Researchers from the Johns Hopkins Bloomberg School of Public Health linked Medicare claims to data derived from in-person interviews with more than 3,700 community-living older adults with disability. The goal was to quantify differences in total Medicare spending by whether the participants experienced negative consequences due to inadequate support with household activities, mobility, or self-care. The researchers found that the participants with disability incurred Medicare spending that was more than twice as high as among those without disability. More than 1 in 5 older adults with mobility or self-care disability reported negative consequences due to no one being available to help and median per-person Medicare spending among those adults was significantly higher than for those who did not experience negative consequences.
According to the researchers, these findings suggest that the beneficial effects of comprehensive community-based long-term services and supports may extend beyond improved health, well-being and participation to reduced spending on health services. They propose greater use of strategies that target both health and function.
4. New Cholesterol guidelines focus on a healthy lifestyle and if likely to benefit, shared decision-making regarding statins
New clinical practice guidelines on cholesterol management from the American Heart Association and American College of Cardiology (AHA/ACC) and multiple prevention oriented societies* endorse a heart-healthy lifestyle beginning in childhood to reduce lifetime risk for atherosclerotic cardiovascular disease (ASCVD). For primary prevention, in those likely to benefit, the guidelines recommend a clinician-patient risk discussion before a decision is made about statin treatment. A synopsis of the guidelines is published in Annals of Internal Medicine.
In November 2018, the AHA/ACC and multiple prevention oriented societies* released a new clinical practice guideline on cholesterol management that was accompanied by an in-depth risk assessment report on primary prevention of ASCVD.
A panel of experts conducted a systematic review and meta-analyses of randomized controlled trials that examined cardiovascular outcomes. High-quality observational studies were used for estimation of ASCVD risk. An independent panel systematically reviewed the trial evidence about the benefits and risks of adding nonstatin medications to statin therapy compared with receiving statin therapy alone in persons who have ASCVD and judged to be at very high risk. Based on the evidence, the AHA/ACC Multi-Society recommendations include:
