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Hopkins’ Economics of Alzheimer’s Disease & Services Center

Research Projects - 2021 & 2022 Award Year

The Hopkins' Economics of Alzheimer's Disease and Services Center funded four pilot projects in 2022:

OnurADRD, Family Caregiving and Children's labor supply in Denmark. Onur Altindag, PhD, MA - Principal Investigator

A significant share of long-term care needs related to ADRD are met informally by family members, many of whom also work, and the increasing demand for care has potential to impede economic growth by reducing formal employment among the working-age population. A full accounting of the economic burden of ADRD must include the substantial spillovers in the form of reduced labor force participation and lost earnings of family caregivers. In this project, we will study the labor supply response to ADRD-related caregiving among adult men and women in Denmark and document the distribution of economic costs within families based on demographic characteristics. Our study will contribute to a greater understanding of the substantial, but often difficult to measure economic consequences that ADRD imposes on families and on national budgets pointing to targeted policies to mitigate these costs.

DardenAn Economic Approach to Mental Health and Cognitive Ability in the Elderly. Michael Darden, PhD - Principal Investigator

My research seeks to improve our understanding of the determinants of cognitive decline. I propose to use economic modeling to address two fundamental problems in this literature: dynamic selection and measurement error. Dynamic selection occurs when the composition of data changes over the age profile due to mortality. For example, dynamic selection biases the relationship between cigarette smoking and cognitive health because smokers experience excess mortality. Measurement error occurs when we use proxy measures (e.g., word recall scores) in the place of latent variables (e.g., cognitive health). Economists have developed statistical models for both dynamic selection and measurement error, but my research is the first to apply these methods to cognitive health and its determinants.

PowellCare Partners and Support of Older Adults with Hearing Loss and Dementia. Danielle Powell, AuD, PhD - Principal Investigator

The purpose of this project is to understand the role of care partners in health care in the context of caring for an older adult with hearing loss and dementia. Caring for the growing number of older adults with dementia presents complex medical and communication challenges. These challenges may be compounded in the context of hearing loss where the additional burden of hearing loss among older adults with dementia may place added stressors on cognitive reserve, hinder communication further, and create additional emotional/social burdens on care partners. With this work, we aim to understand how care partners influence health management of older adults with hearing loss and/or dementia to inform future work to improve communication between older adults with dementia, care partners, and clinicians — critical for the health and social/emotional support of older adults and their care partners.

ReiderHealth Care Service Utilization and Cost of Hip Fracture Care in Older Adults with Dementia. Lisa Reider, PhD, MHS - Principal Investigator

Hip fractures are a significant cause of morbidity and mortality in older adults and have a substantial impact on health care service utilization and cost. Each year over 300,000 older adults are hospitalized for hip fracture in the United States with an estimated annual direct cost of $17 billion dollars. Given the increase in older adults nationally, these numbers are expected to grow. The risk of hip fracture is nearly three times higher in older adults with dementia owing to higher rates of osteoporosis and a greater propensity for falls. Nearly 40% of older adults with hip fracture are cognitively impaired and are more likely to experience post-operative complications, longer lengths of hospital stay, hospital readmission and greater loss of independent function. This is a vulnerable group that require a higher treatment focus and more resources to meet their complex needs, though little is known about the incremental service utilization and cost associated with dementia for hip fracture. Therefore, we will compare health care service utilization and cost for hip fracture among older adults with versus without dementia using 20% Medicare FFS claims and will determine if dementia is predictive of higher cost independent of standard risk adjustment variables. This research has important implications for future bundled payment policy and the provision of value-based care for these individuals.

The Hopkins' Economics of Alzheimer's Disease and Services Center funded four pilot projects in 2021: 

StephanieExamining Emergency Department Length of Stay for Older Adults with Dementia. Stephanie Nothelle, MD – Principal Investigator

Older adults with dementia go to the Emergency Department (ED) more frequently than older adults without dementia. The ED is a potentially overstimulating environment for older adults with dementia given the background noise, large number of unfamiliar people and interrupted opportunities for sleep. Further, the ED is associated with higher costs of care for older adults with dementia compared to those without dementia, placing financial strain on patients, families and society. Given these risks, reducing the time spent in the ED, particularly from long extremes is important for older adults with dementia. In this study we will determine if length of stay in the ED is longer for older adults with dementia and if there are any facility characteristics associated with longer lengths of stay for older adults with dementia. These results will serve as important foundational information that could be used to target ED dementia care interventions.

NicholasGenetic Risk for Alzheimer’s Disease and Later-Life Decisions and Outcomes: Exploring the Role of the Family and Human Capital. Nicholas W. Papageorge, PhD, MA – Principal Investigator

The purpose of this project is to use data on genetic propensities to develop ADRD to better understand the life course trajectories of people who may eventually develop ADRD, including their educational attainment, work life, income, financial decisions, and wealth accumulation. Of particular interest are individuals who are not diagnosed with ADRD or who do not exhibit significant cognitive decline according to standard measures (either because they lack access to medical care or, alternatively, because their condition is mild enough or their environment protective enough that cognitive decline falls under the radar). Using genetic data to better understand people who may not exhibit cognitive decline using standard measures or who are not diagnosed can help us to better understand the full extent of ADRD. Preliminary results suggest that many people with a genetic propensity for ADRD and who are not diagnosed and who do not exhibit strong cognitive decline according to standard measures still exhibit other negative outcomes (e.g., earlier retirement or less wealth) suggesting that the ways we currently diagnose or recognize illness are not sufficient to capture the full population in need of treatment. Findings will not only help us to recognize more potential patients, but may also help us to understand treatment. If some people with a genetic propensity for ADRD do not exhibit symptoms, it may be by chance, but may also be because policy-modifiable environmental factors are protective. Understanding what these factors are and why they are protecting could eventually be used to inform best treatment practices.

MeganUse of high cost care among Veterans with comorbid mental illness and Alzheimer’s and related dementia. Megan Shepherd-Banigan, PhD, MPH - Principal Investigator

We will examine 12-month health care use patterns among Veterans 65+ with pre-existing mental illness and a new Alzheimer’s Disease and Related Dementias (ADRD) diagnosis. Specifically, we will examine the extent to which pre-existing mental illness is a risk factor for poor quality care for individuals with ADRD. The incidence of ADRD is projected to increase exponentially in the coming decades and mental illness is associated with a 2-fold higher risk for developing ADRD. Co-occurrence of ADRD and mental illness likely complicates health care delivery for this population, yet there is little understanding of the implications of this co-occurrence on service utilization patterns which drive Medicare costs. Findings from this study will provide information about the extent to which pre-existing mental illness impedes high quality care for older adults with ADRD, as evidenced by higher ED use, inpatient visits, and 30-day readmissions. This information will provide a foundation upon which to develop health system strategies that improve care coordination and quality for this understudied population.

VarshiniDementia and sensory impairment: Economic consequences for patients and caregivers. Varshini Varadaraj, MD, MPH – Principal Investigator

Dementia and sensory impairment are salient features of aging that share common risk factors, and sensory impairment is itself a risk factor for cognitive decline. These commonly co-occurring conditions may be associated with impairment in financial capacity, putting older adults at risk for financial loss and fund mismanagement. In addition, caring for older adults with chronic conditions may be associated with financial difficulties among caregivers. Financial capacity is central to older adults’ independence and well-being, and their caregivers’ welfare and capacity for caregiving. Therefore, a deeper understanding of the interplay between dementia and sensory impairment and the impact of the resultant cumulative risk on financial wellbeing of older adults and their caregivers is required. This project aims to examine the economic impact (income, economic wellbeing, financial literacy) of having co-occurring dementia and sensory impairment (vision and hearing impairments) on older adults, and their family caregivers, using nationally representative data. The resulting findings will highlight gaps and opportunities for the development of supportive services and policies to help older adults with financial management.