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Although administrative claims data can be used to identify high-need (HN) Medicare beneficiaries, persistence in HN status among beneficiaries and subsequent variation in outcomes are unknown. We use national-level claims data to classify Fee-for-Service (FFS) Medicare beneficiaries as HN annually among beneficiaries continuously enrolled between 2013 and 2015. To examine persistence of HN status over time, we categorize longitudinal patterns in HN status into being never, newly, transiently, and persistently HN and examine differences in patients’ demographic characteristics and outcomes. Among survivors, 23% of beneficiaries were HN at any time—4% persistently HN, 13% transiently HN, and 6% newly HN. While beneficiaries who were persistently HN had higher mortality, utilization, and expenditures, classification as HN at any time was associated with poor outcomes. These findings demonstrate longitudinal variability of HN status among FFS beneficiaries and reveal the pervasiveness of poor outcomes associated with even transitory HN status over time.

Objectives Measurement of food insecurity in older adults is focused on financial barriers to food access. Given that older adults are particularly susceptible to additional access-related barriers including functional limitations and lack of social support, the objective of this study was to construct a summary indicator of food insecurity incorporating these domains. Methods We used nationally representative survey data from Round 5 of the National Health and Aging Trends Study (NHATS; n = 7,070). We constructed a summary indicator of food insecurity using factors within the following three domains: functional, social support, and financial limitations. First, we identified the prevalence of food insecurity among the sample as defined by the new summary indicator. Then, we estimated unadjusted and adjusted logistic regression models to assess the association between the expanded measure of food insecurity and biopsychosocial factors. Results In 2015, 4.3% (95% confidence interval [CI] 3.75–4.94) of community-dwelling older adults, approximately 1,673,775 million people, were characterized as having food insecurity. Multivariable-adjusted regression models identified that being homebound (odds ratio [OR] 3.49, 95% CI 2.03, 6.00), frail (OR 9.50, 95% CI 4.92–18.37), and experiencing community disability (OR 5.19, 95% CI 3.90–6.90) was associated with food insecurity. Discussion Food insecurity among older adults is broader than lacking adequate financial resources to obtain food; it is also associated with social and functional limitations. A more comprehensive conceptualization will aid future study on the impact of food insecurity on health status, utilization, and outcomes to inform senior nutrition program targeting and services.

Structured Abstract Objective To examine racial differences in use of rehabilitation services and functional improvement while rehabilitation services were received Design Secondary analysis of the 2016 National Health and Aging Trends Study (NHATS) Setting Standardized in-person home interviews Participants 6,309 community-dwelling Medicare enrollees, 1,276 of whom reported receiving rehabilitation services in the previous 12 months Measures Patient-reported use of rehabilitation services, setting (inpatient, outpatient, home-based), reason for use, and perceptions of change in functioning after receiving rehabilitation services Results Controlling for gender, dual eligibility for Medicaid, age, number of chronic conditions, functional mobility at the prior round, income, and geographic region, Whites had 1.38 times the odds of receiving rehabilitation in any setting compared to Blacks (95% CI=1.09, 1.75). Among those receiving therapy, Whites were more likely to receive home-based and inpatient rehabilitation services, but there were no racial differences in improvement in function. Conclusion Strategies are needed to identify possible barriers to use of rehabilitation services for vulnerable groups of aging individuals who need rehabilitation services, particularly for older African Americans.

OBJECTIVES High‐need (HN) Medicare beneficiaries heavily use healthcare services at a high cost. This population is heterogeneous, composed of individuals with varying degrees of medical complexity and healthcare needs. To improve healthcare delivery and decrease costs, it is critical to identify the subpopulations present within this population. We aimed to (1) identify distinct clinical phenotypes present within HN Medicare beneficiaries, and (2) examine differences in outcomes between phenotypes. DESIGN Latent class analysis was used to identify phenotypes within a sample of HN fee‐for‐service (FFS) Medicare beneficiaries aged 65 years and older using Medicare claims and post‐acute assessment data. SETTING Not applicable. PARTICIPANTS Two cross‐sectional cohorts were used to identify phenotypes. Cohorts included FFS Medicare beneficiaries aged 65 and older who survived through 2014 (n = 415 659) and 2015 (n = 416 643). MEASUREMENTS The following variables were used to identify phenotypes: acute and post‐acute care use, functional dependency in one or more activities of daily living, presence of six or more chronic conditions, and complex chronic conditions. Mortality, hospitalizations, healthcare expenditures, and days in the community were compared between phenotypes. RESULTS Five phenotypes were identified: (1) comorbid ischemic heart disease with hospitalization and skilled nursing facility use (22% of the HN sample), (2) comorbid ischemic heart disease with home care use (23%), (3) home care use (12%), (4) high comorbidity with hospitalization (32%), and (5) Alzheimer's disease/related dementias with functional dependency and nursing home use (11%). Mortality was highest in phenotypes 1 and 2; hospitalizations and expenditures were highest in phenotypes 1, 3, and 4. CONCLUSIONS Our findings represent a first step toward classifying the heterogeneity among HN Medicare beneficiaries. Further work is needed to identify modifiable utilization patterns between phenotypes to improve the value of healthcare provided to these subpopulations. J Am Geriatr Soc 68:70–77, 2019

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OBJECTIVES: Physical function declines with aging and is accelerated for persons with cardiovascular disease (CVD). While CVD increases the risk of functional decline in late life, little is known about differences in trajectories of functional decline. To determine whether there is more than 1 trajectory of functional decline in Americans with cardiovascular disease (CVD) who are functionally independent. DESIGN: Secondary analysis of National Health and Aging Trends Study (NHATS). Latent class growth modeling was used to estimate trajectories of function over 4 years of follow-up. SETTING: Annual structured in-home interviews. PARTICIPANTS: Americans aged 65 and older with CVD who were functionally independent at baseline (N = 392). MEASUREMENTS: We compared trajectories of function in individuals with CVD with trajectories of those without and examined the association between risk factors (sex, age at baseline, education level, comorbidity) and trajectory group membership. Function was measured using the Short Physical Performance Battery. RESULTS: Three functional trajectories emerged: rapid functional decline (23.8%), gradual functional decline (44.2%), and stable function (32.0%). Similar trajectories were seen for those without CVD, with a smaller proportion in the rapid functional decline group (16.2%). Women, older participants, and those with less education and greater comorbidity were less likely to be in the stable function group than the rapid functional decline group. CONCLUSION: Although function declines in late life for independently functioning persons with CVD, some individuals remain stable, and others decline gradually or rapidly. Persons with CVD were more likely to experience rapid functional decline than those without, suggesting that CVD increases the risk of rapid functional decline. Risk factors predicted functional trajectory group membership, not just overall decline.

PURPOSE: To examine the impact of global risk, a measure comprising age, comorbidities, function, and cognitive statuses, on treatment selection and outcomes among older home care recipients with diffuse large B-cell lymphoma. METHODS: From SEER-Medicare, we selected home care recipients diagnosed with diffuse large B-cell lymphoma in 2011-2015, who had pretreatment Outcome and Assessment Information Set (OASIS) evaluations. We created a global risk indicator categorizing patients as low-, moderate-, or high-risk on the basis of OASIS assessments. We examined the association of global risk with receipt of therapy and among chemotherapy recipients, with mortality, emergency department visits, hospitalization, and intensive care unit admission within 30 days from first treatment in logistic models, reporting adjusted odds ratios (OR) with 95% CI. We compared overall survival across risk groups estimating adjusted hazard ratios. RESULTS: Of the 1,232 patients (median age, 80 years), 65% received chemotherapy. High-risk patients ( v moderate-risk) were less likely to receive any chemotherapy (OR, 0.50; 95% CI, 0.39 to 0.64) and curative regimens (OR, 0.59; 95% CI, 0.40 to 0.86) if treated, although even in the moderate-risk group, only 61% received curative regimens. High-risk patients were more likely to experience acute mortality (OR, 2.24; 95% CI, 1.43 to 3.52), emergency department visits (OR, 1.35; 95% CI, 1.00 to 1.83), hospitalization (OR, 1.60; 95% CI, 1.19 to 2.17), or intensive care unit admission (OR, 1.52; 95% CI, 1.04 to 2.22) and had inferior overall survival (hazard ratio, 1.41; 95% CI, 1.11 to 1.78). CONCLUSION: Global risk on the basis of OASIS is easily available, suggesting a potential way to improve patient selection for curative treatment and institution of preventive measures.