ArticleThe American journal of managed care2024
Utilization of low- and high-value health care by individuals with and without cognitive impairment.
Article in The American journal of managed care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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Who cites it
2 citing papers in PubMed.
- Health Care Utilization Patterns Among Adults With or Without Functional Disabilities.JAMA network open · 2025Article
- Psychological Stress and Cognitive Brain Health: Policies to Reduce Dementia Risk.Policy insights from the behavioral and brain sciences · 2025Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
objectivesCognitive impairment and dementia have rising prevalence and impact the health care utilization and lives of older adults. Receipt of low-value (LV) care and underutilization of high-value (HV) care by individuals with these cognitive disorders may have negative consequences for patient health, health system efficiency, and societal welfare. Evidence on health care value among cognitively impaired individuals is limited; we thus ascertained receipt of LV and HV health care in older adults with normal cognition, cognitive impairment without dementia (CIND), and dementia. STUDY
designRetrospective cohort study of Health and Retirement Study data linked to Medicare claims (1996-2018).
methodsWe examined the association between cognitive decline and the receipt of 5 LV and 7 HV services vs individuals with no change in cognition.
resultsReceipt of LV care ranged from 4% to 13% regardless of cognitive status. Cognitive decline (from unimpaired to either CIND or dementia) was associated with decreased probability of receipt of 1 LV service (colorectal cancer screening at 85 years and older [5-percentage-point reduction; P = .047]) and 3 HV services (glucose-lowering drugs [7-percentage-point reduction; P = .029], statins [32-percentage-point reduction; P = .045], and antiresorptive therapy [61-percentage-point reduction; P = .019]).
conclusionsLV service receipt is wasteful and may be harmful, but it was not consistently associated with cognitive status. Lack of HV care for those with cognitive impairment could be a missed opportunity to improve well-being or reduce preventable adverse events. Our results suggest opportunities for improving the quality of care received by all older adults, including those with cognitive impairment.
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