Depression Treatment and Outcomes among Older Adults with Dementia in the United States

痴呆患者中抑郁症的高患病率（25%-45%）以及与之相关的 广泛的负面结果需要研究来评估抑郁症治疗的有效性 在痴呆症患者中。据我们所知，迄今尚未进行任何研究， 在真实的世界中评估老年痴呆症患者的抑郁症治疗结果。我们 一项拟议的研究将是同类研究中第一次使用具有全国代表性的老年人样本 评估与医疗保健有效性数据相关的依从性和结局 和信息集（HEDIS）抗抑郁药物管理（AMM）措施。我们的长期 目的是为医疗保健提供者、患者和护理人员提供真实的证据， 明智的决定，优先治疗抑郁症，这是特别重要的，以保持功能 提高痴呆症患者生活质量。为了实现这一目标，我们 提出三个具体目标-（目标1）：量化不适当的程度并确定预测因素， 新诊断为重度抑郁症的老年痴呆症患者使用抗抑郁药的情况。(Aim（2）： 确定急性和持续性HEDIS AMM测量的依从性程度和预测因素 老年痴呆症和新诊断的重度抑郁症患者的阶段治疗。(Aim 3）：检查 与急性和急性期遵守HEDIS AMM措施相关的健康结局和支出， 新诊断为主要精神分裂症的老年痴呆症患者的抑郁症治疗的延续阶段 萧条我们将采用回顾性纵向队列研究设计，使用Medicare 5%样本索赔数据 （2011-2013），以供研究。研究人群将包括老年人（年龄≥ 65岁） 最近被诊断为重度抑郁症的痴呆症患者将使用HEDIS确定抑郁症治疗 急性期有效AMM的抑郁治疗建议（至少使用84天抗抑郁药） 在治疗开始的前115天内）和继续（至少180天的抗抑郁药使用 在治疗开始的前232天期间）新的重性抑郁症诊断后的治疗阶段。我们将 通过使用稳健的研究设计（治疗权重的逆概率）实现研究目的，以及 应用先进的统计技术，如多水平建模、考克斯比例风险回归 和具有对数链接和伽马分布的广义线性模型。除了提供真实世界的证据 抑郁症治疗的有效性，我们的研究结果也有可能显着影响修订 现有的HEDIS AMM措施适用于治疗老年痴呆症患者的抑郁症。

High prevalence of depression (25%-45%) among individuals with dementia and the associated worsening of a wide array of negative outcomes warrants research to evaluate the effectiveness of depression treatment among individuals with dementia. To the best of our knowledge, no study to date has been conducted to evaluate depression treatment outcomes among older adults with dementia in real world situations. Our proposed study will be the first of its kind study to use a large nationally representative sample of older adults with dementia to assess the adherence to and outcomes associated with the Healthcare Effectiveness Data and Information Set (HEDIS) antidepressant medication management (AMM) measures. Our long-term objective is to provide real-world evidence for healthcare providers, patients and caregivers, who can make informed decisions to prioritize treatment for depression, which is especially important to maintain functional independence and improve quality of life among individuals with dementia. To accomplish this objective, we propose three specific aims - (Aim 1): Quantify the extent and identify predictors of inappropriate antidepressant use among older adults with dementia newly diagnosed with major depression. (Aim 2): Determine the degree and predictors of adherence to the HEDIS AMM measures in acute and continuation phase treatment among older adults with dementia and newly diagnosed major depression. (Aim 3): Examine health outcomes and expenditures associated with adherence to HEDIS AMM measures during acute and continuation phases of depression treatment among older adults with dementia newly diagnosed with major depression. We will use a retrospective longitudinal cohort study design with Medicare 5% sample claims data (2011-2013) for the purpose of this study. The study population will consist of older adults (age ≥ 65 years) with dementia newly diagnosed with major depression. Depression treatment will be identified using the HEDIS depression treatment recommendation for effective AMM during acute (at least 84 days of antidepressant use during the first 115 days of treatment initiation) and continuation (at least 180 days of antidepressant use during the first 232 days of treatment initiation) phase treatment post new major depression diagnosis. We will achieve the study aims by using a robust study design (Inverse Probability of Treatment Weighting) and applying advanced statistical techniques such as multi-level modeling, Cox Proportional Hazards regression and Generalized Linear Model with log-link and gamma distribution. Apart from providing real-world evidence of effectiveness of depression treatment, our findings also have the potential to significantly influence revisions of the existing HEDIS AMM measures to be adapted for treating depression among older adults with dementia.