Should I stay or should I go again: Multiple switching between fee-for-service Medicare and Medicare advantage among older beneficiaries.

Objective: To evaluate whether having previously disenrolled from Medicare Advantage (MA) is associated with lower hazards of future MA enrollment.

Data Sources And Study Setting: Secondary data from Medicare.

Study Design: We examined beneficiaries with baseline FFS enrollment from 2017-2019 using a 20% sample of Medicare claims.

Achieving goal-concordant care: Formal and informal advance care planning for White, Black, and Hispanic older adults.

Introduction: Advance care planning (ACP) aims to ensure that patients receive goal-concordant care (GCC), which is especially important for racially or ethnically minoritized populations at greater risk of poor end-of-life outcomes. However, few studies have evaluated the impact of advance directives (i.e.

Association of Medicare Home Health Ratings With Older Adult Fall Injuries: An Instrumental Variables Analysis.

Objectives: To understand the role of high-quality home health care for fall prevention.

Design: A 100% sample of national Medicare claims and home health survey data (2015-2017) were used to assess fall injuries and receipt of a fall risk assessment among recently hospitalized Medicare fee-for-service home health users aged ≥66 years. Subanalyses examined patients by prior fall history status and hospital admission diagnosis type (eg, neurologic, respiratory, cardiovascular, infection, and orthopedic diagnoses).

Unaddressed functional difficulty and care support among White, Black, and Hispanic older adults in the last decade.

Unaddressed functional difficulties contribute to disparities in healthy aging. While the Affordable Care Act (ACA) is believed to have reshaped long-term care, little is known how it has collectively altered the prevalence of older adults with functional difficulties and their use of family and formal care. This study uses nationally representative data from the Health and Retirement Study (2008 - 2018) to describe racial-ethnic differences in prevalence of community-dwelling older adults who had difficulty with, but lacked assistance for self-care, mobility, and household activities before and after the ACA.

Medicare's Hospital Readmission Reduction Program reduced fall-related health care use: An unexpected benefit?

Objective: To assess whether Medicare's Hospital Readmissions Reduction Program (HRRP) was associated with a reduction in severe fall-related injuries (FRIs).

Data Sources And Study Setting: Secondary data from Medicare were used.

Study Design: Using an event study design, among older (≥65) Medicare fee-for-service beneficiaries, we assessed changes in 30- and 90-day FRI readmissions before and after HRRP's announcement (April 2010) and implementation (October 2012) for conditions targeted by the HRRP (acute myocardial infarction [AMI], congestive heart failure [CHF], and pneumonia) versus "non-targeted" (gastrointestinal) conditions.

Prescription characteristics associated with fall-related injury risk among older adults prescribed benzodiazepines: a cohort study.

Background: Benzodiazepines (BZD) are widely prescribed to older adults despite their association with increased fall injury. Our aim is to better characterize risk-elevating factors among those prescribed BZD.

Methods: A retrospective cohort study using a 20% sample of Medicare beneficiaries with Part D prescription drug coverage.

Time to dementia diagnosis by race: A retrospective cohort study.

Background: Non-Hispanic Black individuals may be less likely to receive a diagnosis of dementia compared to non-Hispanic White individuals. These findings raise important questions regarding which factors may explain this observed association and any differences in the time to which disparities emerge following dementia onset.

Methods: We conducted a retrospective cohort study using survey data from the 1995 to 2016 Health and Retirement Study linked with Medicare fee-for-service claims.

Depressive Symptoms and Caregiving Intensity Before and After Onset of Dementia in Partners: A Retrospective, Observational Study.

Background: Caring for a partner with dementia poses significant emotional burden and high care demands, but changes in impacts before and after dementia onset is unclear.

Objective: Examine changes in depressive symptoms and hours of care provided by caregivers through the course of their partners' cognitive decline.

Methods: Retrospective, observational study using household survey data from 2000-2016 Health and Retirement Study and count models to evaluate older individuals' (ages ≥51 y) depressive symptoms (measured using the shortened Center for Epidemiologic Studies Depression Scale) and weekly caregiving in the 10 years before and after their partners' dementia onset (identified using Telephone Interview Cognitive Status screening).

Impact of Medicare eligibility on informal caregiving for surgery and stroke.

Objective: To assess whether the intensity of family and friend care changes after older individuals enroll in Medicare at age 65.

Data Sources: Health and Retirement Study survey data (1998-2018).

Study Design: We compared informal care received by patients hospitalized for stroke, heart surgery, or joint surgery and who were stratified into propensity-weighted pre- and post-Medicare eligibility cohorts.

Racial and Ethnic Differences in Informal and Formal Advance Care Planning Among U.S. Older Adults.

Objective: To examine advance care planning (ACP) trends among an increasingly diverse aging population, we compared informal and formal ACP use by race/ethnicity among U.S. older adults (≤65 years).

Medicare spending associated with a dementia diagnosis among older adults.

Background: Over 6 million Americans have Alzheimer's Disease or Related Dementia (ADRD) but whether spikes in spending surrounding a new diagnosis reflect pre-diagnosis morbidity, diagnostic testing, or treatments for comorbidities is unknown.

Methods: We used the 1998-2018 Health and Retirement Study and linked Medicare claims from older (≥65) adults to assess incremental quarterly spending changes just before versus just after a clinical diagnosis (diagnosis cohort, n = 2779) and, for comparative purposes, for a cohort screened as impaired based on the validated Telephone Interview for Cognitive Status (TICS) (impairment cohort, n = 2318). Models were adjusted for sociodemographic and health characteristics.

Incidence of and County Variation in Fall Injuries in US Residents Aged 65 Years or Older, 2016-2019.

This cross-sectional study examines national trends and geographic variation of fall injury rates among older US residents.

Changes in activity levels, physical functioning, and fall risk during the COVID-19 pandemic.

Background: Physical function worsens with older age, particularly for sedentary and socially isolated individuals, and this often leads to injuries. Through reductions in physical activity, the COVID-19 pandemic may have worsened physical function and led to higher fall-related risks.

Methods: A nationally representative online survey of 2006 U.

Skilled Nursing Facilities Modify the Relationship Between Depressive Symptoms and Hospital Readmissions but Not Health Outcomes Among Older Adults.

Despite detrimental effects of depressive symptoms on self-care and health, hospital discharge practices and the benefits of different discharge settings are poorly understood in the context of depression. This retrospective cohort study comprised 23,485 hospitalizations from Medicare claims linked to the Health and Retirement Study (2000-2014). Respondents with depressive symptoms were no more likely to be referred to home health, whereas the probability of discharge to skilled nursing facilities (SNFs) went up a half percentage point with each increasing symptom, even after adjusting for family support and health.

Using Medicare claims in identifying Alzheimer's disease and related dementias.

Introduction: This study develops a measure of Alzheimer's disease and related dementias (ADRD) using Medicare claims.

Methods: Validation resembles the approach of the American Psychological Association, including (1) content validity, (2) construct validity, and (3) predictive validity.

Results: We found that four items-a Medicare claim recording ADRD 1 year ago, 2 years ago, 3 years ago, and a total stay of 6 months in a nursing home-exhibit a pattern of association consistent with a single underlying ADRD construct, and presence of any two of these four items predict a direct measure of cognitive function and also future claims for ADRD.

Are Improvements Still Needed to the Modified Hospital Readmissions Reduction Program: a Health and Retirement Study (2000-2014)?

Background: To address concerns that the Hospital Readmissions Reduction Program (HRRP) unfairly penalized safety net hospitals treating patients with high social and functional risks, Medicare recently modified HRRP to compare hospitals with similar proportions of high-risk, dual-eligible patients ("peer group hospitals"). Whether the change fully accounts for patients' social and functional risks is unknown.

Objective: Examine risk-standardized readmission rates (RSRRs) and hospital penalties after adding patient-level social and functional and community-level risk factors.

Associations Between Alzheimer's Disease and Related Dementias and Depressive Symptoms of Partner Caregivers.

Family members-mainly spouses and partners-are the primary caregivers for individuals with Alzheimer's disease and related dementias (ADRDs), chronic progressive illnesses requiring increasing levels of care. We performed a retrospective observational analysis comparing depressive symptoms of 16,650 older individuals with partners without ADRDs, and those recently (within 2 years) or less recently diagnosed (≥2 years prior), controlling for lagged sociodemographic and health characteristics. The mean number of reported depressive symptoms was 1.

Prehospital and Posthospital Fall Injuries in Older US Adults.

Importance: To date, measurement and treatment of older adult fall injury has been siloed within specific care settings, such as a hospital or within a nursing home or community. Little is known about changes in fall risk across care settings. Understanding the occurrence of falls across settings has implications for measuring and incentivizing high-value care across care settings.

Association of Medicaid Eligibility With Surgical Readmission Among Medicare Beneficiaries.

Importance: The Centers for Medicare & Medicaid Services is beginning to consider adjusting for social risk factors, such as dual eligibility for Medicare and Medicaid, when evaluating hospital performance under value-based purchasing programs. It is unknown whether dual eligibility represents a unique domain of social risk or instead represents clinical risk unmeasured by variables available in traditional Medicare claims.

Objective: To assess how dual eligibility for Medicare and Medicaid is associated with risk-adjusted readmission rates after surgery.

A Framework for Aging-Friendly Services and Supports in the Age of COVID-19.

COVID-19 has revealed gaps in services and supports for older adults, even as needs for health and social services have dramatically increased and may produce a cascade of disability after the pandemic subsides. In this essay, we discuss the perfect storm of individual and environmental risk factors, including deconditioning, reductions in formal and informal care support, and social isolation. We then evaluate opportunities that have arisen for strengthening person-centered services and supports for older adults, through in-home acute and primary medical care, aggressive use of video telehealth and social interaction, and implementation of volunteer or paid intergenerational service.

Assessment of Hospital Readmissions From the Emergency Department After Implementation of Medicare's Hospital Readmissions Reduction Program.

Importance: The Medicare Hospital Readmissions Reduction Program (HRRP) is associated with reduced readmission rates, but it is unknown how this decrease occurred.

Objective: To examine whether the HRRP was associated with changes in the probability of readmission at emergency department (ED) visits after hospital discharge (ED revisits) overall and depending on whether admission is typically indicated for the patient's condition at the ED revisit.

Design, Setting, And Participants: This retrospective cohort study used hospital and ED discharge data from California, Florida, and New York from January 1, 2010, to December 31, 2014.

Physical Activity and Falls Among a National Cohort of Older Veterans.

The more than 20 million U.S. veterans have a history of physical activity engagement but face increasing disability as they age.

Association Between Financial Incentives in Medicare's Hospital Readmissions Reduction Program and Hospital Readmission Performance.

Importance: The strongest evidence for the effectiveness of Medicare's Hospital Readmissions Reduction Program (HRRP) involves greater reductions in readmissions for hospitals receiving penalties compared with those not receiving penalties. However, the HRRP penalty is an imperfect measure of hospitals' marginal incentive to avoid a readmission for HRRP-targeted diagnoses.

Objectives: To assess the association between hospitals' condition-specific incentives and readmission performance and to examine the responsiveness of hospitals to condition-specific incentives compared with aggregate penalty amounts.