Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
RAND Corporation, Santa Monica, California.
JAMA Netw Open. 2021 May 3;4(5):e219622. doi: 10.1001/jamanetworkopen.2021.9622.
Adults with dementia may experience poorer quality of chronic disease management because of the difficulty in reporting symptoms and engaging in shared decision-making associated with cognitive impairment.
To compare the quality of chronic disease management received by adults with and without dementia.
DESIGN, SETTING, AND PARTICIPANTS: For this cross-sectional study, nationally representative data from noninstitutionalized patients 65 years or older were obtained from the 2002-2015 Medical Expenditure Panel Survey. The control group comprised adults of similarly limited life expectancy without dementia comprised . Data analysis was performed in June 2020.
Dementia diagnosis.
Quality of chronic disease management based on 14 individual quality indicators. The association between dementia status and the quality of chronic disease management (3 composite categories: preventive care, diabetes care, and medication treatment) was examined using multivariable linear regression models. Survey weights, sampling strata, and primary sampling unit variables were used to produce national estimates adjusted for nonresponse.
This study included 2506 adults (mean [SD] age, 81.4 [4.7] years; 1259 [49.3%] female; 1243 [50.7%] male), of whom 1335 (53.3%) had a diagnosis of dementia and 1171 (46.7%) did not have a diagnosis of dementia. After adjusting for potential confounders, adults with dementia received lower-quality preventive care compared with adults of similar life expectancy without dementia (adjusted absolute difference [aAD], -6.1 percentage points [pp]; 95% CI, -9.7 to -2.5 pp; P = .001). We found no evidence that the quality of care differed in diabetes care (aAD, 1.7 pp; 95% CI, -4.5 to 7.9 pp; P = .59) and medication treatment (aAD, 1.0 pp; 95% CI, -5.0 to 7.0 pp; P = .75).
In this cross-sectional study, the quality of chronic disease management for adults with dementia was not substantially different from that for those without dementia despite potential barriers. Future studies are warranted to gain a better understanding of the underlying mechanism of these findings for preventive care.
由于认知障碍导致报告症状和参与共同决策的困难，痴呆症成年人可能在慢性病管理方面的质量较差。
比较有和没有痴呆症的成年人接受的慢性病管理质量。
设计、地点和参与者：这项横断面研究从全国代表性的非住院 65 岁及以上患者中获取 2002 年至 2015 年医疗支出调查的数据。对照组由具有相似预期寿命且没有痴呆症的成年人组成。数据分析于 2020 年 6 月进行。
痴呆症诊断。
基于 14 项单独的质量指标的慢性病管理质量。使用多变量线性回归模型检查痴呆状态与慢性病管理质量（3 个综合类别：预防保健、糖尿病护理和药物治疗）之间的关联。使用调查权重、抽样层和主要抽样单位变量对非应答进行调整，得出全国估计值。
这项研究纳入了 2506 名成年人（平均[标准差]年龄 81.4[4.7]岁；1259[49.3%]女性；1243[50.7%]男性），其中 1335 名（53.3%）患有痴呆症，1171 名（46.7%）没有痴呆症诊断。在调整潜在混杂因素后，与预期寿命相似的无痴呆症成年人相比，痴呆症成年人接受的预防保健质量较差（调整绝对差值[aAD]，-6.1 个百分点[pp]；95%CI，-9.7 至-2.5 pp；P = .001）。我们没有发现糖尿病护理（aAD，1.7 pp；95%CI，-4.5 至 7.9 pp；P = .59）和药物治疗（aAD，1.0 pp；95%CI，-5.0 至 7.0 pp；P = .75）方面的护理质量存在差异的证据。
在这项横断面研究中，尽管存在潜在障碍，但痴呆症成年人的慢性病管理质量与没有痴呆症的成年人没有实质性差异。需要进一步的研究来更好地了解这些发现对预防保健的潜在机制。
