Long-term Care Costs Research Articles

Physical Frailty and Future Costs of Long-Term Care in Older Adults: Results from the NCGG-SGS

Introduction: Frailty is associated with adverse outcomes, but few studies have determined associations between the frailty phenotype and measures of healthcare burden, including long-term care insurance (LTCI) costs, in older community-dwelling populations. Objective: The aim of this study was to examine the association between frailty status and subsequent LTCI costs in Japanese community-dwelling older adults. Methods: The prospective data were from a cohort study (National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes [NCGG-SGS]). The participants were community-dwelling older adults (mean age 71.8 years, women 50.7%) participating in an NCGG-SGS baseline examination held between August 2011 and February 2012 in Obu, Japan (N = 4,539). At baseline, we assessed the physical frailty phenotype using the Japanese version of the CHS criteria and categorized it as robust, pre-frail, or frail. We also ascertained care-needs certification and total costs using long-term care services in Japan’s public LTCI system during the 29 months. Results: During the 29-month follow-up period, 239 participants (5.3%) required the LTCI system’s care-needs certification and 163 participants (3.6%) used LTCI services. Participants classified as frail (odds ratio 5.85, 95% confidence interval 3.54–9.66) or pre-frail (2.40, 1.58–3.66) at the baseline assessment had an increased risk of requiring care-needs certification compared with robust participants. The mean total costs for LTCI services during the 29 months were ¥6,434 ($63.1) for robust, ¥19,324 ($189.5) for pre-frail, and ¥147,718 ($1,448.2) for frail participants (1 US dollar = 102 Japanese yen in July 2014). There were significantly higher costs associated with advancing frailty status. Individual frailty components (slowness, weakness, exhaustion, low activity, and weight loss) were also associated with higher total costs for using LTCI services. Discussion/Conclusion: Frail community-dwelling older adults had a higher risk of requiring the LTCI system’s care-needs certification and the subsequent total LTCI costs.

Economic Burden of Alzheimer's Disease Dementia in Japan.

Background:Alzheimer’s disease dementia (ADD) is the leading cause of long-term care in Japan.Objective:This study estimates the annual healthcare and long-term care costs in fiscal year 2018 for adults over 65 years of age with ADD in Japan and the informal care costs and productivity loss for their families.Methods:Healthcare and long-term care costs for ADD were estimated according to the disease severity classified by the clinical dementia rating (CDR) score, using reports from a literature review. For the costs of time spent on caregiving activities, productivity loss for ADD family caregivers aged 20–69 and informal care costs for all ADD family caregivers were estimated.Results:The total healthcare cost of ADD was JPY 1,073 billion, of which 86% (JPY 923 billion) was attributed to healthcare costs other than ADD drug costs (JPY 151 billion). The healthcare costs other than ADD drug costs by severity were less than JPY 200 billion for CDR 0.5, CDR 1, and CDR 2, respectively, but increased to JPY 447 billion (48%) for CDR 3. The public long-term care costs were estimated to be JPY 4,783 billion, which increased according to the severity. Total productivity loss for ADD family caregivers aged 20–69 was JPY 1,547 billion and the informal care cost for all ADD family caregivers was JPY 6,772 billion.Conclusion:ADD costs have a significant impact on public-funded healthcare, long-term care systems, and families in Japan. To minimize the economic burden of ADD, prolonging healthy life expectancy is the key factor to address.

A Model-Based Estimation of Annual Long-Term Care Costs in Germany Following Post-Operative Cognitive Dysfunction (POCD) in Elderly Patients

Acute post-operative delirium (POD) and long-term post-operative cognitive dysfunction (POCD) are frequent and associated with increased mortality, dependency on care giving and institutionalization rates. The POCD-related cost burden on the German long-term care insurance provides an indication for the savings potential from risk-adapted treatment schemes. Comprehensive estimates have not been assessed or published so far. A model-based cost-analysis was designed to estimate POCD-related costs in the long-term care insurance. Comprehensive analysis of inpatient operations and procedures (OPS-codes) served as the base for case number calculations, which were then used as input to the actual cost model. POCD-incidence rates were obtained from the BioCog study. Various sensitivity analyses were performed to assess uncertainty of the model results. Total POCD related annual costs in the German long-term care insurance account for approximately 1.6 billion EUR according to the base case of our analysis. Total annual costs for all POCD cases depend on surgery numbers, incidence rates, other assumptions, and uncertain input parameters. The financial burden to the long-term care insurance is substantial, even in a conservative scenario of the cost model. Variability of results stems from uncertain assumptions, POCD-incidence rates and from uncertain patient numbers who are undergoing surgery and are therefore at risk to develop POCD.

State Variation in Long-Term Care Availability, Regulation, and Cost and Suicide Mortality Among Older Adults in the United States: 2010–2015

ObjectivesResidential long-term care (LTC) facilities may be key settings for the prevention of suicide among older adults; however, little is known about the relationship between statewide policies determining characteristics of LTC facilities and suicide mortality. The primary goal of this study was to evaluate the association between state policies regarding availability, regulation, and cost of LTC and suicide mortality among adults aged 55 and older in the United States over a 5-year period. DesignLongitudinal ecological study. Setting and ParticipantsLTC residents from 16 states reporting mortality data to the National Violent Death Reporting System (NVDRS) from 2010 to 2015. MethodsWe linked suicide data from the NVDRS and data sources on LTC services and regulations for 16 states. We applied a natural language-processing algorithm to identify suicide deaths related to LTC. We used fixed effect regression models to assess whether state variation in LTC characteristics is related to variation in the rate of suicide (both overall and related to LTC) among older adults. ResultsThere were 25,040 suicides among those aged 55 and older reported to the NVDRS during the study period; 382 suicides were determined to be associated with LTC in some manner. After adjusting for state-level characteristics, greater average nursing home capacity was significantly associated with increase in the cumulative incidence of suicide related to LTC (β = 0.087, SE = 0.026, P < .01), but not overall suicide incidence. Neither cost nor regulation measures were significantly associated with state-level LTC-related suicide incidence. Conclusions and ImplicationsState-level variations in LTC facility capacity are related to variation in LTC-related suicide incidence among older adults. Given the challenges of preventing suicide among older adults through facility- or individual-level interventions, policies governing the features and provision of LTC services may therefore serve as a means for public health suicide prevention.

Review on Pricing Models for Long-term Care Insurance

Funding for long-term care costs among elderly people is a critical matter, especially due to high costs and an unexpected length of time. Placement for long-term care that is funded under Jabatan Kebajikan Masyarakat (JKM) is very limited, hence, the next option is through private nursing homes. However, the cost could be up to RM 2,000 a month for each person. Therefore, Long- Term Care Insurance is an alternative to fund for Long-Term Care costs as it is expected to reduce financial burden during old age. It is a risk protection mechanism for an insured that needs health and financial protection when an individual is unable to do activities of daily living (ADL) or supports in instrumental activities of daily living (IADL). This paper reviews three models that have been used in pricing long-term care insurance. All three models use the equivalent principle of premium to price the insurance policy. However, the probability and assumptions used for each model differ, depending on the insured's needs and profile.

The Healthcare Cost Burden in Adults with High Risk for Cardiovascular Disease.

ObjectiveWe calculated the short- and long-term care resource use and costs in adults with high-risk conditions for cardiovascular disease (HRCVD) as defined by the Canadian Cardiovascular Society dyslipidemia guidelines.MethodsWe linked Alberta health databases to identify patients aged ≥ 18 years with HRCVD between fiscal year (FY) 2012 and FY2016. The first HRCVD event was the index event. Patients were categorized into (1) primary prevention patients and (2) secondary prevention patients at the index event and were followed until death, they moved out of the province, or they were censored at March 2018. We calculated the resource use and costs for each of the 5 years after the index event.ResultsThe study included 459,739 HRCVD patients (13,947 [3%] were secondary prevention patients). The secondary prevention patients were older (median age 61 years vs. 55 years; p < 0.001), and there were fewer females in this group (30.4% vs. 51.3%; p < 0.001). The total healthcare costs in the first year decreased over time (FY2012: 1.16 billion Canadian dollars (CA$); FY2016: CA$1.05 billion; p < 0.001). An HRCVD patient incurred CA$12,068, CA$5626, and CA$4655 during the first, second, and fifth year, respectively (p for trend < 0.001). During the first year, healthcare costs per secondary prevention patient (CA$36,641) were triple that for a primary prevention patient (CA$11,299; p < 0.001), primarily due to higher hospitalization costs in secondary prevention patients (CA$26,896 vs. CA$6051; p < 0.001).ConclusionsThe healthcare costs for HRCVD patients were substantial but decreased over time. The costs were highest in the year following the index event and decreased thereafter. Secondary prevention patients incurred higher costs than the primary prevention patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41669-021-00257-8.

Determinants of Demand for Private Long-Term Care Insurance (Empirical Evidence from Poland)

The main aim of the article is to evaluate determinants of demand for private long-term care insurance in Poland. Since this type of insurance is not (yet) offered on the market, the demand was examined through a survey in which respondents declared their willingness to purchase it. From the obtained results, it can be concluded that Poles declare a high propensity for private protection in the event of dependence. The vast majority (almost two-thirds) of the respondents were interested in purchasing long-term care insurance, while only one in sixteen respondents showed no such interest. Factors that predominantly determine the willingness to buy are as follows: individual foresight, knowledge about the costs of long-term care, preferences regarding methods of financing care, having children, and the level of education.

Development of a predictive model for integrated medical and long-term care resource consumption based on health behaviour: application of healthcare big data of patients with circulatory diseases

BackgroundMedical costs and the burden associated with cardiovascular disease are on the rise. Therefore, to improve the overall economy and quality assessment of the healthcare system, we developed a predictive model of integrated healthcare resource consumption (Adherence Score for Healthcare Resource Outcome, ASHRO) that incorporates patient health behaviours, and examined its association with clinical outcomes.MethodsThis study used information from a large-scale database on health insurance claims, long-term care insurance, and health check-ups. Participants comprised patients who received inpatient medical care for diseases of the circulatory system (ICD-10 codes I00-I99). The predictive model used broadly defined composite adherence as the explanatory variable and medical and long-term care costs as the objective variable. Predictive models used random forest learning (AI: artificial intelligence) to adjust for predictors, and multiple regression analysis to construct ASHRO scores. The ability of discrimination and calibration of the prediction model were evaluated using the area under the curve and the Hosmer-Lemeshow test. We compared the overall mortality of the two ASHRO 50% cut-off groups adjusted for clinical risk factors by propensity score matching over a 48-month follow-up period.ResultsOverall, 48,456 patients were discharged from the hospital with cardiovascular disease (mean age, 68.3 ± 9.9 years; male, 61.9%). The broad adherence score classification, adjusted as an index of the predictive model by machine learning, was an index of eight: secondary prevention, rehabilitation intensity, guidance, proportion of days covered, overlapping outpatient visits/clinical laboratory and physiological tests, medical attendance, and generic drug rate. Multiple regression analysis showed an overall coefficient of determination of 0.313 (p < 0.001). Logistic regression analysis with cut-off values of 50% and 25%/75% for medical and long-term care costs showed that the overall coefficient of determination was statistically significant (p < 0.001). The score of ASHRO was associated with the incidence of all deaths between the two 50% cut-off groups (2% vs. 7%; p < 0.001).ConclusionsASHRO accurately predicted future integrated healthcare resource consumption and was associated with clinical outcomes. It can be a valuable tool for evaluating the economic usefulness of individual adherence behaviours and optimising clinical outcomes.

System Simulation and Policy Response: Long-Term Care Needs of the Elderly with Disabilities in China (2021-2050)

Background: In the near future, pressures on long-term care (LTC) are expected to grow with demographic transition. Higher demand for formal services is emerging in China also because of people’s expectations for high-quality care. This study aims to provide quantitative estimates of the associated LTC financial liability in the medium to long run to 2050, and is expected to further facilitate policy design on national LTC systems, which begin to be formulated and debated. Methods: We first analyze the health status of Chinese elderly through the Sample Survey of the Aged Population in Urban and Rural China (SSAPUR) in 2015, 2016 and 2017, the largest database of research on aging in China. Subsequently, we estimate LTC needs and the government’s financial burden for the next 3 decades according Qingdao model. Results: The average elderly disability rate is 4.4% in 2015-2017, and the gender differences (3.9% for males, 4.67% for females), disparities between rural and urban areas, age differences exist. The proportion of public expenditure on long-term care costs will increase from 0.35 percent in 2021 to 0.68 percent in 2050, and that of proportion in GDP will increase from 0.1 percent to 0.2 percent. Conclusions: Compared with OECD countries, China’s LTC system started late and developed relatively slowly. The “policy window” between 2021 and 2036 is critical for China in developing LTC policies. In the period of “gradually getting wealthy and quickly getting old”, policy-makers should give priority to achieve “healthy aging” instead of “survival aging”.

Long-Term Care Financing for an Aging Population: The Experience of Singapore

Singapore has a rapidly aging population. Long-term care (LTC) is one of the largest financial risks facing elderly in Singapore. Singapore implemented Eldershield, a long-term care insurance scheme which provided defined cash benefit payouts in the event of severe disability; but capped at a maximum of six years. Eldershield enrolled people at age 40, but offered an opt-out option. As of 2015, 65% of those aged 40 to 83 opted to be covered by Eldershield, making Singapore as having the highest voluntary LTC insurance rate in the world. This paper uses an actuarial multi-state disability model and calibrates the transition probabilities and duration-of-stay at various health (disability) states to assess the adequacy and comprehensiveness of Eldershield. The time-limited cash benefit design in Eldershield helped defray about 13% of LTC costs. Removing the time cap will help defray 23% and 26% of the LTC costs for elderly male and female respectively. Furthermore, the simulation results demonstrate that relaxing the trigger benefit and having staggered payouts will improve the adequacy of long-term care insurance. The experience of Singapore’s LTC insurance offers insights into the challenges of designing an insurance that tends to occur at higher age and insuring against a cost that could range from zero to a significantly large sum over a long period. Even with the enhanced Careshield Life, which provides cash payouts for life, other policy designs, for example caregiver grants, may be needed to ensure more adequate financing of long-term care.

Public implementation of a web-based program for veterans with risky alcohol use and PTSD: A RE-AIM evaluation of VetChange

BackgroundEvidence-based web and mobile interventions are available for a range of mental health concerns. Little is known about how self-administered web interventions are used outside of controlled research trials, and there is a critical need to empirically examine real-world public implementation of such programs. To this end, the aim of the current study was to evaluate and describe outcomes of a nationwide public implementation of VetChange, a self-administered web intervention for veterans with problematic alcohol use and symptoms of PTSD. MethodThe study used the RE-AIM framework to organize outcomes along five key dimensions: reach, effectiveness, adoption, implementation, and maintenance. This naturalistic observation study included program use information for all who registered an account with VetChange during the 2-year study period and who self-identified as a returning veteran. We collected program use data automatically via normal website operation; a subset of program users provided additional self-report outcome data. The study used linear multilevel mixed modeling to evaluate changes in alcohol use and PTSD symptoms over a six-month postregistration period. ResultsVetChange successfully reached a large, geographically diverse sample of returning veterans with risky drinking and PTSD symptoms. Despite variable, overall modest, rates of intervention use over time, registered users demonstrated significant improvements in drinking, PTSD, and quality of life, and participants maintained these outcomes at a six-month follow-up. ConclusionsGiven the observed low cost per acquisition, positive clinical outcomes, and the potential to produce long-term cost savings through reduced health care burden associated with chronic alcohol use disorder and PTSD, this study demonstrates how web-based interventions can provide public health benefits and reduce long-term health care costs.

PND46 Cost-Effectiveness of MRI-Guided Thrombolysis for Stroke Patients with Unknown Time of Onset

The aim of this study was to assess cost-effectiveness of MRI-guided thrombolysis with intravenous alteplase for acute ischemic stroke in patients with unknown time of onset compared to placebo. A Markov model was designed to predict cost-effectiveness over a 25 year time horizon. The data used in this analysis was extracted from the WAKE-UP trial, a European multi-center randomized controlled trial investigating the effects of intravenous thrombolysis with alteplase vs placebo based on a mismatch in MRI imaging in patients with unknown time of symptom onset. Incremental costs and effects over the patients’ lifetime were estimated. The model consisted of an in-patient acute care phase and a rest of life phase. Health states were defined by the modified Rankin Scale score. After the initial stroke, patients remained in their mRS score until death or recurrent stroke. Health state utilities were extracted from published literature. Cost data of acute care was taken from the University Medical Center Hamburg-Eppendorf, Germany. To establish cost of long-term care in the rest-of-life phase, mRS scores were matched to German degrees of care based on expert opinion. The analysis was conducted from a German societal perspective. Treatment with alteplase dominated placebo with incremental costs of 51,009€ ($40,807) and 1.30 gains in Quality-Adjusted Life Years (QALYs) at a discount rate of 5%. Univariate sensitivity analysis and probabilistic sensitivity analysis (Monet Carlo Simulation) was conducted to test robustness, both indicating robustness of our results across a wide range of parameters. MRI-guided thrombolysis with intravenous alteplase compared to placebo is cost-effective in ischemic stroke patients with unknown time of onset.

Economic burden of epilepsy in children: A population-based matched cohort study in Canada.

The economic burden of childhood epilepsy to the health care system remains poorly understood. This study aimed to determine phase-specific and cumulative long-term health care costs in children with epilepsy (CWE) from the health care payer perspective. This cohort study utilized linked health administrative databases in Ontario, Canada. Incident childhood epilepsy cases were identified from January 1, 2003 to June 30, 2017. CWE were matched to children without epilepsy (CWOE) on age, sex, rurality, socioeconomic status, and comorbidities, and assigned prediagnosis, initial, ongoing, and final care phase based on clinical trajectory. Phase-specific, 1-year and 5-year cumulative health care costs, attributable costs of epilepsy, and distribution of costs across different ages were evaluated. A total of 24411 CWE were matched to CWOE. The costs were higher for prediagnosis and initial care than ongoing care in CWE. Hospitalization was the main cost component. The costs of prediagnosis, initial, and ongoing care were higher in CWE than CWOE, with the attributable costs at $490 (95% confidence interval [CI] = $352-$616), $1322 (95% CI = $1247-$1402), and $305 (95% CI = $276-$333) per 30 patient-days, respectively. Final care costs were lower in CWE than CWOE, with attributable costs at -$2515 (95% CI = -$6288 to $961) per 30 patient-days. One-year and 5-year cumulative costs were higher in CWE ($14776 [95% CI = $13994-$15546] and $39261 [95% CI = $37132-$41293], respectively) than CWOE ($6152 [95% CI = $5587-$6768] and $15598 [95% CI = $14291-$17006], respectively). The total health care costs were highest in the first year of life in CWE for prediagnosis, initial, and ongoing care. Health care costs varied along the continuum of epilepsy care, and were mainly driven by hospitalization costs. The findings identified avenues for remediation, such as enhancing care around the time of epilepsy diagnosis and better care coordination for epilepsy and comorbidities, to reduce hospitalization costs and the economic burden of epilepsy care.

Value of treatment by comprehensive stroke services for the reduction of critical gaps in acute stroke care in Europe.

Stroke is the second leading cause of death and dependency in Europe and costs the European Union more than €30bn, yet significant gaps in the patient pathway remain and the cost-effectiveness of comprehensive stroke care to meet these needs is unknown. The European Brain Council Value of Treatment Initiative combined patient representatives, stroke experts, neurological societies and literature review to identify unmet needs in the patient pathway according to Rotterdam methodology. The cost-effectiveness of comprehensive stroke services was determined by a Markov model, using UK cost data as an exemplar and efficacy data for prevention of death and dependency from published systematic reviews and trials, expressing effectiveness as quality-adjusted life-years (QALYs). Model outcomes included total costs, total QALYs, incremental costs, incremental QALYs and the incremental cost-effectiveness ratio (ICER). Key unmet needs in the stroke patient pathway included inadequate treatment of atrial fibrillation (AF), access to neurorehabilitation and implementation of comprehensive stroke services. In the Markov model, full implementation of comprehensive stroke services was associated with a 9.8% absolute reduction in risk of death of dependency, at an intervention cost of £9566 versus £6640 for standard care, and long-term care costs of £35169 per 5.1251 QALYS vs. £32347.40 per 4.5853 QALYs, resulting in an ICER of £5227.89. Results were robust in one-way and probabilistic sensitivity analyses. Implementation of comprehensive stroke services is a cost-effective approach to meet unmet needs in the stroke patient pathway, to improve acute stroke care and support better treatment of AF and access to neurorehabilitation.

Clinical and Economic Burden of Hyperkalemia: A Nationwide Hospital-Based Cohort Study in Japan

Rationale & ObjectiveHyperkalemia is a common electrolyte abnormality of chronic kidney disease and heart failure associated with increased mortality and morbidity. We aimed to assess the long-term economic burden of hyperkalemia.DesignObservational cohort study using a Japanese nationwide hospital claims database (April 1, 2008, to September 30, 2018).Setting & Population: Patients 18 years or older with at least 1 serum potassium value (N = 1,208,894).ExposuresHyperkalemia defined with the presence of at least 2 serum potassium values ≥ 5.1 mmol/L.Outcome MeasuresDirect health care costs and resource use in patients with hyperkalemia within and after 12 months from first hyperkalemia episodes.Analytical ApproachHealth care costs and resource use were compared with propensity score–matched or nonmatched normokalemic controls. Multivariable regression analysis was performed to examine factors associated with health care costs.Results27,534 patients with hyperkalemia and 233,098 normokalemic controls were studied. Mean ± SD age was 73±13 years in patients with hyperkalemia; among them, 59% and 35% had chronic kidney disease and heart failure, respectively. In the propensity score–matched cohort (n = 5,859 in each group), average numbers of hospitalizations per patient per year in patients with hyperkalemia within and after 12 months were 1.2 and 1.6 times higher, respectively, compared with those in patients with normokalemia. The total cost per patient in patients with hyperkalemia was higher than for controls, with mean differences of $8,611 (95% CI, $8,046-$9,175) within 12 months and $5,150 (95% CI, $4,733-$5,566) after 12 months. The number of repeat hyperkalemic episodes was the factor with the strongest association with long-term health care costs, whereas severity of hyperkalemia was not associated.LimitationsThis study used secondary data; therefore, residual confounders may not be fully excluded.ConclusionsHyperkalemia was associated with significant long-term economic burden with frequent hospitalizations due to recurrent episodes, indicating the importance of hyperkalemia treatment for the sake of reducing health economic burdens and clinical complications.

Associations of aging trajectories for an index of frailty score with mortality and medical and long-term care costs among older Japanese undergoing health checkups.

Using up to 13 years of repeated-measures data, we identified aging trajectories for an index in frailty score among older Japanese undergoing health checkups. In addition, we examined whether these trajectories were associated with all-cause and cause-specific mortality and healthcare costs. In total, 1698 adults aged ≥65 years completed annual assessments during 2002-2014. During follow-up, the average number of follow-up assessments was 3.9, and the total number of observations was 6373. Frailty was defined by using the following criteria from Fried's phenotype: slowness, weakness, exhaustion, low physical activity and weight loss. We identified four aging trajectories for frailty. Specifically, 6.5%, 47.3%, 30.3% and 16.0% of participants were in the high, second, third and low trajectory groups, respectively. As compared with the low trajectory group, the high trajectory group had greater risks of cardiovascular disease (adjusted hazard ratios of 3.42) and other-cause death (adjusted hazard ratios of 3.04). The high trajectory group had the highest medical costs until late in the eighth decade of life, costs decreased after age 70 years and were lowest at age 90 years (estimated at $116.7); however, medical and long-term care costs greatly increased after age 80 years in the second and third trajectory groups. Higher aging trajectories in frailty score were associated with elevated risks for cardiovascular, other-cause and all-cause death among older Japanese receiving health checkups. Medical and care needs greatly increased for the second and third trajectory groups when their frailty level was progressed in later life. Geriatr Gerontol Int 2020; 20: 1072-1078..

Frailty: A key concept to improve older person care.

Frailty is associated with increased hospitalization, hospital length of stay, intensive care unit admission, ED re-presentations, discharge to long-term care, mortality, and healthcare costs The CFS demonstrated higher sensitivity for predicting mortality and, when used in combination with systemic inflammatory response criteria and the Quick Sequential Organ Failure Assessment, improved prognostication than any individual score alone Fernando SM, Guo KH, Lukasik M, Frailty and associated prognosis among older emergency department patients with suspected infection: a prospective, observational cohort study

Long-term health and socioeconomic outcome of obstructive sleep apnea in children and adolescents

BackgroundThere is limited information about the long-term outcome of obstructive sleep apnea (OSA) diagnosed in children and adolescents for educational and social factors. Here, we estimate the long-term socioeconomic outcome and health care costs of OSA. MethodsThe historical case-control cohort study included Danish individuals with OSA diagnosed in childhood or adolescence between 1994 and 2015. Health care costs and socioeconomic data were obtained from nationwide administrative and health registers. A total of 5419 were diagnosed during this period; of these we traced 1004 patients who we compared with 4085 controls (mean index age, 10.2 years; Standard Deviation (SD), 5.6 years) until the age of 20 years. Controls were matched for age, gender, and residency. ResultsComparing the OSA patient and control groups at age 20 years we found: 1) lower parental educational level; 2) significantly lower educational level also after adjustment for parental educational level; 3) lower school grade-point averages; 4) lower employment rate and lower income, which was not fully compensated when transfer payments were considered; and 5) patients' initial health care costs were higher due to higher morbidity. Patients showed higher mortality rates than controls (Hazard Ratio (HR) = 7.63, 95% CI = 4.87–11.95, P < 0.001). ConclusionsOSA in children and adolescent is associated with a significant influence on morbidity, mortality, educational level, grading, social outcome, and welfare consequences.

Continuity of care and health care cost among community‐dwelling older adult veterans living with dementia

To estimate the causal impact of continuity of care (COC) on total, institutional, and noninstitutional cost among community-dwelling older veterans with dementia. Combined Veterans Health Administration (VHA) and Medicare data in Fiscal Years (FYs) 2014-2015. FY 2014 COC was measured by the Bice-Boxerman Continuity of Care (BBC) index on a 0-1 scale. FY 2015 total combined VHA and Medicare cost, institutional cost of acute inpatient, emergency department [ED], long-/short-stay nursing home, and noninstitutional long-term care (LTC) cost for medical (like skilled-) and social (like unskilled-) services were assessed controlling for covariates. An instrumental variable for COC (change of residence by more than 10 miles) was used to account for unobserved health confounders. Community-dwelling veterans with dementia aged 66 and older, enrolled in Traditional Medicare (N=102073). Mean BBC in FY 2014 was 0.32; mean total cost in FY 2015 was $35425. A 0.1 higher BBC resulted in (a) $4045 lower total cost; (b) $1597 lower acute inpatient cost, $119 lower ED cost, $4368 lower long-stay nursing home cost; (c) $402 higher noninstitutional medical LTC and $764 higher noninstitutional social LTC cost. BBC had no impact on short-stay nursing home cost. COC is an effective approach to reducing total health care cost by supporting noninstitutional care and reducing institutional care.

Implement a Portable Smart Device for Elder Health Care

The population structure of Taiwan is evolving toward aged society. The ratio of elderly population over total population is increasingly approaching to 1/4 or above, leading to the increasing demand of the aged care in Taiwanese society. Further the increasing the long-term care cost would have a great impact on National financial burden. As for the delimitation on the growth rate of the elder population, we would like to develop an auxiliary aid capable of reminding people’s daily exercise, as well as detecting the people’s aged degree. In this study we implement such an aid by a cost-effective, intelligent ring type sensor capable of measuring people’s essential tremor as well as recording people’s daily exercise/showing them up at a user friendly interface. Based on the state of the art sensor technology, the intelligent sensor comes out to be capable of recording aged people’s essential tremor spectrum via fast Fourier transform (FFT) and their daily exercise simultaneously. With gathering both of detecting information, the sensor would be transmitting the information in a real-time fashion toward people’s cellular phone via a Bluetooth interface. Then an application on the phone could evaluate the degree of the aging and show the daily sport records toward the medical staff at the remote site. In order encourage elderly people to exercise and prevent elderly people from falling accidentally, the device also has fall warning function. It is believed via such a surveillance on elder people and referring their daily sport records in a long term fashion, the phenomenon of population aging could be effectively improved.