# Identifying Approaches to Measure and Reduce Harmful, Low-Value Care Among Older Americans with Mild Cognitive Impairment and Dementia

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA LOS ANGELES · 2021 · $532,358

## Abstract

ABSTRACT
 Low-value care is patient care that provides no net benefit in specific clinical scenarios, and often causes
harm. Older adults with mild cognitive impairment and dementia (MCID) frequently receive low-value care and
are particularly vulnerable to its harms (e.g., routine benzodiazepine drug prescriptions offer limited benefit to
adults with MCID and can cause delirium or falls). Reducing the delivery of low-value care can improve health
outcomes for this vulnerable group by lessening exposure to harms as well as curtailing unnecessary
spending. To begin to reduce the problem of low-value care delivery in older adults with MCID, it is important to
understand the extent of the national problem, identify the characteristics of patients and the delivery systems
with the greatest risk exposure, and whether two currently implemented U.S. strategies (payment reform and a
large education campaign) were associated with less delivery of low-value care among older adults with MCID.
In this context, we propose three specific aims: 1) to generate national estimates of low-value care trends,
costs, and harms in older adults with MCID (2008–2018), 2) to identify subgroups of older adults with MCID at
the greatest risk of receiving low-value care, and 3) to assess whether two U.S. strategies were associated
with less low-value care delivered to older adults with MCID.
 We propose to achieve these aims by linking Medicare claims data with the Health and Retirement Study
(HRS), which is a nationally representative longitudinal study of community-dwelling and institutionalized older
Americans on the health and economic changes of aging. We will pursue these aims using national
longitudinal data and by applying rigorous analytical approaches such as interrupted time series methods with
contemporaneous control groups. Ultimately, we seek to build a foundation of evidence to inform future U.S.
health policies that can reduce low-value care and improve patient-oriented outcomes in older Americans with
MCID.

## Key facts

- **NIH application ID:** 10099212
- **Project number:** 1R01AG070017-01
- **Recipient organization:** UNIVERSITY OF CALIFORNIA LOS ANGELES
- **Principal Investigator:** John N. Mafi
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $532,358
- **Award type:** 1
- **Project period:** 2020-12-15 → 2025-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10099212

## Citation

> US National Institutes of Health, RePORTER application 10099212, Identifying Approaches to Measure and Reduce Harmful, Low-Value Care Among Older Americans with Mild Cognitive Impairment and Dementia (1R01AG070017-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10099212. Licensed CC0.

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