Optimal Prevention & Treatment In Medically Complex Alzheimer Patients (OPTIMAL)

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DESCRIPTION (provided by applicant): As specified in RFA-HS-08-003, we are proposing an analytic epidemiologic study using an existing patient cohort to explore the potential benefits and harms of preventive interventions in the "real world" setting of a large primary care practice. Consistent with the goals of the RFA, we have selected cognitive impairment among older adults as the targeted chronic condition. We will explore the potential benefits and harms of preventive interventions among older adults with cognitive impairment and also examine health status with regard to two other conditions including both a medical and mental health condition: (a) late life depression and (b) cardiovascular disease. The preventive interventions to be studied are cancer screening (breast, prostate, and colon) and influenza vaccination. The study cohort consists of 3,954 patients aged 60 and older who, as part of an earlier study, completed cognitive screening during office visits to their primary care physicians in 1991-93. Comprehensive follow-up information on these patients is available from the Regenstrief Medical Record System, including data on provision of preventive health measures, cancer incidence, and vital status. The specific aims for this application are to: 1) Describe the 15-year mortality trajectories for older adults with cognitive impairment, with and without the additional comorbid conditions of depression and cardiovascular disease; 2) Describe the incidence of and outcome for the following preventive health services among older adults with and without cognitive impairment, depression, and cardiovascular disease: a) cancer screening (breast, colon cancer, and prostate); b) influenza vaccination; and 3) Determine the extent to which temporal trends of increasing utilization of preventive health services extend to this study population. This work seeks to optimize decisions about preventive care and management of dementia among complex primary care patients. These data form the foundation for future work to determine which treatments and combinations of treatment offer the most benefit and the highest quality care.