Health Care Utilization of US Medicare Beneficiaries Living with Parkinson’s Disease

Pearson, Caroline F.; Hartzman, Alex; Munevar, Dianne; Feeney, Megan; Dolhun, Rachel; Todaro, Veronica; Rosenfeld, Sheera; Willis, Allison W.; Beck, James C.

doi:10.1101/2022.06.03.22275470

Cited by 3 publications

(6 citation statements)

References 19 publications

(53 reference statements)

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“…Our data may not fully capture deaths among all individuals with ADRDs, if ADRD was undiagnosed, or if the diagnosis was not considered to contribute to death . However, the patterns of temporal changes in ADRD-related excess deaths that our study revealed are corroborated by Medicare data, which showed a decline in excess deaths among individuals with ADRD in 2021 . Our findings may underestimate the number of ADRD-related deaths from racial and ethnic minority groups in whom ADRD underdiagnosis is common .…”

Section: Discussionmentioning

confidence: 59%

“… 29 However, the patterns of temporal changes in ADRD-related excess deaths that our study revealed are corroborated by Medicare data, which showed a decline in excess deaths among individuals with ADRD in 2021. 30 Our findings may underestimate the number of ADRD-related deaths from racial and ethnic minority groups in whom ADRD underdiagnosis is common. 31 Finally, the 2022 death certificate data are provisional.…”

Section: Discussionmentioning

confidence: 67%

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Excess Mortality With Alzheimer Disease and Related Dementias as an Underlying or Contributing Cause During the COVID-19 Pandemic in the US

et al. 2023

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ImportanceAdults with Alzheimer disease and related dementias (ADRD) are particularly vulnerable to the direct and indirect effects of the COVID-19 pandemic. Deaths associated with ADRD increased substantially in pandemic year 1. It is unclear whether mortality associated with ADRD declined when better prevention strategies, testing, and vaccines became widely available in year 2.ObjectiveTo compare pandemic-era excess deaths associated with ADRD between year 1 and year 2 overall and by age, sex, race and ethnicity, and place of death.Design, Setting, and ParticipantsThis time series analysis used all death certificates of US decedents 65 years and older with ADRD as an underlying or contributing cause of death from January 2014 through February 2022.ExposureCOVID-19 pandemic era.Main Outcomes and MeasuresPandemic-era excess deaths associated with ADRD were defined as the difference between deaths with ADRD as an underlying or contributing cause observed from March 2020 to February 2021 (year 1) and March 2021 to February 2022 (year 2) compared with expected deaths during this period. Expected deaths were estimated using data from January 2014 to February 2020 fitted with autoregressive integrated moving average models.ResultsOverall, 2 334 101 death certificates were analyzed. A total of 94 688 (95% prediction interval [PI], 84 192-104 890) pandemic-era excess deaths with ADRD were estimated in year 1 and 21 586 (95% PI, 10 631-32 450) in year 2. Declines in ADRD-related deaths in year 2 were substantial for every age, sex, and racial and ethnic group evaluated. Pandemic-era ADRD-related excess deaths declined among nursing home/long-term care residents (from 34 259 [95% PI, 25 819-42 677] in year 1 to −22 050 [95% PI, −30 765 to −13 273] in year 2), but excess deaths at home remained high (from 34 487 [95% PI, 32 815-36 142] in year 1 to 28 804 [95% PI, 27 067-30 571] in year 2).Conclusions and RelevanceThis study found that large increases in mortality with ADRD as an underlying or contributing cause of death occurred in COVID-19 pandemic year 1 but were largely mitigated in pandemic year 2. The most pronounced declines were observed for deaths in nursing home/long-term care settings. Conversely, excess deaths at home and in medical facilities remained high in year 2.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 67%

Excess Mortality With Alzheimer Disease and Related Dementias as an Underlying or Contributing Cause During the COVID-19 Pandemic in the US

et al. 2023

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“…A unifying principle of rehabilitative care is the integration of the multidisciplinary team. This integration may be facilitated on a practice level by scheduled and regular multidisciplinary rehabilitative team meetings in outpatient, inpatient rounding, and/or case conference settings [27,55,56]. Examples from interprofessional, multidisciplinary rehabilitation care for stroke and other neurological conditions may provide insights for team-based opportunities for people with PD [57][58][59].…”

Section: E4mentioning

confidence: 99%

“…Based on the available evidence-base and its expert opinion, the Task Force presents what it considers optimal rehabilitative interventions across the stages of PD for the disciplines of OT, PT, SLP, and psychology/neuropsychology. The Task Force chose to focus on these disciplines for this document given current literature supporting their roles in PD and their generally greater availability and accessibility to the PD community across diverse practice settings and delivery models, even though often under-utilized, at present [23,24,56]. To date, the largest body of evidence exists for PT, and PT is more commonly represented among rehabilitation services used in PD compared to OT and SLP [23,24]; however, for this document, we have chosen to present the rehabilitation disciplines in alphabetical order as OT, PT, and SLP, followed by psychology/neuropsychology.…”

Section: Guidance For Discipline-specific Rehabilitative Interventionsmentioning

confidence: 99%

Delivering Multidisciplinary Rehabilitation Care in Parkinson’s Disease: An International Consensus Statement

Goldman,

Volpe,

Ellis

et al. 2024

JPD

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Background: Parkinson’s disease (PD) is a complex neurodegenerative disorder impacting everyday function and quality of life. Rehabilitation plays a crucial role in improving symptoms, function, and quality of life and reducing disability, particularly given the lack of disease-modifying agents and limitations of medications and surgical therapies. However, rehabilitative care is under-recognized and under-utilized in PD and often only utilized in later disease stages, despite research and guidelines demonstrating its positive effects. Currently, there is a lack of consensus regarding fundamental topics related to rehabilitative services in PD. Objective: The goal of the international Parkinson’s Foundation Rehabilitation Medicine Task Force was to develop a consensus statement regarding the incorporation of rehabilitation in PD care. Methods: The Task Force, comprised of international multidisciplinary experts in PD and rehabilitation and people directly affected by PD, met virtually to discuss topics such as rehabilitative services, existing therapy guidelines and rehabilitation literature in PD, and gaps and needs. A systematic, interactive, and iterative process was used to develop consensus-based statements on core components of PD rehabilitation and discipline-specific interventions. Results: The expert-based consensus statement outlines key tenets of rehabilitative care including its multidisciplinary approach and discipline-specific guidance for occupational therapy, physical therapy, speech language pathology/therapy, and psychology/neuropsychology across all PD stages. Conclusions: Rehabilitative interventions should be an essential component in the comprehensive treatment of PD, from diagnosis to advanced disease. Greater education and awareness of the benefits of rehabilitative services for people with PD and their care partners, and further evidence-based and scientific study are encouraged.

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“…Long-standing research documents that PD is diagnosed less commonly in Black (versus White) adults [52][53][54][55], with a prevalence ratio of 0.58 (95% CI 0.575-0.81) using 1995 and 2000-2005 Medicare data [55]. In an analysis using 2019 Medicare data, Black adults represented only 5.9% of the PD cohort despite accounting for 10.5% of the Medicare population [56]. It is also established that PD diagnoses are often delayed in Black adults and occur at a greater disease severity [52][53][54].…”

Section: Parkinsonismmentioning

confidence: 99%

Under-Diagnosis of Dementia with Lewy Bodies in Individuals Racialized as Black: Hypotheses Regarding Potential Contributors

Armstrong,

Barnes

2024

JAD

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Dementia with Lewy bodies (DLB) is one of the most common degenerative dementias after Alzheimer’s disease (AD) dementia. DLB is under-diagnosed across populations but may be particularly missed in older Black adults. The object of this review was to examine key features of DLB and potential associations with race in order to hypothesize why DLB may be under-diagnosed in Black adults in the U.S. In terms of dementia, symptoms associated with high rates of co-pathology (e.g., AD, vascular disease) in older Black adults may obscure the clinical picture that might suggest Lewy body pathology. Research also suggests that clinicians may be predisposed to give AD dementia diagnoses to Black adults, potentially missing contributions of Lewy body pathology. Hallucinations in Black adults may be misattributed to AD or primary psychiatric disease rather than Lewy body pathology. Research on the prevalence of REM sleep behavior in diverse populations is lacking, but REM sleep behavior disorder could be under-diagnosed in Black adults due to sleep patterns or reporting by caregivers who are not bed partners. Recognition of parkinsonism could be reduced in Black adults due to clinician biases, cultural effects on self-report, and potentially underlying differences in the frequency of parkinsonism. These considerations are superimposed on structural and systemic contributions to health (e.g., socioeconomic status, education, structural racism) and individual-level social exposures (e.g., social interactions, discrimination). Improving DLB recognition in Black adults will require research to investigate reasons for diagnostic disparities and education to increase identification of core symptoms in this population.

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Health Care Utilization of US Medicare Beneficiaries Living with Parkinson’s Disease

Cited by 3 publications

References 19 publications

Excess Mortality With Alzheimer Disease and Related Dementias as an Underlying or Contributing Cause During the COVID-19 Pandemic in the US

Excess Mortality With Alzheimer Disease and Related Dementias as an Underlying or Contributing Cause During the COVID-19 Pandemic in the US

Delivering Multidisciplinary Rehabilitation Care in Parkinson’s Disease: An International Consensus Statement

Under-Diagnosis of Dementia with Lewy Bodies in Individuals Racialized as Black: Hypotheses Regarding Potential Contributors

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