Abstract
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. To compare the quality of chronic disease management received by adults with and without dementia. 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. Dementia diagnosis. 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. 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). In 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.
Highlights
Little is known about the quality of chronic disease management provided to adults with dementia in the US
After adjusting for potential confounders, adults with dementia received lower-quality preventive care compared with adults of similar life expectancy without dementia
We found no evidence that the quality of care differed in diabetes care and medication treatment
Summary
Little is known about the quality of chronic disease management provided to adults with dementia in the US. Memory deficits and impaired executive function may be associated with limited ability to report symptoms, missed appointments, difficulty in shared decision-making processes, and failure to follow treatment recommendations.[6] Behaviors associated with dementia, such as aggression and impulsivity, add another layer of complexity to the provision of high-quality chronic disease management. Existing studies[7,8,9,10,11,12,13] are limited to those conducted outside the US, those based on data obtained from limited regions in the US,[14,15] or those restricted to nursing home residents[16,17,18]; the association of dementia status with the quality of chronic disease management among community-dwelling individuals in the US at the national level is largely unknown
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