Health and Financial Implications of Early-Stage Alzheimer's Disease and Related Dementias

早期阿尔茨海默病和相关痴呆症对健康和财务的影响

• 批准号: 10096210
• 负责人: Lauren Hersch Nicholas
• 金额: $ 1.92万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2020-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10096210
• 关键词: Acute; Adult; Adverse event; Affect; Alzheimer disease screening; Alzheimer' s disease related dementia; American; Behavior; Brain; Chronic; Chronic Disease; Client; Clinical; Collaborations; Coupled; Data; Data Linkages; Dementia; Detection; Diagnosis; Diagnostic; Early Diagnosis; Elder Abuse; Equilibrium; Ethicists; Ethics; Event; Family; Family Physicians; Family health status; Family member; Financial Hardship; Fraud; Frequencies; Government; Health; Health Resources; Health Services; Healthcare Systems; Hospitalization; Household; Impaired cognition; Individual; Industry; Institution; Investments; Lead; Link; Logistics; Medicare claim; Memory; Patients; Pattern; Physicians; Policies; Prevalence; Privacy; Privatization; Process; Recording of previous events; Reporting; Research; Research Personnel; Risk; Role; Security; Self-control as a personality trait; Services; Source; Spouses; Sum; Symptoms; Testing; Time; Transact; Work; caregiving; clinical Diagnosis; experience; financial decision making; financial exploitation; forgetting; functional decline; maltreatment; mortality; payment; population health; privacy protection; tool; working group

Project Summary/Abstract Alzheimer's Disease and Related Dementias (ADRD) are chronic, disabling cognitive impairments that will affect an estimated 12 million Americans by 2050. Undetected, these changes can lead to financial losses from elder abuse and fraud, forgetting to pay bills, and compromised financial decision-making. Often, cognitive impairment is not discovered until after patients have lost significant sums of money and experienced additional functional decline. One possible solution is to recognize the early signs of ADRD in financial data. In pilot data (R21AG053698), we linked 20 years of Medicare claims to quarterly credit reports, demonstrating that ADRD patients without a spouse/partner are more likely to miss bill payments, develop subprime credit, and experience adverse financial events for years prior to their diagnosis, a pattern unique to ADRD. Our prior work suggests that banking and credit data can be used to screen for dementia in the clinical setting, and to protect patients and families from ADRD-linked financial exploitation and other losses, including health effects of dealing with additional financial stress. We propose to test these hypotheses in the following aims, using newly created financial data linkages and partnering with patients, government, and industry: Aim 1: Test whether and when unique financial symptoms of ADRD are present in credit data prior to clinical diagnosis in coupled households. Aim 2: Test whether unique financial symptoms of ADRD can be observed in banking and brokerage data before accountholders experience elder mistreatment, fraud, and diminished capacity. Aim 3: Compare 4-year rates of mortality and hospitalization among spouses of ADRD patients with and without adverse credit events by the time of diagnosis. Aim 4: Assess the feasibility and ethical implications of using financial data to detect ADRD. We will use a 20-year panel of Medicare claims linked to consumer credit reports for Aims 1 and 3 and more than 10 years of account information from a large US bank in Aim 2. We will compare ADRD to other health conditions and sources of elder mistreatment to determine whether it has a unique financial presentation. Our study team includes an interdisciplinary group of physicians, economists, ethicists, and health services researchers with a long history of collaboration in partnership with the Federal Reserve, patient and industry stakeholders. Findings from this study will provide the most comprehensive information to date on the prevalence and magnitude of financial losses and elder mistreatment prior to ADRD diagnosis, as well as their impact on spousal health. This information is critical for many public and private decisions ranging from when and whether to begin screening for ADRD, the potential role of financial institutions in protecting clients who may be unaware of their early cognitive decline, and whether consumer data are sufficiently informative about health to require additional privacy protection.

项目总结/摘要 阿尔茨海默氏病和相关痴呆症（ADRD）是一种慢性、致残性认知障碍， 预计到2050年将影响1200万美国人。如果不被发现，这些变化可能会导致财务损失 虐待老人和欺诈，忘记支付账单，以及妥协的财务决策。通常情况下， 认知障碍直到患者失去了大量金钱并经历了 额外的功能下降。一个可能的解决方案是在财务数据中识别ADRD的早期迹象。 在试点数据（R21 AG 053698）中，我们将20年的医疗保险索赔与季度信用报告联系起来，证明 没有配偶/伴侣的ADRD患者更有可能错过账单支付，发展次级信贷， 并且在诊断前数年内经历不良财务事件，这是ADRD特有的模式。 我们先前的工作表明，银行和信用数据可以用于在临床上筛查痴呆症。 环境，并保护患者和家庭免受与ADRD相关的经济剥削和其他损失，包括 处理额外的财务压力对健康的影响。我们建议在下面的实验中检验这些假设 目标，使用新创建的财务数据链接，并与患者，政府和行业合作：Aim 1：测试ADRD的独特财务症状是否以及何时存在于临床之前的信用数据中 在夫妻家庭中进行诊断。目的2：测试是否可以观察到ADRD的独特财务症状 在账户持有人经历老年人虐待，欺诈和减少之前， 容量目的3：比较ADRD患者的配偶4年死亡率和住院率， 并且在诊断时没有不良信用事件。目标4：评估可行性和道德 使用财务数据检测ADRD的影响。 我们将使用一个20年的医疗保险索赔小组，与目标1和3的消费者信用报告相关联， Aim 2中一家美国大型银行10多年的账户信息。我们将比较ADRD与其他 健康状况和虐待老人的来源，以确定它是否有一个独特的财政 演示文稿. 我们的研究团队包括一个跨学科的医生，经济学家，伦理学家和健康 服务研究人员与联邦，病人和 行业利益相关者。这项研究的结果将提供迄今为止最全面的信息， ADRD诊断前经济损失和老年人虐待的患病率和程度，以及 对配偶健康的影响这些信息对于许多公共和私人决策至关重要， 以及是否开始筛查ADRD，金融机构在保护客户方面的潜在作用， 可能不知道他们早期的认知能力下降，以及消费者数据是否提供了足够的信息， 健康需要额外的隐私保护。