Additional file 2 of Amyloid-β PET scans, economic strain and financial decision-making among persons with cognitive impairment and care partners: a mixed-methods analysis of the CARE-IDEAS study

Figshare · 2026-04-14

Supplementary Material 2.

Amyloid-β PET scans, economic strain and financial decision-making among persons with cognitive impairment and care partners: a mixed-methods analysis of the CARE-IDEAS study

Figshare · 2026-04-14

Abstract Background To explore the relationship between receipt of amyloid-β PET scan results and subsequent experiences of economic strain and financial decision-making for persons with cognitive impairment and their care partners. Methods A parallel convergent mixed-methods design where quantitative and qualitative data were simultaneously collected and analyzed. Participants included a subset of community-residing Medicare beneficiaries with cognitive impairment who had an amyloid-β PET scan at a participating specialty center and their care partners, from the IDEAS study. Regression models tested associations between an elevated scan result and objective and subjective economic strain outcomes. Qualitative semi-structured interviews were conducted with patients and care partners ~24-36 months post-scan occurrence. Results Participants' mean age was 75, were majority White, non-Hispanic, highly educated, in good health, and well-resourced. Care partners were mainly spouses. Patients and care partners with elevated amyloid did not have higher economic strain at any post-disclosure time point compared to those with a negative scan. However, difficulty paying bills increased substantially for all participants over 18-24 months. Themes related to patient and care partner experiences of financial decision-making considering the scan were: 1) the need to make or update financial plans, 2) perceived care needs and financial resources for meeting care needs, and 3) involvement of family members in financial plans. Conclusions Despite engaging in financial decision-making post-scan, participants reported experiencing economic strain, as measured by difficulty paying bills. More research is needed across the wealth distribution to develop methods for identifying and addressing economic strain experiences following a diagnosis of dementia.

Additional file 1 of Amyloid-β PET scans, economic strain and financial decision-making among persons with cognitive impairment and care partners: a mixed-methods analysis of the CARE-IDEAS study

Figshare · 2026-04-14

Supplementary Material 1.

Additional file 2 of Amyloid-β PET scans, economic strain and financial decision-making among persons with cognitive impairment and care partners: a mixed-methods analysis of the CARE-IDEAS study

Figshare · 2026-04-14

Supplementary Material 2.

Amyloid-β PET scans, economic strain and financial decision-making among persons with cognitive impairment and care partners: a mixed-methods analysis of the CARE-IDEAS study

Figshare · 2026-04-14

Abstract Background To explore the relationship between receipt of amyloid-β PET scan results and subsequent experiences of economic strain and financial decision-making for persons with cognitive impairment and their care partners. Methods A parallel convergent mixed-methods design where quantitative and qualitative data were simultaneously collected and analyzed. Participants included a subset of community-residing Medicare beneficiaries with cognitive impairment who had an amyloid-β PET scan at a participating specialty center and their care partners, from the IDEAS study. Regression models tested associations between an elevated scan result and objective and subjective economic strain outcomes. Qualitative semi-structured interviews were conducted with patients and care partners ~24-36 months post-scan occurrence. Results Participants' mean age was 75, were majority White, non-Hispanic, highly educated, in good health, and well-resourced. Care partners were mainly spouses. Patients and care partners with elevated amyloid did not have higher economic strain at any post-disclosure time point compared to those with a negative scan. However, difficulty paying bills increased substantially for all participants over 18-24 months. Themes related to patient and care partner experiences of financial decision-making considering the scan were: 1) the need to make or update financial plans, 2) perceived care needs and financial resources for meeting care needs, and 3) involvement of family members in financial plans. Conclusions Despite engaging in financial decision-making post-scan, participants reported experiencing economic strain, as measured by difficulty paying bills. More research is needed across the wealth distribution to develop methods for identifying and addressing economic strain experiences following a diagnosis of dementia.

Additional file 1 of Amyloid-β PET scans, economic strain and financial decision-making among persons with cognitive impairment and care partners: a mixed-methods analysis of the CARE-IDEAS study

Figshare · 2026-04-14

Supplementary Material 1.

Technology Activities and Cognitive Trajectories Among Community-Dwelling Older Adults From the NHATS 2015-2023

Innovation in Aging · 2025-12-01

Abstract This study examines the associations between the onsets and cessations of technology use and cognitive trajectories among community-dwelling older adults without dementia. While using digital technology is positively associated with cognitive function, the impacts of specific activities on distinct cognitive domains are underexplored. Data were collected from 5,566 older adults involved in the National Health and Aging Trends Study (NHATS) from 2015 to 2023. Assessed technology activities included online shopping, banking, medication refills, social media use, and checking health conditions online. Cognitive domains measured were episodic memory, executive function, and orientation. Linear mixed-effects models analyzed associations between technology activity transitions and cognitive outcomes, adjusting for demographic, socioeconomic, and health-related factors. Onsets of online shopping (β = 0.044**), medication refills (β = 0.070***), and social media (β = 0.065**) were associated with improved episodic memory. Conversely, cessations of online banking (β=-0.083**) and social media (β=-0.064**) related to decreased episodic memory. Initiating instrumental, social, and health-related technology activities mitigated cognitive decline in orientation. Online shopping onset mitigated episodic memory decline (β = 0.013*) while cessation worsened it (β=-0.022*); a similar trend occurred with social media cessation (β=-0.018*). More device ownership consistently linked to better cognitive functioning across activities. Higher educational attainment also correlated with superior cognitive domain performance, indicating potential disparities. Results suggest engagement in technology activities supports cognitive health in older adults. Future interventions should promote initiation and sustainment of these activities to mitigate cognitive decline in aging populations.

Telehealth Use by Residence Type Among Older Adults Receiving Long-Term Services and Supports

Innovation in Aging · 2025-12-01

Abstract Telehealth can improve access to geriatric care, particularly for vulnerable older adults facing transportation, mobility, and health-related barriers to in-person care. However, integration of telehealth into geriatric care must account for the different residence types where older adults use telehealth. This study examined the association between residence type and telehealth use among older recipients of long-term services and supports (LTSS) using cross-sectional data from the 2021-2022 National Core Indicators-Aging and Disability Adult Consumer Survey. The analytic sample included 6,925 LTSS users aged ≥ 65 years without intellectual or developmental disability: 69.2% lived in the community, 20% in residential care, and 10.9% in nursing facilities. Telehealth use was reported by 39.2% of community-dwelling respondents, 33.5% in residential care, and 20.3% in nursing facilities. Complete-case multivariable logistic regression, adjusting for sociodemographic and health-related factors with state-level random intercepts, revealed that those in residential care and nursing facilities had significantly lower adjusted odds of telehealth use than their community-dwelling counterparts (residential care: OR, 0.80 [95% CI, 0.69-0.92]; nursing facilities: OR, 0.37 [95% CI, 0.29-0.47]), with nursing home residents also having lower adjusted odds than those in residential care (OR, 0.46 [95% CI, 0.36-0.60]). These findings highlight differences in telehealth use among older LTSS users, with those in residential and nursing facilities having lower odds of telehealth use compared to community-dwelling individuals. Targeted efforts to promote telehealth adoption in institutional and congregate care settings may help bridge this gap.

Caregiving During the Covid-19 Pandemic Through Publicly-Funded Home- and Community-Based Services

Innovation in Aging · 2025-12-01

Abstract Workforce shortages in home- and community-based services (HCBS) were exacerbated during the COVID-19 pandemic. We evaluated changes in HCBS use and consumer-reported unmet HCBS needs for (1) personal care aide (PCA) and (2) caregiver support/respite (CS/R) in 2021-2022 (during the pandemic) versus 2018-2019 (pre-pandemic), in the US National Core Indicators- Aging & Disability Adult Consumer Survey. We included 7143 community-dwelling HCBS consumers (age, ≥65 years, from 11 states). We calculated adjusted odds ratios (aOR) and 95% confidence interval (CI) for HCBS use and consumer-reported unmet HCBS needs for PCA and CS/R using logistic regression, adjusting for sociodemographic and health-related variables (fixed effects), with random intercept for state (to account for clustering by state). For PCA, compared to 2018-2019, during 2021-2022, there was a significant increase in the odds of both PCA use (aOR, 1.24; 95% CI, 1.09, 1.40) and unmet PCA needs (aOR, 1.23; 95% CI, 1.03, 1.46), suggesting that pandemic policy efforts to mitigate service disruptions were insufficient to decrease unmet PCA needs. For CS/R, during 2021-2022, there was a significant increase in the odds of CS/R use (aOR, 1.24; 95% CI, 1.09, 1.40) and a simultaneous significant decrease in the odds of unmet CS/R needs (aOR, 0.49; 95% CI, 0.35, 0.70), suggesting that temporary pandemic policies for CS/R may have successfully abated consumers-reported unmet CS/R service needs. These cross-sectional findings call for more rigorous investigation to identify which temporary pandemic-related CS/R policies were effective; to inform disaster preparedness efforts for mitigating HCBS disruptions during future public health emergencies.

The cost of non-drug interventions that improve function and reduce dementia-related behaviors

BMC Geriatrics · 2025-12-04

To determine the net cost of non-drug interventions that maintain or improve a person with dementia’s physical function and/or reduce challenging behaviors. Cost data are needed to inform the adoption of non-drug interventions in health systems and the development of policies to incentivize their use. We modified a person-level microsimulation to model the cost of four non-drug interventions relative to usual care: Collaborative Care, Care of Persons with Dementia in their Environments (COPE), Tailored Activity Program (TAP), and Skills2Care. We also conducted a value of information analysis to quantify the optimal sample size of conducting a new randomized trial that would reduce uncertainty on the cost savings of each intervention from a societal perspective. Finally, we conducted sensitivity analyses. Collaborative Care, TAP and COPE were cost savings compared to usual care (-$572, -$1,816, and -$5,262, respectively). Skills2Care results in a $89 net increase in cost compared to usual care. The value of information analysis identified the optimal sample size of a potential future study: Skills2Care (optimal n = 8,560), TAP (optimal n = 5,650), COPE (optimal n = 3,910) and Collaborative Care (optimal n = 3,630). In one-way sensitivity analyses, when we applied a pessimistic assumption for the treatment effect, COPE and TAP were still cost saving, while Collaborative Care cost more than usual care. Conclusions did not materially change in sensitivity analyses that varied treatment cost. Non-drug dementia care interventions that maintain or improve a person with dementia’s function and/or reduce challenging behaviors present a viable clinical / economic model of care for health systems. Three (Collaborative Care, Care of Persons with Dementia in their Environments, and Tailored Activity Program) of four (Skills2Care) non-drug dementia interventions that maintain or improve a person with dementia’s physical function and/or reduce challenging behaviors are cost savings compared to usual care. The National Institutes of Health is investing in pragmatic trials to test the effectiveness of dementia care interventions. Using a value of information analysis, we found that large sample sizes (between 3,630 and 8,560 people) are needed to reduce uncertainty as to whether non-drug dementia care interventions are cost savings. This finding reinforces the need for pragmatic studies and also highlights the value of microsimulation methodologies. Findings demonstrate the financial benefit of selected evidence-based caregiver support programs for health systems engaged in the GUIDE model or operating in a capitated payment system.