IMPORTANCE Adults with dementia may experience poorer quality of chronic disease management because of the difficulty in reporting symptoms and engaging in shared decision-making associated with cognitive impairment. OBJECTIVE To compare the quality of chronic disease management received by adults with and without dementia. DESIGN, SETTING, AND PARTICIPANTS For this cross-sectional study, nationally representative data from noninstitutionalized patients 65 years or older were obtained from the 2002-2015 Medical Expenditure Panel Survey. The control group comprised adults of similarly limited life expectancy without dementia comprised . Data analysis was performed in June 2020. EXPOSURES Dementia diagnosis. MAIN OUTCOMES AND MEASURES Quality of chronic disease management based on 14 individual quality indicators. The association between dementia status and the quality of chronic disease management (3 composite categories: preventive care, diabetes care, and medication treatment) was examined using multivariable linear regression models. Survey weights, sampling strata, and primary sampling unit variables were used to produce national estimates adjusted for nonresponse. RESULTS This study included 2506 adults (mean [SD] age, 81.4 [4.7] years; 1259 [49.3%] female;1243 [50.7%] male), of whom 1335 (53.3%) had a diagnosis of dementia and 1171 (46.7%) did not have a diagnosis of dementia. After adjusting for potential confounders, adults with dementia received lower-quality preventive care compared with adults of similar life expectancy without dementia (adjusted absolute difference [aAD], −6.1 percentage points [pp]; 95% CI, −9.7 to −2.5 pp; P = .001). We found no evidence that the quality of care differed in diabetes care (aAD, 1.7 pp; 95% CI, −4.5 to 7.9 pp; P = .59) and medication treatment (aAD, 1.0 pp; 95% CI, −5.0 to 7.0 pp; P = .75). CONCLUSIONS AND RELEVANCEIn this cross-sectional study, the quality of chronic disease management for adults with dementia was not substantially different from that for those without dementia despite potential barriers. Future studies are warranted to gain a better understanding of the underlying mechanism of these findings for preventive care.
The detrimental effects of incarceration on physical and mental health are widely acknowledged. However, 76% of the United States jail population is awaiting trial without having been convicted of a crime (Sawyer and Wagner 2020). This is driven by the monetary bail system, which the state of California moved to abolish by passing the 2018 California Money Bail Reform Act (Senate Bill 10, hereafter SB 10). SB 10 proposes the use of algorithmically driven risk assessment tools to determine pretrial release. However, actuarial risk assessments are not calibrated to California’s diverse demography and are insufficient to determine which defendants pose flight or public safety risks. SB 10 is predicted to perpetuate similar socioeconomic and racial disparities as the current system, while failing to decrease pretrial detention. We recommend opposing SB 10 in favor of pretrial release for most misdemeanor and nonviolent defendants. The funding currently allocated for pretrial detainment should be redirected toward evidence-based and restorative pretrial supervision practices through the enactment of new bail-reform legislation by the state of California. Increasing the use of diversion programs, which redirect defendants to the appropriate mental health or substance abuse programs, also presents opportunities to restore treatment to the jurisdiction of public health rather than criminal justice. Transitioning from a reliance on pretrial detention to pretrial services will mitigate the collateral effects of incarceration while improving public health, public safety, and substantially reducing the cost of incarceration.
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