Treatment for Urinary Incontinence in Women Older Than 65 Years.

Importance: Urinary incontinence (UI) is common among women older than 65 years and negatively affects quality of life. However, the prevalence of UI treatment and determinants of treatment are largely unknown.

Objectives: The aim of this study was to identify rates of UI treatment and factors associated with treatment in older women with self-reported UI.

Nursing Home to Nursing Home Transfers during the Early COVID-19 Pandemic.

Objectives: To examine the nursing home to nursing home transfer rates before and during the early COVID-19 pandemic and to identify risk factors associated with those transfers in a state with a policy to create COVID-19-care nursing homes.

Design: Cross-sectional cohorts of nursing home residents in prepandemic (2019) and COVID-19 (2020) periods.

Setting And Participants: Michigan long-term nursing home residents were identified from the Minimum Data Set.

Behaviours of older adults and caregivers preparing for elective surgery: a virtually conducted mixed-methods research protocol to improve surgical outcomes.

Introduction: Older adults (age ≥65 years) are pursuing increasingly complex, elective surgeries; and, are at higher risk for intraoperative and postoperative complications. Patients and their caregivers frequently struggle with the postoperative recovery process at home, which may contribute to complications. We aim to identify opportunities to intervene during the preoperative period to improve postoperative outcomes by understanding the preparatory behaviours of older adults and their caregivers before a complex, elective surgery.

Opioid and CNS-Depressant Medication Prescribing among Older Adults Enrolled in Medicare Advantage Versus Fee-for-Service Medicare.

Objective: To examine whether prescription fills of opioids and central nervous system (CNS) depressants are lower in Medicare Advantage (MA) plans, which aim to provide more coordinated and integrated care, than fee-for-service (FFS) Medicare.

Methods: Data from the 2015 National Health and Aging Trends Study linked with Medicare claims. Community-dwelling adults ≥65 enrolled in Medicare Part D were included (n = 5,652).

Aortic valve replacement among patients with Alzheimer's disease and related dementias.

Background: Transcatheter aortic valve replacement (TAVR) has made palliation from aortic stenosis more broadly available to populations previously thought to be too high risk for surgery, such as those with Alzheimer's disease and related dementias (ADRD); however, its safety and effectiveness in this context are uncertain.

Methods: We performed a retrospective cohort study of national Medicare beneficiaries, aged 66 and older with Parts A and B, between 2010 and 2016. Patients undergoing AVR were identified, and follow-up was available through 2017.

Physician network position and patient outcomes following implantable cardioverter defibrillator therapy.

Objective: To evaluate two novel measures of physician network centrality and their associations with implantable cardioverter defibrillator (ICD) procedure volume and health outcomes.

Data Sources: Medicare claims and the National Cardiovascular Data Registry data from 2007 to 2011.

Study Design: We constructed a national cardiovascular disease patient-sharing physician network and used network analysis to characterize physician network centrality with two measures: within-hospital degree centrality (number of connections within a hospital) and across-hospital degree centrality (number of connections across hospitals).

Assessing Variation in Implantable Cardioverter Defibrillator Therapy Guideline Adherence With Physician and Hospital Patient-sharing Networks.

Background: Implantable cardioverter defibrillator (ICD) therapy is used for primary prevention of death among people with heart failure, and new evidence in 2005 on its effectiveness changed practice guidelines in the United States.

Objectives: The objective of this study is to examine how the connectedness of physicians and hospitals, measured using network analysis, relates to guideline-consistent ICD implantation.

Research Design: We constructed physician and hospital networks for cardiovascular disease.

E-Prescribing and Adverse Drug Events: An Observational Study of the Medicare Part D Population With Diabetes.

Background: Although the adoption of e-prescriptions among physicians has increased substantially under the Medicare Improvements for Patients and Providers Act and Meaningful Use programs, little is known of its impact on patient outcomes.

Objective: To examine the impact of e-prescribing on emergency visits or hospitalizations for diabetes-related adverse drug events (ADEs) including hypoglycemia.

Design: This is a prospective, observational cohort study with patient fixed effects.

Screening Mammography Use Among Older Women Before and After the 2009 U.S. Preventive Services Task Force Recommendations.

Background: It is uncertain how changes in the U.S. Preventive Services Task Force breast cancer screening recommendations (from annual to biennial mammography screening in women aged 50-74 and grading the evidence as insufficient for screening in women aged 75 and older) have affected mammography use among Medicare beneficiaries.

An analysis of patient-sharing physician networks and implantable cardioverter defibrillator therapy.

The application of social network analysis to the organization of healthcare delivery is a relatively new area of research that may not be familiar to health services statisticians and other methodologists. We present a methodological introduction to social network analysis with a case study of physicians' adherence to clinical guidelines regarding use of implantable cardioverter defibrillators (ICDs) for the prevention of sudden cardiac death. We focus on two hospital referral regions (HRRs) in Indiana, Gary and South Bend, characterized by different rates of evidence-based ICD use (86% and 66%, respectively).

Uptake of the centers for medicare and medicaid obesity benefit: 2012-2013.

Objective: To assess the use of the Medicare Obesity Benefit (MOB) by a licensed physician or associate provider in an outpatient setting in older adults.

Methods: A serial cross-sectional analysis of fee-for-service Medicare claims (2012 and 2013) was used to assess the use of the MOB. Number and proportion of Medicare beneficiaries over age 65 using the benefit were assessed.

Continuity of Care and Health Care Utilization in Older Adults With Dementia in Fee-for-Service Medicare.

Importance: Poor continuity of care may contribute to high health care spending and adverse patient outcomes in dementia.

Objective: To examine the association between medical clinician continuity and health care utilization, testing, and spending in older adults with dementia.

Design, Setting, And Participants: This was a study of an observational retrospective cohort from the 2012 national sample in fee-for-service Medicare, conducted from July to December 2015, using inverse probability weighted analysis.

Treatment Patterns with Antidementia Drugs in the United States: Medicare Cohort Study.

Objectives: To evaluate frequency of use of two anti-dementia drug classes approved for treatment of symptoms, whether populations most likely to benefit are treated, and correlates of treatment initiation.

Design: Nationally representative cohort study.

Setting: Fee-for-service Medicare.

Identification Of Four Unique Spending Patterns Among Older Adults In The Last Year Of Life Challenges Standard Assumptions.

The assumption that health care spending skyrockets at the end of life might suggest that policy makers should target the last few months of life to control costs. However, spending patterns leading up to death have not been fully examined. We applied a new methodology to administrative claims data for older Medicare beneficiaries who died in 2012 to characterize trajectories of health care spending in the last year of life.

Who Is Providing the Predominant Care for Older Adults With Dementia?

Objectives: To identify which clinical specialties are most central for care of people with dementia in the community and long-term care (LTC) settings.

Design: Cross-sectional analysis.

Participants: Fee-for-service Medicare beneficiaries aged ≥65 years with dementia.

Characteristics and Service Use of Medicare Beneficiaries Using Federally Qualified Health Centers.

Background: Federally Qualified Health Centers (FQHCs) provide primary care for millions of Americans, but little is known about Medicare beneficiaries who use FQHCs.

Objective: To compare patient characteristics and health care service use among Medicare beneficiaries stratified by FQHC use.

Research Design: Cross-sectional analysis of 2011 Medicare fee-for-service beneficiaries aged 65 years and older.

Comparison of Site of Death, Health Care Utilization, and Hospital Expenditures for Patients Dying With Cancer in 7 Developed Countries.

Importance: Differences in utilization and costs of end-of-life care among developed countries are of considerable policy interest.

Objective: To compare site of death, health care utilization, and hospital expenditures in 7 countries: Belgium, Canada, England, Germany, the Netherlands, Norway, and the United States.

Design, Setting, And Participants: Retrospective cohort study using administrative and registry data from 2010.

Regional Supply of Chiropractic Care and Visits to Primary Care Physicians for Back and Neck Pain.

Background: Whether availability of chiropractic care affects use of primary care physician (PCP) services is unknown.

Methods: We performed a cross-sectional study of 17.7 million older adults who were enrolled in Medicare from 2010 to 2011.

Association between apple consumption and physician visits: appealing the conventional wisdom that an apple a day keeps the doctor away.

Importance: Fruit consumption is believed to have beneficial health effects, and some claim, "An apple a day keeps the doctor away."

Objective: To examine the relationship between eating an apple a day and keeping the doctor away.

Design, Setting, And Participants: A cross-sectional study of a nationally representative sample of the noninstitutionalized US adult population.

Frailty, cognitive impairment, and functional disability in older women with female pelvic floor dysfunction.

Introduction And Hypothesis: There is a growing body of evidence demonstrating frailty as an important predictor of surgical outcomes in older adults undergoing major surgeries. The age-related onset of many symptoms of female pelvic floor dysfunction (PFD) in women suggests that many women seeking treatment for PFD may also have a high prevalence of frailty, which could potentially impact the risks and benefits of surgical treatment options. Our primary objective was to determine the prevalence of frailty, cognitive impairment, and functional disability in older women seeking treatment for PFD.

Functional disability among older women with fecal incontinence.

Objective: The prevalence of functional disability for basic activities of daily living (ADLs) in older women with fecal incontinence (FI) is not well characterized. Our objective was to determine the prevalence of functional disability among community-dwelling older women with FI.

Study Design: We conducted a secondary database analysis of the 2005-2006 National Social Life, Health and Aging Project, a cross-sectional study of community-dwelling older adults that had been conducted by single in-home interviews.

Dementia in the USA: state variation in prevalence.

Background: The number of dementia patients will increase over the next decades. However, we lack information on the geographic distribution of these patients. We aimed to describe the variation of dementia prevalence and to then compare the observed to expected prevalence.