Data

791 PD patients among 24,831 subjects in the National Long Term Care Survey (NLTCS) of NIA (longitudinal survey at 3 5-year intervals from 1984 to 1994) designed to study disabled Medicare recipients.  Survey data were linked to actual Medicare claims data for 5 years, 1991-1995.

Demographics

-- PD subjects in this study are about 3 years older than non-PD subjects (mean age 78.5+/-7.6 years vs. 75.1+/-8.3 years).

-- PD subjects living in community are 3 times more likely to have severe disability (5-6 ADLs) and over twice as likely to reside in an institution.

-- Overall, 3.4% of whites and 1.8% of blacks in this elderly population had PD. When PD is defined by survey (“Have you ever been told by a doctor that you have PD?”), 25%  more whites report having PD than blacks. When PD is defined by Medicare claims,  twice as many whites receive treatment for PD than blacks. This apparent disparity needs further investigation.

Speciality Care

-- Only half of PD subjects report visits to neurologists, although much more likely than non-PD subjects (52 % vs. 15%).

--  Visits to neurologists are related to gender and education of patients. Low education (less than elementary school) 50.8% males and 37.0% females see neurologist. High education (Graduated HS/Some college) 63.6% males and 51.9% females. Intermediate education in between.

--  PD subjects also more likely to see other medical specialists than non PD subjects, but much less likely (1/3) to have encounters for surgery or diagnostic lab procedures.

-- PD subjects are nearly twice as likely to use home health services and nearly 3 times more likely to have claims from skilled nursing facilities.

-- PD subjects had longer physician visits than non-PD subjects -- only 1/4 as likely to have a “very short” office visit and 1/2 as likely to have a “shorter than average” office visit

Comorbidities

-- PD subjects had more arthritis, broken bones, broken hips, dementia, and diabetes than non-PD subjects. The cost of PD escalates substantially with other comorbid conditions, very common for this older group.

-- PD subjects are substantially more likely to break bones, including hips. Males with PD are 4 times more likely to break a hip, females 2.5 times more likely.

--PD subjects Broken hip increases Per Person Per Year (PPY) cost 2.2 times over PD PPY cost with no comorbid disease. Costs to care for broken hip for PD subjects are substantially greater than for non-PD subjects.

Implications

These findings suggest public health opportunities that warrant further investigation.  A key example is the design of programs to investigate and address disparities in incidence, diagnosis and treatment of PD based on gender, race, and economic status.  Also key targets for public health interventions are improvement of diagnosis and treatment of PD by non-specialists versus comorbid conditions (e.g., arthritis, dementia) and prevention of costly complications of PD from falls.