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

项目摘要/摘要 阿尔茨海默病和相关痴呆(ADRD)是一种慢性、致残性认知障碍， 到2050年，估计将影响1200万美国人。在未被发现的情况下，这些变化可能会导致经济损失 从虐待老人和欺诈，忘记支付账单，以及妥协的财务决策。通常， 认知障碍直到患者损失了大笔金钱并经历了 额外的功能衰退。一种可能的解决方案是在金融数据中识别ADRD的早期迹象。 在试点数据(R21AG053698)中，我们将20年的医疗保险索赔与季度信用报告联系起来，演示了 没有配偶/伴侣的ADRD患者更有可能拖欠账单，发展次级信贷， 并在确诊前多年经历不利的财务事件，这是ADRD独有的模式。 我们先前的工作表明，银行和信贷数据可以在临床上用于筛查痴呆症 并保护患者和家属免受与反兴奋剂有关的金融剥削和其他损失，包括 应对额外的财务压力对健康的影响。我们建议从以下几个方面检验这些假设 AIM，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：在临床之前，测试信用数据中是否以及何时出现ADRD的独特财务症状 在夫妻家庭中的诊断。目标2：测试是否可以观察到ADRD的独特财务症状 在银行和经纪公司的数据中，在账户持有人经历年长的虐待、欺诈和减薪之前 容量。目的3：比较ADRD患者配偶的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：评估可行性和伦理 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，将其与AIMS 1和3的消费者信用报告联系起来，并 来自AIM 2的一家美国大银行10多年的账户信息。我们将比较ADRD和其他 健康状况和虐待老年人的来源，以确定其是否有独特的经济 演示文稿。 我们的研究团队包括一个由医生、经济学家、伦理学家和健康专家组成的跨学科小组 与美联储、Patient和 行业利益相关者。这项研究的结果将提供迄今为止关于 在被诊断为ADRD之前，经济损失和虐待老年人的流行率和程度以及他们 对配偶健康的影响。这些信息对许多公共和私人决策至关重要，从何时开始 以及是否开始筛查ADRD，金融机构在保护以下客户方面的潜在作用 可能没有意识到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。

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.