• Am J Manag Care · Jul 2024

    Utilization of low- and high-value health care by individuals with and without cognitive impairment.

    • Douglas Barthold, Shangqing Jiang, Anirban Basu, Elizabeth A Phelan, Stephen Thielke, Soo Borson, and A Mark Fendrick.
    • The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, 1959 NE Pacific St, Box 357630, Seattle, WA 98195. Email: barthold@uw.edu.
    • Am J Manag Care. 2024 Jul 1; 30 (7): 316323316-323.

    ObjectivesCognitive impairment and dementia have rising prevalence and impact the health care utilization and lives of older adults. Receipt of low-value (LV) care and underutilization of high-value (HV) care by individuals with these cognitive disorders may have negative consequences for patient health, health system efficiency, and societal welfare. Evidence on health care value among cognitively impaired individuals is limited; we thus ascertained receipt of LV and HV health care in older adults with normal cognition, cognitive impairment without dementia (CIND), and dementia.Study DesignRetrospective cohort study of Health and Retirement Study data linked to Medicare claims (1996-2018).MethodsWe examined the association between cognitive decline and the receipt of 5 LV and 7 HV services vs individuals with no change in cognition.ResultsReceipt of LV care ranged from 4% to 13% regardless of cognitive status. Cognitive decline (from unimpaired to either CIND or dementia) was associated with decreased probability of receipt of 1 LV service (colorectal cancer screening at 85 years and older [5-percentage-point reduction; P = .047]) and 3 HV services (glucose-lowering drugs [7-percentage-point reduction; P = .029], statins [32-percentage-point reduction; P = .045], and antiresorptive therapy [61-percentage-point reduction; P = .019]).ConclusionsLV service receipt is wasteful and may be harmful, but it was not consistently associated with cognitive status. Lack of HV care for those with cognitive impairment could be a missed opportunity to improve well-being or reduce preventable adverse events. Our results suggest opportunities for improving the quality of care received by all older adults, including those with cognitive impairment.

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