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  • Oxford University Press (OUP)  (9)
  • 1
    Online Resource
    Online Resource
    Claims-Based Frailty Index as a Measure of Dementia Severity in Medicare Claims Data
    Oxford University Press (OUP) ; 2023
    In:  The Journals of Gerontology: Series A ( 2023-07-10)
    Details
    In: The Journals of Gerontology: Series A, Oxford University Press (OUP), ( 2023-07-10)
    Abstract: Dementia severity is unavailable in administrative claims data. We examined whether a claims-based frailty index (CFI) can measure dementia severity in Medicare claims. Methods 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. Results 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 & lt;0.280. Conclusions Our study suggests that CFI can be useful in identifying moderate-to-severe dementia from administrative claims among older adults with dementia.
    Type of Medium: Online Resource
    ISSN: 1079-5006 , 1758-535X
    URL: Article
    DOI: 10.1093/gerona/glad166
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2043927-1
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  • 2
    Online Resource
    Online Resource
    A Novel Algorithm for Analysis of Multiple Endpoints Using Risk–Benefit Profiles
    Oxford University Press (OUP) ; 2021
    In:  Innovation in Aging Vol. 5, No. Supplement_1 ( 2021-12-17), p. 813-813
    Details
    In: Innovation in Aging, Oxford University Press (OUP), Vol. 5, No. Supplement_1 ( 2021-12-17), p. 813-813
    Abstract: Often it is necessary to evaluate effectiveness of an intervention on the basis of multiple event outcomes of variable benefit and harm, which may develop over time. An attractive approach is to order combinations of these events based on desirability of the overall outcome (e.g. from cure without any adverse events to death), and then determine whether the intervention shifts the distribution of these ordered outcomes towards more desirable (Evans, Follmann 2016). The win ratio introduced in Pocock et al 2012 was an earlier implementation of this approach. More recently Claggett et al 2015 proposed a more comprehensive method allowing nonparametric and regression-based inference in presence of competing risks. Key to the method is weighting observations by inverse probability of censoring (IPC) processes specific to participants and event types. The method has seemingly great practical utility, but computation of weights is a non-trivial challenge with real-life data when each event can have its own censoring time. We present a novel recursive algorithm solving this problem for an arbitrary number of events ordered by clinical importance or desirability. The algorithm can be implemented in SAS or R software, and computes IPC weights, as well as nonparametric or parametric estimates and resampling-based measures of uncertainty. We illustrate the approach using data from the SPRINT trial of antihypertensive intervention, comparing risk-benefit profiles for robust, pre-frail, and frail subpopulations, and in analysis of fall as a function of progressive risk factors. More general use of the software tools deploying the method is described.
    Type of Medium: Online Resource
    ISSN: 2399-5300
    URL: Article
    DOI: 10.1093/geroni/igab046.2989
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2905697-4
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  • 3
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    CLAIMS-BASED FRAILTY INDEX (CFI) AS A MEASURE OF DEMENTIA SEVERITY IN MEDICARE BENEFICIARIES WITH ADRD
    Oxford University Press (OUP) ; 2022
    In:  Innovation in Aging Vol. 6, No. Supplement_1 ( 2022-12-20), p. 780-780
    Details
    In: Innovation in Aging, Oxford University Press (OUP), Vol. 6, No. Supplement_1 ( 2022-12-20), p. 780-780
    Abstract: Lack of a dementia severity measure in administrative claims data is a major barrier in Alzheimer’s Disease and Related Dementias (ADRD) research using such data sources. A claims-based frailty index (CFI; range 0 to 1, higher scores indicating greater frailty) is a validated measure of frailty that can be calculated from administrative claims data and is correlated with functional status. We conducted a cross-sectional study to examine whether CFI can be a claims-based measure to differentiate dementia severity in 814 participants with ADRD with linked to Medicare claims in the National Health and Aging Trends Study (NHATS). We estimated the Functional Assessment Staging Test (FAST) scale (3: mild cognitive impairment; 4: mild dementia; 5: moderate dementia; 6–7 moderate-to-severe dementia) using NHATS variables and calculated CFI from Medicare claims in the prior 12 months. The prevalence of FAST stage 5 or higher was 244 (weighted percentage, 25.9%). The C-statistic of CFI to identify FAST stage 5 or higher was 0.78 [95% CI:0.73–0.82], with a CFI cut-point of 0.3 achieving the maximum sensitivity 72.5% and specificity 67.5%. The equipercentile linking procedure showed that CFI scores of 0.30, 0.35, and 0.40 corresponded to FAST stages 4, 5, and 6, respectively. Our results support the utility of a CFI as a proxy of dementia severity in administrative claims data.
    Type of Medium: Online Resource
    ISSN: 2399-5300
    URL: Article
    DOI: 10.1093/geroni/igac059.2820
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2905697-4
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  • 4
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    Online Resource
    COGNITIVE FUNCTION CONTRIBUTES TO THE NONLINEAR RELATIONSHIP BETWEEN AGE AND DUAL-TASK GAIT IN MID-AGED POPULATION
    Oxford University Press (OUP) ; 2022
    In:  Innovation in Aging Vol. 6, No. Supplement_1 ( 2022-12-20), p. 230-230
    Details
    In: Innovation in Aging, Oxford University Press (OUP), Vol. 6, No. Supplement_1 ( 2022-12-20), p. 230-230
    Abstract: The capacity to maintain safe walking is critical to functional independence in older adults. However, the timing/stage when such capacity starts to diminish, and its potential contributors have not been well characterized. To explore that, we here conducted analysis based upon the data of 651 participants of age between 40 and 65 years from Barcelona Brain Health Initiative Study. Each participants completed: 1) one 45-second trial of walking normally (single-task) and while performing a serial-subtraction-by-three task (dual-task), of which gait was measured using a smartphone-based gait-assessment application; and 2) a battery of cognitive tests. The dual-task cost (DTC) (i.e., percent changes from single- to dual-task condition) to mean stride time (ST) and stride time variability (STV) and the score of global cognitive function were obtained. The LOESS analyses demonstrated nonlinear relationships between age and DTCs with a turning point at age of 54 years (R2 & gt;3%). Regression models showed significantly greater associations (p=0.01~0.03) between age and DTCs (i.e., older age, worse gait) (β=0.22~0.28, p & lt; 0.006), as well as between global cognitive function and DTCs (β=-0.28~-0.18, p & lt; 0.002), in older group (i.e., age≥54 years) compared to younger group. The structural-equation-modeling suggested that in older group, cognitive function mediated the relationship between age and dual-task gait (p & lt; 0.02) with a contribution of 43~47% to such relationship. The observations here revealed that as early at age of 54 years, dual-task gait starts to significantly diminish, and its dependence on cognitive function dramatically increases, providing critical knowledge for the management of mobility and cognitive aging in mid-age population.
    Type of Medium: Online Resource
    ISSN: 2399-5300
    URL: Article
    DOI: 10.1093/geroni/igac059.914
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2905697-4
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  • 5
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    Online Resource
    BRAIN ACTIVITY DURING DUAL-TASK STANDING IN OLDER ADULTS WITH MILD COGNITIVE IMPAIRMENT
    Oxford University Press (OUP) ; 2022
    In:  Innovation in Aging Vol. 6, No. Supplement_1 ( 2022-12-20), p. 736-736
    Details
    In: Innovation in Aging, Oxford University Press (OUP), Vol. 6, No. Supplement_1 ( 2022-12-20), p. 736-736
    Abstract: Performance of a cognitive task while standing disrupts balance in older adults. This disruption is exaggerated in those with mild cognitive impairment (MCI). Moreover, older adults with MCI who exhibit greater dual-task ‘cost’ are more likely to develop falls and dementia. EEG studies suggest that cognitive-motor dual-tasking is associated with brain activity fluctuations originating from central brain regions at specific frequencies, particularly in the alpha-band (8–13 Hz). We hypothesized that older adults with MCI would demonstrate decreased EEG alpha power during dual-task standing compared to healthy controls, and that decreased alpha power would be associated with elevated dual-task cost. We recorded postural sway and EEG in 14 participants with MCI [Montreal Cognitive Assessment (MoCA) & lt; 25] and 16 healthy older adults [MoCA & gt;25] as they completed trials of standing with and without serial subtractions. Postural sway metrics were derived, and from EEG we calculated absolute alpha-, theta-, and beta-band powers within a-priori defined regions-of-interest: the left and right anterior, central, and posterior regions. Repeated Measures ANOVA demonstrated that participants with MCI exhibited decreased alpha power in the central regions during dual-task standing compared to healthy controls (p= 0.01). No significant difference was observed for theta and beta-band powers between participants with MCI and healthy controls. In those with MCI, lower alpha power during dual-task standing correlated with increased dual-task cost to postural sway path (worse balance) (r=-0.4, p=0.03). These results provide preliminary evidence that specific patterns of brain activity during dual-tasking are disrupted in MCI and this is associated with elevated dual-task costs.
    Type of Medium: Online Resource
    ISSN: 2399-5300
    URL: Article
    DOI: 10.1093/geroni/igac059.2680
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2905697-4
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  • 6
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    Online Resource
    BAC DOOR: A Clinician Ranking Exercise for Better Staphylococcus aureus Bacteremia Trial Design
    Oxford University Press (OUP) ; 2016
    In:  Open Forum Infectious Diseases Vol. 3, No. suppl_1 ( 2016-12-01)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 3, No. suppl_1 ( 2016-12-01)
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofw172.769
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2016
    detail.hit.zdb_id: 2757767-3
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  • 7
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    Online Resource
    On the choice of time scales in competing risks predictions
    Oxford University Press (OUP) ; 2017
    In:  Biostatistics Vol. 18, No. 1 ( 2017-01), p. 15-31
    Details
    In: Biostatistics, Oxford University Press (OUP), Vol. 18, No. 1 ( 2017-01), p. 15-31
    Type of Medium: Online Resource
    ISSN: 1465-4644 , 1468-4357
    URL: Article
    DOI: 10.1093/biostatistics/kxw024
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2017
    detail.hit.zdb_id: 2020601-X
    SSG: 12
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  • 8
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    Correlates of Segmental Pulse Wave Velocity in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study
    Oxford University Press (OUP) ; 2016
    In:  American Journal of Hypertension Vol. 29, No. 1 ( 2016-01), p. 114-122
    Details
    In: American Journal of Hypertension, Oxford University Press (OUP), Vol. 29, No. 1 ( 2016-01), p. 114-122
    Type of Medium: Online Resource
    ISSN: 0895-7061 , 1941-7225
    URL: Article
    DOI: 10.1093/ajh/hpv079
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2016
    detail.hit.zdb_id: 1479505-X
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  • 9
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    Online Resource
    Neurocognitive Function Among Middle-aged and Older Hispanic/Latinos: Results from the Hispanic Community Health Study/Study of Latinos
    Oxford University Press (OUP) ; 2015
    In:  Archives of Clinical Neuropsychology Vol. 30, No. 1 ( 2015-02-01), p. 68-77
    Details
    In: Archives of Clinical Neuropsychology, Oxford University Press (OUP), Vol. 30, No. 1 ( 2015-02-01), p. 68-77
    Type of Medium: Online Resource
    ISSN: 0887-6177 , 1873-5843
    URL: Article
    DOI: 10.1093/arclin/acu066
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2015
    detail.hit.zdb_id: 2003528-7
    SSG: 5,2
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