Quality of Care and Outcomes Among a Diverse Group of Long-Term Care Residents With Alzheimer’s Disease and Related Dementias

Rivera‐Hernandez, Maricruz; Kumar, Amit; Roy, Indrakshi; Fashaw-Walters, Shekinah; Baldwin, Julie A.

doi:10.1177/08982643211043319

Cited by 5 publications

(11 citation statements)

References 49 publications

(64 reference statements)

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“…55 Anti-depressant use was also higher in NHW compared to other racial/ethnic groups. 56 Finally, one study found higher rates of anti-psychotic medication (i.e., "low value care") in Hispanic Americans and NHW compared to the "other race" category. 57 Two studies reported on potentially inappropriate medication use-"drugs that should generally be avoided because they are ineffective or pose an unnecessarily high risk for older adults, and drugs that are appropriate to use in older persons only at certain doses, frequencies, or duration of therapies."…”

Section: Total Sample (N) Racial/ethnic Populations Resultsmentioning

confidence: 99%

“…Six studies reported on use of psychotropic medications across racial/ethnic groups 52–57 . Three of these studies found higher use of anti‐psychotic medication in Hispanic Americans compared to NHW 52–54 adults while one study reported higher use in NHW compared to Hispanic Americans 55 .…”

Section: Resultsmentioning

confidence: 99%

“…One study reported lower use of anti‐psychotic medication in Black Americans and AA/PI compared to NHW, Hispanic Americans, and AI/AN groups 56 and another study found higher use of anxiolytics in Black Americans compared to NHW individuals 55 . Anti‐depressant use was also higher in NHW compared to other racial/ethnic groups 56 . Finally, one study found higher rates of anti‐psychotic medication (i.e., “low value care”) in Hispanic Americans and NHW compared to the “other race” category 57 …”

Section: Resultsmentioning

confidence: 99%

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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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Section: Total Sample (N) Racial/ethnic Populations Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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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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“…Yet, little work has examined racial/ethnic disparities in QOL domains measured by validated instruments studied in AD/ADRD populations (Qin et al, 2021). While previous studies have found racial/ethnic disparities in NH QoC outcomes for people with AD/ADRD (Rivera-Hernandez et al, 2019, 2022), this is the first study to use multiple sources of data to examine racial/ethnic disparities in QoL for NH residents with AD/ADRD, giving voice to a vulnerable population’s experience.…”

Section: Discussionmentioning

confidence: 97%

“…Importantly, minoritized persons have poorer access to NHs with specialized dementia care units, which may be associated with better outcomes (Rivera-Hernandez et al, 2019). Finally, Rivera-Hernandez et al (2019, 2022) examined differences in NH QoC among Medicare beneficiaries (Rivera-Hernandez et al, 2019, 2022). They found that a larger share of Hispanic Medicare residents who are admitted to NHs have AD/ADRD compared with Black and White beneficiaries.…”

Section: Background and Contextmentioning

confidence: 99%

Racial Differences in Nursing Home Quality of Life Among Residents Living With Alzheimer’s Disease and Related Dementias

et al. 2023

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Objectives Among nursing home (NH) residents with Alzheimer’s disease (AD) and AD-related dementias (AD/ADRD), racial/ethnic disparities in quality of care exist. However, little is known about quality of life (QoL). This study examines racial/ethnic differences in self-reported QoL among NH residents with AD/ADRD. Methods: Validated, in-person QoL surveys from 12,562 long-stay NH residents with AD/ADRD in Minnesota (2012–2015) were linked to Minimum Data Set assessments and facility characteristics. Hierarchical linear models assessed disparities in resident-reported mean QoL score (range, 0–100 points), adjusting for case-mix and facility factors. Results: Compared to White residents, racially/ethnically minoritized residents reported significantly lower total mean QoL scores (75.53 points vs. 80.34 points, p < .001). After adjustment for resident- and facility-level characteristics, significant racial/ethnic differences remained, with large disparities in food enjoyment, attention from staff, and engagement domains. Discussion: Policy changes and practice guidelines are needed to address racial/ethnic disparities in QoL of NH residents with AD/ADRD.

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Physician Antipsychotic Overprescribing Letters and Cognitive, Behavioral, and Physical Health Outcomes Among People With Dementia

Harnisch,

Barnett,

Coussens

et al. 2024

JAMA Netw Open

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ImportanceAntipsychotics, such as quetiapine, are frequently prescribed to people with dementia to address behavioral symptoms but can also cause harm in this population.ObjectiveTo determine whether warning letters to high prescribers of quetiapine can successfully reduce its use among patients with dementia and to investigate the impacts on patients’ health outcomes.Design, Setting, and ParticipantsThis is a secondary analysis of a randomized clinical trial of overprescribing letters that began in April 2015 and included the highest-volume primary care physician (PCP) prescribers of quetiapine in original Medicare. Outcomes of patients with dementia were analyzed in repeated 90-day cross-sections through December 2018. Analyses were conducted from September 2021 to February 2024.InterventionsPCPs were randomized to a placebo letter or 3 overprescribing warning letters stating that their prescribing of quetiapine was high and under review by Medicare.Main Outcomes and MeasuresThe primary outcome of this analysis was patients’ total quetiapine use in days per 90-day period (the original trial primary outcome was total quetiapine prescribing by study PCPs). Prespecified secondary outcomes included measures of cognitive function and behavioral symptoms from nursing home assessments, indicators of depression from screening questionnaires in assessments and diagnoses in claims, metabolic diagnoses derived from assessments and claims, indicators of use of the hospital and other health care services, and death. Outcomes were analyzed separately for patients living in nursing homes and in the community.ResultsOf the 5055 study PCPs, 2528 were randomized to the placebo letter, and 2527 were randomized to the 3 warning letters. A total of 84 881 patients with dementia living in nursing homes and 261 288 community-dwelling patients with dementia were attributed to these PCPs. There were 92 874 baseline patients (mean [SD] age, 81.5 [10.5] years; 64 242 female [69.2%]). The intervention reduced quetiapine use among both nursing home patients (adjusted difference, –0.7 days; 95% CI, −1.3 to −0.1 days; P = .02) and community-dwelling patients (adjusted difference, −1.5 days; 95% CI, −1.8 to −1.1 days; P &lt; .001). There were no detected adverse effects on cognitive function (cognitive function scale adjusted difference, 0.01; 95% CI, −0.01 to 0.03; P = .19), behavioral symptoms (agitated or reactive behavior adjusted difference, −0.2%; 95% CI −1.2% to 0.8% percentage points; P = .72), depression, metabolic diagnoses, or more severe outcomes, including hospitalization and death.Conclusions and RelevanceThis study found that overprescribing warning letters to PCPs safely reduced quetiapine prescribing to their patients with dementia. This intervention and others like it may be useful for future efforts to promote guideline-concordant care.Trial RegistrationClinicalTrials.gov Identifier: NCT05172687

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Quality of Care and Outcomes Among a Diverse Group of Long-Term Care Residents With Alzheimer’s Disease and Related Dementias

Cited by 5 publications

References 49 publications

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

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

Racial Differences in Nursing Home Quality of Life Among Residents Living With Alzheimer’s Disease and Related Dementias

Physician Antipsychotic Overprescribing Letters and Cognitive, Behavioral, and Physical Health Outcomes Among People With Dementia

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