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geriatrics, aging, elderly, Medicare

Nicholas K Schiltz, David F Warner, Jiayang Sun, Paul M Bakaki, Avi Dor, Charles W Given, Kurt C Stange, Siran M Koroukian
BACKGROUND: Multimorbidity affects the majority of elderly adults and is associated with higher health costs and utilization, but how specific patterns of morbidity influence resource use is less understood. OBJECTIVE: The objective was to identify specific combinations of chronic conditions, functional limitations, and geriatric syndromes associated with direct medical costs and inpatient utilization. DESIGN: Retrospective cohort study using the Health and Retirement Study (2008-2010) linked to Medicare claims...
March 2017: Medical Care
Shaunak S Adkar, Ryan S Turley, Ehsan Benrashid, Sandhya Lagoo, Cynthia K Shortell, Leila Mureebe
BACKGROUND: The initiation of bundled payment for care improvement by Centers for Medicare and Medicaid Services (CMS) has led to increased financial and performance accountability. As most vascular surgery patients are elderly and reimbursed via CMS, improving their outcomes will be critical for durable financial stability. As a first step in forming a multidisciplinary pathway for the elderly vascular patients, we sought to identify modifiable perioperative variables in geriatric patients undergoing lower extremity bypass (LEB)...
January 2017: Annals of Vascular Surgery
Paul Rizk, William Morris, Philip Oladeji, Michael Huo
Postoperative delirium is a serious complication following hip surgery in elderly patients that can adversely affect outcomes in both hip fracture and arthroplasty surgery. Recently, the incidence of hip fracture in the Medicare population was estimated at approximately 500 000 patients per year, with the majority treated surgically. The annual volume of total hip arthroplasty is nearly 450 000 patients and is projected to increase over the next 15 to 20 years. Subsequently, the incidence of postoperative delirium will rise...
June 2016: Geriatric Orthopaedic Surgery & Rehabilitation
Mayank Ajmera, Amit Raval, Steve Zhou, Wenhui Wei, Rituparna Bhattacharya, Chunshen Pan, Usha Sambamoorthi
BACKGROUND: Among elderly patients, the management of type 2 diabetes mellitus (T2DM) is complicated by population heterogeneity and elderly-specific complexities. Few studies have been done to understand treatment intensification among elderly patients failing multiple oral antidiabetic drugs (OADs). OBJECTIVE: To examine the association between time to treatment intensification of T2DM and elderly-specific patient complexities. METHODS: In this observational, retrospective cohort study, elderly (aged ≥ 65 years) Medicare beneficiaries (n = 16,653) with inadequately controlled T2DM (hemoglobin A1c ≥ 8...
December 2015: Journal of Managed Care & Specialty Pharmacy
Eric Burton, Beatrice Ugiliweneza, Shiao Woo, Stephen Skirboll, Maxwell Boaky
The Surveillance, Epidemiology and End Results (SEER) database was used to determine the treatment patterns, outcomes and cost of therapy in elderly patients with glioblastoma multiforme (GBM). The SEER-Medicare linked database was used to identify patients aged >66 years with GBM diagnosed between 1997 and 2009. The patients were stratified by initial treatment following diagnostic surgery (resection or biopsy) into 6 groups as follows: No treatment, standard radiation therapy (SRT) with and without concurrent temozolomide (TMZ), hypofractionated RT (HRT) with and without concurrent TMZ, or TMZ alone...
September 2015: Molecular and Clinical Oncology
Raymond Y Hsu, Yoojin Lee, Roman Hayda, Christopher W DiGiovanni, Vincent Mor, Jason T Bariteau
BACKGROUND: The purpose of this study was to examine the incidence of adverse events in elderly patients who required inpatient admission after sustaining an ankle fracture and to consider these data in relation to geriatric hip fracture and other geriatric patient admissions. METHODS: A retrospective cohort study of patients admitted with an ankle fracture, a hip fracture, or any other diagnosis was performed with the Medicare Part A database for 2008. The primary outcome measure was the one-year mortality rate, examined with multivariate analysis factoring for both patient age and preexisting comorbidity...
November 4, 2015: Journal of Bone and Joint Surgery. American Volume
Aluko A Hope, Michelle N Gong, Carmen Guerra, Hannah Wunsch
OBJECTIVES: To estimate the effect of pre-intensive care unit (ICU) health categories on mortality during and after critical illness, focusing specifically on the effect of pre-ICU frailty on short- and long-term mortality. DESIGN: Retrospective cohort study. SETTING: Medicare claims data from 2004 to 2008. PARTICIPANTS: A nationally representative sample of elderly Medicare beneficiaries admitted to an ICU in 2005. MEASUREMENTS: Participants were classified into four pre-ICU health categories (robust, cancer, chronic organ failure, frailty) using claims data from the year before admission, allowing for assignment to multiple categories...
June 2015: Journal of the American Geriatrics Society
Joanne Lynn, Anne Montgomery
Current options being discussed by policymakers cannot yield the highly reliable, highly efficient service delivery system-inclusive of both health care and community-based supportive services-that the nation's upcoming and transformative "age wave" will require. More far-reaching and rapid innovations in policy and health care delivery are essential. The MediCaring Accountable Care Community initiative is a comprehensive model that can deliver higher quality care for frail elderly Medicare beneficiaries at a lower per capita cost...
April 2015: Gerontologist
Katelyn Rittenhouse, Carissa Harnish, Brian Gross, Amelia Rogers, Jo Ann Miller, Roxanne Chandler, Frederick B Rogers
BACKGROUND: To date, there are almost 500 accountable care organizations (ACOs) across the United States emphasizing cost-effective care. Readmission largely impacts health care cost; therefore, we sought to determine factors associated with geriatric trauma readmissions (recidivism) within our institution. METHODS: All admissions from 2000 to 2011 attributed to patients 65 years or older at our Level II trauma center, recently verified by Medicare as an ACO, were queried...
February 2015: Journal of Trauma and Acute Care Surgery
Katherine A Ornstein, Linda DeCherrie, Rima Gluzman, Elizabeth S Scott, Jyoti Kansal, Tushin Shah, Ralph Katz, Theresa A Soriano
OBJECTIVES: To assess the oral health status, use of dental care, and dental needs of homebound elderly adults and to determine whether medical diagnoses or demographic factors influenced perceived oral health. DESIGN: Cross-sectional analysis. SETTING: Participants' homes in New York City. PARTICIPANTS: Homebound elderly adults (N = 125). MEASUREMENTS: A trained dental research team conducted a comprehensive clinical examination in participants' homes and completed a dental use and needs survey and the Geriatric Oral Health Assessment Index...
January 2015: Journal of the American Geriatrics Society
Thomas C Tsai, E John Orav, Ashish K Jha
IMPORTANCE: Despite policies aimed at incentivizing clinical integration, few data exist on whether fragmentation of care is associated with worse outcomes for elderly patients undergoing major surgery. OBJECTIVE: To determine whether postdischarge surgical care fragmentation is associated with worse outcomes and whether distances between hospitals explain differences in patient outcomes. DESIGN, SETTING, AND PARTICIPANTS: We used the 100% Medicare inpatient file for claims from January 1, 2009, through November 30, 2011...
January 2015: JAMA Surgery
Christine G Gourin, Heather M Starmer, Robert J Herbert, Kevin D Frick, Arlene A Forastiere, David W Eisele, Harry Quon
OBJECTIVES/HYPOTHESIS: To examine associations between pretreatment variables, short-term and long-term swallowing and airway impairment, and survival in elderly patients treated for laryngeal squamous cell cancer (SCCA). STUDY DESIGN: Retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data. METHODS: Longitudinal data from 2,370 patients diagnosed with laryngeal SCCA from 2004 to 2007 were evaluated using cross-tabulations, multivariate logistic regression, and survival analysis...
April 2015: Laryngoscope
Keturah R Faurot, Michele Jonsson Funk, Virginia Pate, M Alan Brookhart, Amanda Patrick, Laura C Hanson, Wendy Camelo Castillo, Til Stürmer
PURPOSE: Estimating drug effectiveness and safety among older adults in population-based studies using administrative health care claims can be hampered by unmeasured confounding as a result of frailty. A claims-based algorithm that identifies patients likely to be dependent, a proxy for frailty, may improve confounding control. Our objective was to develop an algorithm to predict dependency in activities of daily living (ADL) in a sample of Medicare beneficiaries. METHODS: Community-dwelling respondents to the 2006 Medicare Current Beneficiary Survey, >65 years old, with Medicare Part A, B, home health, and hospice claims were included...
January 2015: Pharmacoepidemiology and Drug Safety
Joanna-Grace M Manzano, Ruili Luo, Linda S Elting, Marina George, Maria E Suarez-Almazor
PURPOSE: Hospitalizations among patients with cancer are common and costly and, if unplanned, may interrupt oncologic treatment. The rate of unplanned hospitalizations in the population of elderly patients with cancer is unknown. We sought to describe and quantify patterns and risk factors for early unplanned hospitalization among elderly patients with GI cancer. PATIENTS AND METHODS: We conducted a retrospective cohort study using linked Texas Cancer Registry and Medicare claims data from 2001 to 2009...
November 1, 2014: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Anna M Acee
Depression is significantly higher among elderly adults receiving home healthcare, particularly among adults with Type 2 diabetes. Depression leads to greater medical illness, functional impairment, and chronic pain. Opportunities are often missed to improve mental health and general medical outcomes when mental illness is underrecognized and undertreated. This article discusses the mandate by the Centers for Medicare & Medicaid Services (CMS), Outcome and Assessment Information Set-C (OASIS-C) (2009) for the use of the Patient Health Questionnaire (PHQ-2) to screen for depression in home care patients, with special emphasis on the patient with diabetes...
June 2014: Home Healthcare Nurse
Andreas Becker, Praful Ravi, Florian Roghmann, Quoc-Dien Trinh, Zhe Tian, Alexandre Larouche, Simon Kim, Shahrokh F Shariat, Luis Kluth, Roland Dahlem, Margit Fisch, Markus Graefen, Christian Eichelberg, Pierre I Karakiewicz, Maxine Sun
OBJECTIVE: To assess postoperative complication profiles and 30-day mortality (30 dM) in older patients undergoing either laparoscopic radical nephrectomy (LRN) compared with open partial nephrectomy (OPN) or laparoscopic partial nephrectomy (LPN) for early stage renal cell carcinoma. METHODS: Using the Surveillance, Epidemiology, and End Results-Medicare linked database, 2277 patients aged>65 years with T1 renal cell carcinoma, who underwent LRN, OPN, or LPN were identified (1992-2005)...
June 2014: Urology
Susan M Friedman, Daniel Ari Mendelson
As the world population of older adults-in particular those over age 85-increases, the incidence of fragility fractures will also increase. It is predicted that the worldwide incidence of hip fractures will grow to 6.3 million yearly by 2050. Fractures result in significant financial and personal costs. Older adults who sustain fractures are at risk for functional decline and mortality, both as a function of fractures and their complications and of the frailty of the patients who sustain fractures. Identifying individuals at high risk provides an opportunity for both primary and secondary prevention...
May 2014: Clinics in Geriatric Medicine
Todd R Vogel, Gregory F Petroski, Robin L Kruse
OBJECTIVE: The ability of nursing home residents to function independently is associated with their quality of life. The impact of amputations on functional status in this population remains unclear. This analysis evaluated the effect of amputations-transmetatarsal (TM), below-knee (BK), and above-knee (AK)--on the ability of residents to perform self-care activities. METHODS: Medicare inpatient claims were linked with nursing home assessment data to identify admissions for amputation...
May 2014: Journal of Vascular Surgery
Todd R Vogel, Gregory F Petroski, Robin L Kruse
OBJECTIVE: The impact of interventions for critical limb ischemia (CLI) on functional status in the elderly remains unclear. Open and endovascular procedures were evaluated. METHODS: Medicare inpatient claims were linked with nursing home assessment data to identify elective admissions for lower extremity procedures for CLI. A functional impairment score (0-28; higher scores indicating greater impairment) based on residents' need for assistance with self-care activities, walking, and locomotion was calculated before and after interventions...
February 2014: Journal of Vascular Surgery
Igor Akushevich, Julia Kravchenko, Svetlana Ukraintseva, Konstantin Arbeev, Alexander Kulminski, Anatoliy I Yashin
Multi-morbidity is common among older adults; however, for many aging-related diseases there is no information for U.S. elderly population on how earlier-manifested disease affects the risk of another disease manifested later during patient's lifetime. Quantitative evaluation of risks of cancer and non-cancer diseases for older adults with pre-existing conditions is performed using the Surveillance, Epidemiology, and End Results (SEER) Registry data linked to the Medicare Files of Service Use (MFSU). Using the SEER-Medicare data containing individual records for 2,154,598 individuals, we empirically evaluated age patterns of incidence of age-associated diseases diagnosed after the onset of earlier manifested disease and compared these patterns with those in general population...
December 2013: Experimental Gerontology
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