Assessing the relationship between health utilities, quality of life, and health services use in Alzheimer's disease

Miller, Edward; Schneider, Lon S.; Rosenheck, Robert A.

doi:10.1002/gps.2160

Cited by 7 publications

(17 citation statements)

References 41 publications

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“…Higher utilities imply better adaptation and functioning, which, in turn, should reduce the probability of using particular services. This assumption is supported by two recent studies (Miller, Rosenheck, and Schneider 2009; Miller, Schneider, and Rosenheck 2009). …”

Section: Introductionsupporting

confidence: 73%

“…Since the main effect sign of the HUI-III is negative in baseline models without interactions (Miller, Schneider, and Rosenheck 2009), the sign on each HUI-III*caregiver burden interaction term is hypothesized to be positive, indicating that it has a dampening effect on the inverse relationship between HUI-III score and institutional service use identified previously, i.e. leading to greater use than would be expected at a given level of health.…”

Section: Methodsmentioning

confidence: 98%

“…These include models predicting inpatient medical use (Balardy, et al 2005; Fillenbaum et al, 2000; Miller, Schneider, and Rosenheck 2009; Small et al, 2002; Porell and Carter 2005), nursing home use (Chan et al, 2003; Cohen, et al 1993; Gaugler et al, 2000, 2004; Hebert, et al,. 2001; Hill, et al 2006; Hux, et al 1998; Mausbach, et al 2004; Phillips and Diwan 2003), and residential care use(Cox 1998; Miller, Schneider, and Rosenheck 2009). One rarely studied correlate is health utilities which are measured using instruments that assign patients a quality of life state based on responses to a health status questionnaire weighted using previously determined weights from other populations (Miller, et al 2009; Naglie, et al 2006).…”

Section: Introductionmentioning

confidence: 99%

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Caregiver burden, health utilities, and institutional service use in Alzheimer's disease

Miller

Rosenheck

Schneider

2011

Int J Geriat Psychiatry

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Objective This study examined the moderating effect of caregiver burden on the relationship between the health status of Alzheimer’s disease (AD) patients and their use of institutional services (i.e., hospitalization, nursing home, and residential care). Methods Data were obtained at baseline and 3-, 6-, and 9-months following study entry on 421 community-dwelling patients with AD in the CATIE-AD trial. The outcome variable includes use of any institutional services. Logistic regression was employed to estimate the interaction of Health Utility Index (HUI)-III score (a general health status measure) at outcome and four concurrent caregiver burden measures. Marginal effects were calculated and plotted using random effects models for observations at multiple time points per individual. Average effects were calculated across all observations using models without random effects. Results Random effects results suggest that caregiver burden weakens the inverse relationship between health utilities and institutional service use, leading to greater likelihood of institutional use than would be expected at a given level of health. This is indicated by positive, significant signs on the HUI-III*caregiver burden interaction when burden is measured using the Caregiver Distress Scale, Beck Depression Inventory (BDI), and Caregiver Assessment Survey (all p<.05). It is reinforced by positive, significant average effects deriving from Caregiver Distress and BDI models without random effects (both p<.10). Results deriving from the Burden Interview Scale, though positive, were non-significant and weak by comparison. Conclusion Caregiver support interventions should be offered to individuals caring for less advanced AD patients. Otherwise healthy patients may be at increased risk for institutionalization when caregivers experience high levels of burden.

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Section: Introductionsupporting

confidence: 73%

Section: Methodsmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Caregiver burden, health utilities, and institutional service use in Alzheimer's disease

Miller

Rosenheck

Schneider

2011

Int J Geriat Psychiatry

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“…There is an extensive literature investigating the correlates of cost and utilization associated with AD and other dementia, including inpatient medical, 4-8 nursing home, 7-18 and residential care. 7,8,14,15,19 However, few extant studies examine the relationship between service utilization or costs in AD and health utilities, which may be measured using standard, generic, multi-attribute preference-based utility instruments.…”

Section: Introductionmentioning

confidence: 99%

“…7,8,14,15,19 However, few extant studies examine the relationship between service utilization or costs in AD and health utilities, which may be measured using standard, generic, multi-attribute preference-based utility instruments. 20,21 These instruments assign patients a quality of life state based on responses to a health status questionnaire weighted using previously determined weights from other populations.…”

Section: Introductionmentioning

confidence: 99%

Caregiver Burden, Health Utilities, and Institutional Service Costs Among Community-dwelling Patients With Alzheimer Disease

Miller

Rosenheck

Schneider

2010

Alzheimer Disease &Amp; Associated Disorders

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This study examined the moderating effect of caregiver burden on the relationship between patients’ health status and institutional costs in Alzheimer's disease (AD). Data were obtained on whether 421 community-dwelling patients with AD in the CATIE-AD trial received institutional services in the month preceding baseline and at 3-, 6-, and 9-months follow-up. All participants had a caregiver who lived with or visited them regularly. Outcome variables include hospital, nursing home, residential, and combined institutional costs. Mixed models were employed to estimate the interaction of Health Utility Index (HUI)-III scores (a health status measure) and five measures of caregiver burden. Wherever significant, results indicate that greater caregiver burden weakens the inverse relationship between health utilities and institutional costs, leading to greater costs than would be expected at a given level of health. Altogether 45.0% of the models (9/20) showed this effect (positive coefficient on the burden-HUI interaction term). Interventions should be based on caregiver burden, regardless of care recipient health status, for even seemingly manageable patients may be at heightened risk for institutionalization if caregivers experience sufficiently high levels of burden.

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Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review

Hinton,

Tran,

Peak

et al. 2024

Alzheimer's & Dementia

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INTRODUCTIONWe set out to map evidence of disparities in Alzheimer's disease and Alzheimer's disease related dementias healthcare, including issues of access, quality, and outcomes for racial/ethnic minoritized persons living with dementia (PLWD) and family caregivers.METHODSWe conducted a scoping review of the literature published from 2000 to 2022 in PubMed, PsycINFO, and CINAHL. The inclusion criteria were: (1) focused on PLWD and/or family caregivers, (2) examined disparities or differences in healthcare, (3) were conducted in the United States, (4) compared two or more racial/ethnic groups, and (5) reported quantitative or qualitative findings.RESULTSKey findings include accumulating evidence that minoritized populations are less likely to receive an accurate and timely diagnosis, be prescribed anti‐dementia medications, and use hospice care, and more likely to have a higher risk of hospitalization and receive more aggressive life‐sustaining treatment at the end‐of‐life.DISCUSSIONFuture studies need to examine underlying processes and develop interventions to reduce disparities while also being more broadly inclusive of diverse populations.

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Assessing the relationship between health utilities, quality of life, and health services use in Alzheimer's disease

Abstract: Findings suggest that the HUI-III could be combined with other known correlates of service use to inform population planning associated with AD.

Cited by 7 publications

References 41 publications

Caregiver burden, health utilities, and institutional service use in Alzheimer's disease

Caregiver burden, health utilities, and institutional service use in Alzheimer's disease

Caregiver Burden, Health Utilities, and Institutional Service Costs Among Community-dwelling Patients With Alzheimer Disease

Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review

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