Impact of annual wellness visits on preventing falls and fractures for Alzheimer’s disease and related dementias older adults

Background: Falls and fractures are leading causes of disability and premature death among older adults with Alzheimer’s Disease and Related Dementias (ADRD). Annual Wellness Visits (AWVs), which Medicare reimburses, can screen and manage fall/fracture-related risk factors. This study evaluates the association between AWV and falls/fractures prevention among Medicare beneficiaries with ADRD. Methods: We analysed a cohort of Medicare beneficiaries in 2017 aged ≥68 years with ADRD and continuous enrollment from 2014 to 2016 (n = 1 610 637). AWV recipients were stratified by the number of visits before 2017 (0, 1, 2 or ≥ 3). Kaplan–Meier methods estimated rates of falls and fractures. Patients were censored at end of study (12/31/2021), if they lost Medicare coverage, or switched to HMO. We used inverse probability treatment weighting (IPTW) with propensity score in Cox proportional hazards models to assess the effect of AWVs. Results: AWVs were associated with reduced risks for falls (HR: 0.976 for 2 AWVs; 0.936 for ≥3 AWVs) and fractures (HR: 0.978 for 1 AWV; 0.960 for 2 AWVs; 0.927 for ≥3 AWVs), with greater reductions observed with more AVWs. Time-dependent models revealed AWV in follow-up period had stronger effects on fall and fracture risk (HR: 0.921 and 0.929, respectively). In subgroup analyses, AWV risk reduction was weaker for falls in Black and rural residents with no significant fracture risk reduction. Conclusions: Our studies indicate more AWVs are associated with greater risk reduction of falls/fractures in older adults with ADRD. This study emphasizes expanding awareness of AWVs to prevent falls/fractures in this population.