Prevalence and Cost of Dementia

阿尔茨海默病和相关痴呆症(ADRD)对照顾多少老年人、公共计划(联邦医疗保险、医疗补助)和家庭的此类护理费用有重大影响。认知功能低下是导致功能衰退、制度化和死亡率的重要风险因素。由于其他原因的死亡延迟和人口老龄化，ADRD患者的人数正在上升。目前尚不清楚人口结构调整后的流行率是否正在发生变化。从方便的小样本到横截面设计，ADRD的成本都令人震惊。从对最近获得的具有全国代表性的数据库--国家长期护理调查(NLTCS)--的纵向分析中，可以学到很多东西。拟议工作的具体目标是：(1)通过将基于医疗保险索赔的ADRD诊断与使用NLTCS调查工具确定的患者调和起来，衡量1984年、1989年、1994年和1999年ADRD的年龄和性别调整后的患病率；(2)确定随着时间的推移，ADRD患病率的重要决定因素，包括心血管疾病死亡率的下降和接受挽救生命的干预；(3)确定ADRD患者除ADRD以外的主要疾病(例如，选定的癌症、冠心病)是否比其他类似的残疾老年人接受的强度较小；(4)衡量1984年、1994年和1999年ADRD对Medicare和Medicaid的成本、私人付款人和自付ADRD的成本，以及基于这些估计的这些公共项目的项目成本趋势。为了计算这样的成本估计，我们将考虑在这样的预测中经常被忽视的两个因素：(1)ADRD对其他健康状况治疗的影响和(2)如果ADRD被消除，像Medicare这样的公共计划将因其他疾病而产生其他成本的技术。NLTCS将使该项目能够提供迄今为止关于调整后的ADRD流行率的最佳信息、影响ADRD的因素、ADRD患者是否因急性和慢性健康状况而受到不同对待，以及ADRD将如何影响未来的医疗费用。

Alzheimer's disease and related dementias (ADRD) has a major impact on how many elderly are cared for, the cost of such care to public programs (Medicare, Medicaid) and to families. Poor cognitive functioning is an important risk factor in functional decline, institutionalization and mortality. The number of persons with ADRD is rising as mortality from other causes is delayed and the population ages. It remains unclear whether demographically adjusted prevalence is changing. The cost of ADRD is staggering from small convenience samples and cross sectional designs. There is much to be learned from longitudinal analysis of a nationally representative data bases that has become available recently, the National Long Term Care Survey (NLTCS). The specific aims of the proposed work are: (1) Measure the age and gender adjusted prevalence of ADRD in 1984, 1989, 1994 and 1999 by reconciling Medicare claims based diagnosis of ADRD with patients identified using the survey instrument of NLTCS; (2) Ascertain the important determinants of prevalence over time, including decreasing mortality from cardiovascular diseases and receipt of life saving interventions; (3) Determine whether persons with ADRD receive less intensive treatment for major conditions other than ADRD (e.g., selected cancers, coronary heart disease) relative to otherwise similar disabled elderly persons; (4) Measure the cost of ADRD to Medicare and Medicaid other government agencies, private payers and out-of-pocket the cost of ADRD to Medicare and Medicaid other government agencies, private payers and out-of-pocket expenditures for personal health services for ADRD, in 1984, 1994 and 1999m and project cost trends for these public programs based on these estimates. To compute such cost estimates, we will account for two factors often overlooked in such projections: (1) the impact of ADRD on the treatment of other health conditions and (2) techniques that such public programs as Medicare would incur other costs from other diseases if ADRD were eliminated. The NLTCS will allow this project to provide the best information to date on the adjusted prevalence of ADRD, what factors are influencing same, whether persons with ADRD are treated differently given acute and chronic health conditions, and how ADRD will impact future medical costs.