living (ADL) and eventually need to depend solely on families and/or caregivers for basic functionality. While current treatment and drugs have foundered, the pattern that a person with ADRD receives care presents potential opportunities in managing functional difficulties and delaying the occurrence of functional decline. Continuity of care (COC) provides a patient with a more concentrated visit pattern with their health care providers. Current literature has examined the relationship between COC and healthcare utilization and expenditures, while few have investigated the association between COC and experiencing functional decline. Furthermore, only one study has examined COC among older adults with ADRD, which is a rapidly growing and vulnerable population. Therefore, this study aims to fill the gap in current literature by looking at the impact of COC on experiencing functional decline within one-year time lag among older adults with ADRD.

This study used the Medicare Current Beneficiary Survey (MCBS) 2006-2012 to examine the impact of COC at baseline on experiencing any functional decline in the subsequent year among older adults with ADRD. COC was measured by the Bice-Boxerman index and categorized into three levels (low, medium, and high) based on its distribution within the study sample, and the outcome variable functional decline was defined as having more difficulties in ADL or instrumental ADL (IADL) within the one-year time lag than at baseline.

This study did not find a statistically significant impact of COC on experiencing functional decline among the complete study sample (n = 2,009). However, among those without difficulties in ADL at baseline, a higher level of COC was associated with a 7.5% lower incidence of experiencing functional decline in ADL within the one-year time lag. Additionally, the involvement of PCPs in treatment was shown to decrease the likelihood of experiencing functional decline in IADL within one year by 25.8%. The findings of this study highlight the importance of COC during treatment for older adults with ADRD. Better COC is beneficial for older patients without functional difficulties through preventing and/or delaying functional decline. The implication of this study could serve as evidence to motivate Medicare fee-for-service beneficiaries’ participation in Medicare Annual Wellness Visit for detections of signs of ADRD and for developing/updating personal prevention plan for diseases and disabilities.

Table of Contents

1 Introduction

2 Literature Review

2.1 Functional Decline among Older Adults with ADRD

2.2 Continuity of Care for Older Adults with ADRD

2.3 Current Literature

2.3.1 Measurements of Focal Constructs

2.3.2 Literature on COC and Functional Health

2.3.3 Literature on COC among Older Adults with ADRD

2.4 Summary

3 Methodology

3.1 Conceptual Framework

3.1.1 Theoretical Framework

3.1.2 Focal Relationship

3.1.3 Mediators of the Focal Relationship

3.1.4 Confounders to the Focal Relationship

3.2 Hypotheses

3.3 Data and Analytic Sample

3.3.1 Data: Medicare Current Beneficiary Survey

3.3.2 Analytic Sample

3.4 Measurement

3.4.1 Focal Relationship

3.4.2 Confounders

3.5 Analytic Strategy

3.5.1 Main Logistic Regression

3.5.2 Effect Analysis by Level of Functional Health Status at Baseline

4 Results

4.1 Description of the Study Population and Their Functional Health Status

4.2 Results from the Main Logistic Regression

4.3 Secondary Logistic Regression

5 Discussion

5.1 Key Findings and Conclusions

5.2 Strengths and Limitations

5.3 Policy Implications

5.4 Recommendations for Further Research


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