Low-value care: antipsychotic medication use among community-dwelling medicare beneficiaries with Alzheimer’s disease and related dementias and without severe mental illness

Abstract

Background: Antipsychotic medication use among elderly with Alzheimer’s disease and related dementias (ADRD) and without severe mental illness is considered as low-value care. Our objective was to assess the factors associated with this inappropriate use of antipsychotic medications among community-dwelling Medicare beneficiaries with ADRD and without severe mental illness.

Methods: This study used a retrospective cross-sectional design. Data for this study were derived from the nationally representative Medicare Current Beneficiary Survey (MCBS) and linked Medicare claims. Logistic regression models were used to examine factors associated with low-value care.

Results: Overall 8.5% had low-value care. In the final adjusted logistic regression model, race other than Hispanic or Non-Hispanic White (AOR =0.54, 95% CI = [0.30,0.98]), individuals over 80 years of age (AOR =0.53, 95% CI = [0.36,0.76]), and obese individuals (AOR =0.55, 95% CI = [0.35,0.85]) had significantly lower odds of receiving low-value care. Those with depression (AOR =1.71, 95% CI = [1.21, 2.43]), who lived in the Midwest (AOR =1.7, 95% CI = [1.08,2.68]), and with a higher number of ADL limitations (AOR =1.28, 95% CI = [1.19,1.38]) had significantly higher odds of low-value care.

Conclusions: There were subgroup differences in low-value care. Interventions may target these subgroups to reduce low-value care.

Keywords:

• Antipsychotic medications
• Medicare beneficiaries
• severe mental illness
• Low-value care
• Alzheimer’s disease and related dementias

Disclosure statement

The authors report no conflicts of interest.

Author contribution

All authors contributed to the conception and design of the research. MN conducted the statistical analyses under the supervision of US and CS. MN wrote the first draft. MN, CS, and US worked on successive iterations.

Additional information

Funding

NIH Clinical Center. Research reported in this publication was partially supported by the National Institute of General Medical Sciences of the National Institutes of Health [grant number, 5U54GM104942-03]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.