Fowler, Nicole R.
(2010)
TREATMENT DECISIONS FOR PEOPLE WITH LIFE LIMITING ILLNESSES: AN ANALYSIS OF TREATMENT VARIATION IN SECONDARY PREVENTIVE CARE FOR CARDIOVASCULAR DISEASE AMONG ELDERLY MEDICARE PATIENTS WITH DEMENTIA.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
This dissertation examines the effect of dementia on the treatment of coronary heart disease (CHD) in elderly Medicare beneficiaries. It specifically tests whether rates of utilization of evidence-based secondary preventive medication treatment (chemoprophylaxis) for CHD are different in patients with dementia compared to those without dementia. Data from the Cardiovascular Health Study were used to investigate the long-term effect of dementia on the use of four types of low burden and low risk chemoprophylaxis for CHD over time (ACE inhibitors, beta-blockers, lipoid-lowering medications and antiplatelet medications). The multivariate analyses employed a range of predictors including predisposing patient characteristics such as age, race, sex, education and the interaction of age and dementia status. Enabling variables included in the analyses are study site, income, supplemental insurance status, and residence in a nursing home. The care need variables include functional status, measured by activities of daily living, and comorbidites. The main findings reveal that the presence of any type of dementia, comorbid with CHD, has an effect on the use of beta-blockers and lipid-lowering medications. Additionally, patients with CHD and vascular type dementia are less likely to report taking beta-blockers, lipid-lowering medications, and antiplatelet medications, but more likely to report using ACE inhibitors. The results are mixed regarding the effect of timing of dementia onset of the use of chemoprophylaxis. Those who developed dementia before CHD were less likely to report using a beta-blocker and lipid-lowering mediation, yet, those who developed dementia after CHD did not discontinue use of chemoprophylaxis after the onset of dementia. The results of this dissertation provide new empirical evidence of the difference in the rate of secondary chemoprophylaxis for CHD among elderly patients with dementia compared to those without dementia. Information about the effect of dementia on the treatment of CHD, as well as factors that predict utilization, could inform health policy to improve care for the millions of Americans living with dementia and CHD.
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| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
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| ETD Committee: |
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| Date: |
29 June 2010 |
| Date Type: |
Completion |
| Defense Date: |
2 March 2010 |
| Approval Date: |
29 June 2010 |
| Submission Date: |
12 April 2010 |
| Access Restriction: |
5 year -- Restrict access to University of Pittsburgh for a period of 5 years. |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
Graduate School of Public and International Affairs > Public and International Affairs |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
coronary heart disease; dementia; health policy; Health services research |
| Other ID: |
http://etd.library.pitt.edu/ETD/available/etd-04122010-104416/, etd-04122010-104416 |
| Date Deposited: |
10 Nov 2011 19:36 |
| Last Modified: |
19 Dec 2016 14:35 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/7065 |
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