Publications by authors named "Laura Maclagan"
Article Synopsis
- The study estimates the long-term health system costs of Parkinson's disease across different phases and genders over a 10-year period using data from Ontario, Canada.
- Researchers identified over 43,000 individuals with Parkinson's and compared their costs to matched controls without the disease, focusing on phases from preascertainment to terminal care, standardizing costs to 2020 values.
- Findings reveal that costs increase significantly with the progression of the disease, with a 10-year average cost of $82,153, higher in women and older patients compared to men and younger individuals, emphasizing the heavy financial burden of Parkinson's disease on the healthcare system.
Article Synopsis
- The study aimed to analyze the trends of hyperpolypharmacy (taking 10 or more medications) in older adults before and after their admission to nursing homes in Ontario, Canada.
- It involved a cohort of over 61,000 adults aged 75 and older and found that the prevalence of hyperpolypharmacy rose from 4.4% to 12.0% over ten years, continuing to 13.8% after admission.
- The increase in specific drug classes like antidepressants and antipsychotics indicates a growing need for better medication management in both community and nursing home environments.
Objectives: An unintended consequence of efforts to reduce antipsychotic medications in nursing homes is the increase in use of other psychotropic medications; however, evidence of substitution remains limited. Our objective was to measure individual-level prescribing patterns consistent with substitution of trazodone for antipsychotics.
Design: Retrospective cohort study.
Background: Despite COPD being a risk factor for cardiovascular disease (CVD) and knowing that risk stratification for CVD primary prevention is important, little is known about the real-world risk of CVD among people with COPD with no history of CVD. This knowledge would inform CVD management for people with COPD. The current study aimed to examine the risk of major adverse cardiovascular events (MACE) (including acute myocardial infarction, stroke or cardiovascular death) in a large, complete real-world population with COPD without previous CVD.
View Article and Find Full Text PDFBackground: Research on factors associated with recurrent emergency department (ED) visits and their implications for improving dementia care is lacking. The objective of this study was to examine associations between the individual characteristics of older adults living with dementia and recurrent ED visits.
Methods: We used health administrative databases to conduct a population-based retrospective cohort study among older adults with dementia in Ontario, Canada.
Background: The global burden of Parkinson's disease (PD) has more than doubled over the past three decades, and this trend is expected to continue. Despite generally poorer access to health care services in rural areas, little previous work has examined health system use in persons with PD by rurality. We examined trends in the prevalence of PD and health service use among persons with PD by rurality in Ontario, Canada.
View Article and Find Full Text PDFUnlabelled: Dementia and mild cognitive impairment can be underrecognized in primary care practice and research. Free-text fields in electronic medical records (EMRs) are a rich source of information which might support increased detection and enable a better understanding of populations at risk of dementia. We used natural language processing (NLP) to identify dementia-related features in EMRs and compared the performance of supervised machine learning models to classify patients with dementia.
View Article and Find Full Text PDFObjectives: To investigate whether trazodone is being initiated in lieu of antipsychotics following antipsychotic reduction efforts, this study described changes in medication initiation over time.
Methods: We conducted a retrospective cohort study of new admissions to nursing homes in Ontario, Canada between April 2010 and December 2019 using health administrative data (N = 61,068). The initiation of antipsychotic and trazodone use was compared by year of admission using discrete time survival analysis and stratified by history of dementia.
Background: Potentially inappropriate antipsychotic use has declined in nursing homes over the past decade; however, increases in the documentation of relevant clinical indications (eg, delusions) and the use of other psychotropic medications have raised concerns about diagnosis upcoding and medication substitution. Few studies have examined how these trends over time vary across and within nursing homes, information that may help to support antipsychotic reduction efforts.
Objective: To jointly model facility-level time trends in potentially inappropriate antipsychotic use, antidepressant use, and the indications used to define appropriate antipsychotic use.
Objectives: Population-based chronic disease surveillance systems were likely disrupted by the COVID-19 pandemic. The objective of this study was to examine the immediate and ongoing impact of the COVID-19 pandemic on the claims-based incidence of dementia.
Methods: We conducted a population-based time series analysis from January 2015 to December 2021 in Ontario, Canada.
Article Synopsis
- The study investigates how the COVID-19 pandemic affected healthcare usage for community-dwelling individuals with dementia, Parkinson's disease (PD), and older adults over a specific period in Ontario, Canada.
- It analyzes data from the first wave of the pandemic (March to September 2020) and compares it to the same timeframe in 2019, focusing on metrics like emergency visits and hospitalizations.
- Results showed significant declines in healthcare services for all groups, particularly in nursing home admissions and emergency department visits, although most services rebounded after the initial wave, with physician visits remaining higher than pre-pandemic levels. *
Background: Chronic non-cancer pain is common among older residents of long-term care (LTC) homes and often poorly recognized and treated. With heightened concerns regarding opioid prescribing in recent years, it is important to examine the current prevalence of opioid use and its association with resident characteristics to help identify those potentially at risk of medication harms as well as suboptimal pain management.
Objectives: The aims were to estimate the prevalence and correlates of opioid use among non-palliative LTC residents and explore variation in opioid prevalence and correlates across strata defined by pain frequency and intensity.
Article Synopsis
- Community-dwelling individuals with dementia saw significantly reduced access to emergency department services during the COVID-19 pandemic, particularly in Ontario, compared to pre-pandemic rates.
- A study analyzed emergency visits from March 2020 to February 2021, revealing a 50% drop in visits when the pandemic began and that rates remained lower by the end of the second wave.
- Concerns arise from the continued decline in visits for both urgent and nonurgent health issues, suggesting potential negative impacts on health outcomes for this vulnerable population.
Background: Community-dwelling older adults living with dementia visit the emergency department (ED) more frequently than other older adults, but research on the reasons for repeated visits is lacking. We examined the rate of repeated ED visits and reasons for visits in a cohort of individuals with dementia.
Methods: We conducted a population-based retrospective cohort study of community-dwelling older adults (≥66 years) living with dementia in Ontario, Canada, who visited the ED and were discharged home between April 1, 2010, and March 31, 2019.
Objective: Antipsychotic reduction in nursing homes has been a focus of research and policy attention for several decades; however, there is evidence that these initiatives may have had unintended consequences, such as medication substitution and changes in diagnosis coding. Our objectives were to describe temporal changes in the use of antipsychotics, potential substitution medications, and diagnoses and symptoms used to establish the appropriateness of antipsychotic prescribing.
Design: Repeated cross-sectional study design.
Introduction: Comprehensive, population-based investigations of the extent and temporality of associations between common neurological and psychiatric disorders are scarce.
Methods: This retrospective cohort study used linked health administrative data for Ontarians aged 40-85 years on 1 April 2002, to estimate the adjusted rate of incident dementia, Parkinson's disease (PD), stroke or mood/anxiety disorder (over 14 years) according to the presence and time since diagnosis of a prior disorder. Sex differences in the cumulative incidence of a later disorder were also examined.
Objective: To examine how the COVID-19 pandemic impacted use of home care services for individuals with dementia across service types and sociodemographic strata.
Design: Population-based time series analysis.
Setting And Participants: Community-dwelling adults with dementia in Ontario, Canada, from January 2019 to September 2020.
Introduction/aims: Amyotrophic lateral sclerosis (ALS) symptoms mimic those of other conditions and often require multiple physician and healthcare contacts for investigation and accurate diagnosis. We examined the type and frequency of healthcare service utilization prior to ALS diagnosis and tracheostomy-free survival by sex and rurality among individuals treated with riluzole in Ontario, Canada.
Methods: This population-based cohort study used administrative databases to identify patients aged 18+ y diagnosed with ALS and started on riluzole between April 2002-March 2018.
Importance: COVID-19 has had devastating effects on the health and well-being of older adult residents and health care professionals in nursing homes. Uncertainty about the associated consequences of these adverse effects on the use of medications common to this care setting remains.
Objective: To examine the association between the COVID-19 pandemic and prescription medication changes among nursing home residents.
Palliative care focuses on improving quality of life for patients with life-limiting conditions. Although previous studies have shown palliative care to be associated with reduced acute healthcare use in people with cancer and other illnesses, these findings may not generalize to patients with chronic obstructive pulmonary disease (COPD). We examined the association between palliative care and rates of days at home, locations of death, and acute healthcare use in patients with COPD.
View Article and Find Full Text PDFBackground: Atrial fibrillation (AF) is relatively common among nursing home residents, and decisions regarding anticoagulant therapy in this setting may be complicated by resident frailty and other factors.
Objectives: The aim of this study was to examine trends and correlates of oral anticoagulant use among newly admitted nursing home residents with AF following the approval of direct-acting oral anticoagulants (DOACs).
Methods: We conducted a retrospective cohort study of all adults aged > 65 years with AF who were newly admitted to nursing homes in Ontario, Canada, between 2011 and 2018 (N = 36,466).
Background/objectives: To examine the association between hospitalization for a fall-related injury and the co-prescription of a cholinesterase inhibitor (ChEI) among persons with dementia receiving a beta-blocker, and whether this potential drug-drug interaction is modified by frailty.
Design: Nested case-control study using population-based administrative databases.
Setting: All nursing homes in Ontario, Canada.
Background: In nursing homes, residents with dementia frequently receive potentially inappropriate medications that are associated with an increased risk of adverse events. Despite known sex differences in clinical presentation and sociodemographic characteristics among persons with dementia, few studies have examined sex differences in patterns and predictors of potentially inappropriate medication use.
Objectives: The objectives of this study were to examine sex differences in the patterns of antipsychotic and benzodiazepine use in the 180 days following admission to a nursing home, estimate clinical and sociodemographic predictors of antipsychotic and benzodiazepine use in male and female residents, and explore the effects of modification by sex on the predictors of using these drug therapies.
Objectives: To determine the long-term trajectories of health system use by persons with dementia as they remain in the community over time.
Design: Population-based cohort study using health administrative data.
Setting: Ontario, Canada from 1 April 2007 to 31 March 2014.