Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.
Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
J Gerontol A Biol Sci Med Sci. 2023 Oct 28;78(11):2145-2151. doi: 10.1093/gerona/glad166.
Dementia severity is unavailable in administrative claims data. We examined whether a claims-based frailty index (CFI) can measure dementia severity in Medicare claims.
This cross-sectional study included the National Health and Aging Trends Study Round 5 participants with possible or probable dementia whose Medicare claims were available. We estimated the Functional Assessment Staging Test (FAST) scale (range: 3 [mild cognitive impairment] to 7 [severe dementia]) using information from the survey. We calculated CFI (range: 0-1, higher scores indicating greater frailty) using Medicare claims 12 months prior to the participants' interview date. We examined C-statistics to evaluate the ability of the CFI in identifying moderate-to-severe dementia (FAST stage 5-7) and determined the optimal CFI cut-point that maximized both sensitivity and specificity.
Of the 814 participants with possible or probable dementia and measurable CFI, 686 (72.2%) patients were ≥75 years old, 448 (50.8%) were female, and 244 (25.9%) had FAST stage 5-7. The C-statistic of CFI to identify FAST stage 5-7 was 0.78 (95% confidence interval: 0.72-0.83), with a CFI cut-point of 0.280, achieving the maximum sensitivity of 76.9% and specificity of 62.8%. Participants with CFI ≥0.280 had a higher prevalence of disability (19.4% vs 58.3%) and dementia medication use (6.0% vs 22.8%) and higher risk of mortality (10.7% vs 26.3%) and nursing home admission (4.5% vs 10.6%) over 2 years than those with CFI <0.280.
Our study suggests that CFI can be useful in identifying moderate-to-severe dementia from administrative claims among older adults with dementia.
行政索赔数据中没有痴呆严重程度的信息。我们研究了索赔为基础的衰弱指数（CFI）是否可以衡量医疗保险索赔中的痴呆严重程度。
本横断面研究纳入了全国健康老龄化趋势研究第五轮中可能或可能患有痴呆症且医疗保险索赔可用的参与者。我们使用调查信息估计了功能评估分期测试（FAST）量表（范围：3[轻度认知障碍]至 7[重度痴呆]）。我们使用参与者面谈日期前 12 个月的医疗保险索赔计算了 CFI（范围：0-1，分数越高表示衰弱程度越高）。我们检查了 C 统计量以评估 CFI 识别中重度痴呆（FAST 阶段 5-7）的能力，并确定了最大化敏感性和特异性的最佳 CFI 切点。
在 814 名可能或可能患有痴呆症且可测量 CFI 的参与者中，686 名（72.2%）患者年龄≥75 岁，448 名（50.8%）为女性，244 名（25.9%）为 FAST 阶段 5-7。CFI 识别 FAST 阶段 5-7 的 C 统计量为 0.78（95%置信区间：0.72-0.83），CFI 切点为 0.280，达到了 76.9%的最大敏感性和 62.8%的特异性。CFI≥0.280 的参与者的残疾（19.4% vs 58.3%）和痴呆症药物使用（6.0% vs 22.8%）发生率更高，死亡率（10.7% vs 26.3%）和疗养院入院率（4.5% vs 10.6%）更高在 2 年内比 CFI<0.280 的参与者。
我们的研究表明，CFI 可用于从医疗保险索赔中识别老年痴呆症患者的中重度痴呆症。
