Abstract
Evaluate the independent and interactive effects of dementia and racial/ethnic minority status on functional outcomes during a home health (HH) admission among Medicare beneficiaries. Secondary analysis of data from the Outcome and Assessment Information Set [OASIS] and billing records in a non-profit HH agency in New York. Participants were adults ≥ 65 years old who received HH in CY 2017 with OASIS records at HH admission and HH discharge. Dementia was identified by diagnosis (ICD-10 codes) and cognitive impairment (OASIS: M1700, M1710, M1740). We used OASIS records to assess race/ethnicity (M0140) and functional status (M1800-M1870 on activities of daily living [ADL]). Functional outcome was measured as change in the composite ADL score from HH admission to HH discharge, where a negative score means improvement and a positive score means decline. The sample included 4,783 patients, among whom 93.9% improved in ADLs at HH discharge. In multivariable linear regression that adjusted for HH service use and covariates (R2 = 0.23), being African American (β = 0.21, 95% confidence interval [CI]: 0.06, 0.35, p = 0.005) and having dementia (β = 0.51, 95% CI: 0.41, 0.62, p<0.001) were independently related to less ADL improvement at HH discharge, with significant interaction related to further decrease in ADL improvement. Relative to white patients without dementia, African American patients with dementia (β = 1.08, 95% CI: 0.81, 1.35, p<0.001), Hispanics with dementia (β = 0.92, 95% CI: 0.38, 1.47, p = 0.001) and Asian Americans with dementia (β = 1.47, 95% CI: 0.81, 2.13, p<0.001) showed the least ADL improvement at HH discharge. Racial/ethnic minority status and dementia were associated with less ADL improvement in HH with independent and interactive effects. Policies should ensure that these patients have equitable access to appropriate, adequate community-based services to meet their needs in ADLs and disease management for improved outcomes.
Highlights
Older adults with dementia often have considerable functional limitations and disease management needs with comorbidities [1, 2]
In multivariable linear regression that adjusted for HH service use and covariates (R2 = 0.23), being African American (β = 0.21, 95% confidence interval [CI]: 0.06, 0.35, p = 0.005) and having dementia (β = 0.51, 95% CI: 0.41, 0.62, p
Racial/ethnic minority status and dementia were associated with less ADL improvement in HH with independent and interactive effects
Summary
Older adults with dementia often have considerable functional limitations and disease management needs with comorbidities [1, 2]. In the United States, more than 5.7 million adults older than 65 year have dementia [3], and the majority of them live at home [4]. Dementia causes gradual functional decline with increasing need for assistance with activities of daily living (ADL) over time [3]. A national study estimated that over a 5-year period, 3.3 million older Americans developed incident moderately severe dementia and had an average of three to five ADL limitations [5]. Older adults with dementia experience higher prevalence of comorbidities than peers without dementia, which require substantial disease management efforts. Dementia/comorbidities and functional limitation form a downward spiral which increases the risks for hospitalizations and nursing home admissions [13,14,15,16]
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