Season 2: Episode 10 - Aging, Migraine, and the Evidence Gap in Long-Term Care

Andie Cartwright

Welcome to another episode of the Better Living Through Data podcast! Anthony, I want to start with something that keeps rattling around in my head: when people hear migraine or headache issues, they might typically picture somebody younger trying to power through a workday. They do NOT picture an older adult in long-term or post-acute care whose headache is tangled up with poor sleep, fatigue, a bigger fall risk, and a med list that's already way too long.

Anthony Pero

You've hit on something important there, Andie. In healthcare, the story gets distorted by who shows up in the evidence. And older adults, especially in long-term and post-acute care, are often the people we talk about as high-need, vulnerable, medically complex... and then somehow they get left out when it's time to prove what therapies work in the real world.

Andie Cartwright

Right -- and June is Migraine & Headache Awareness Month, which I actually think is useful here because awareness months can sound soft, marketing-y, poster-on-a-wall stuff. But for this community, recognition matters. If a caregiver sees repeated complaints of head pain, disrupted sleep, exhaustion, maybe sensitivity to light or sound, and just writes it off as part of aging, that patient disappears twice -- once clinically and once in the data.

Anthony Pero

"Disappears twice" is good. And it's true. Awareness is not just social messaging. It's the difference between stigma and recognition. The headache, migraine, and cluster communities have been really explicit about that during June: raise public knowledge, address stigma, build a stronger advocate community. For older adults, I'd add one more piece -- get clinicians and caregivers to stop assuming headache disease is someone else's issue.

Andie Cartwright

Let me push on that. If we already know headache diseases can lower quality of life and drive healthcare use, why are aging patients STILL left out? Is it just that they're harder to study?

Anthony Pero

Harder to study is part of it, yeah, but I think the sharper answer is complexity. An older patient may have multiple comorbidities, functional limitations, cognitive changes, and polypharmacy all at once. So the migraine doesn't arrive as a neat, isolated condition. It shows up in a messy clinical picture. And when evidence generation favors the neat picture, the messy patient gets underrepresented.

Andie Cartwright

The word there is MESSY. Because from a caregiver lens, that's exactly how it looks. It's not "Do you have migraine, yes or no?" It's more like: are they sleeping less, eating less, taking more rescue meds, moving more carefully, feeling wiped out, maybe having a worse day in therapy? Those are not small quality-of-life details. That's daily living.

Anthony Pero

And the therapy piece you just mentioned matters. In long-term and post-acute care, daily function is visible. You can actually see whether symptoms are colliding with ADLs, cognition, sleep patterns, or participation in care. That's a very different lens than a single office visit.

Andie Cartwright

Which is why the stigma bothers me. Because if an older adult says, "I have headaches," people can hear that as vague. Minor. Complaining, even. But stack that onto fatigue, sleep disruption, and medication burden, and suddenly we're not talking about annoyance. We're talking about vulnerability.

Anthony Pero

Exactly. And that's the tension at the center of this whole conversation. The patients with the most complicated care needs are often the least visible in traditional evidence. So June shouldn't just be, "Let's be more aware." It should be: who is missing from the research picture, and what does that absence cost them?

Andie Cartwright

Yeah. Because if the evidence picture skips older adults, then access conversations, treatment decisions, even product strategy -- all of it -- can quietly drift toward healthier, simpler populations. And that's not where the burden always lives.

Anthony Pero

This is where the PointClickCare Life Sciences dataset becomes really important. We have real-world evidence from long-term and post-acute care using electronic health record data that captures, on average, 50+ points per patient per day. That's across more than 15 million patients aged 65 and older, over more than 10 years, with an average long-stay length of over 800 days. Those aren't just big numbers -- that's longitudinal visibility into a population that is usually hard to study well.

Andie Cartwright

I want to grab the "800 days" part, because that's the number people will remember. Over 800 days means you're not getting a snapshot; you're getting, like, a full movie. You can see patterns, changes, medication use, maybe deterioration, maybe stabilization. That's a very different storytelling surface than a one-time chart review.

Anthony Pero

Exactly -- not a snapshot, a movie. And within that broader population, there are over 30,000 unique patients with migraines and nearly 4,000 active unique migraine records. So now you're not speaking in hypotheticals. You have scale in an older population, and you have recency with those nearly 4K active patients.

Andie Cartwright

The 30K-plus number is the one that makes this feel concrete to me. Because once you have that kind of record base, you can stop speaking in generalities. You can ask: who is actually being treated? Who stays adherent? Who drops off? Who seems to get overlooked because the migraine is buried under everything else going on?

Anthony Pero

Right, and the dataset is curated in a way that supports those questions. It connects clinical outcomes and healthcare resource utilization -- so, hospitalization, readmission, LTC transitions, ED visits, length of stay, provider encounters. Then it layers in health-related quality-of-life indicators like pain frequency, duration, location, fatigue, and sleeping patterns. That's how you start tying symptoms to consequences.

Andie Cartwright

Wait -- "sleeping patterns" and "fatigue" in the same data structure as hospitalization and ED visits... that's the bridge, isn't it? Because caregivers live in the symptom world, but decision-makers often live in the utilization world. This lets both things exist in the same sentence.

Anthony Pero

Yes. That's really well put. And it goes further: functional outcomes like ADLs, cognitive patterns, and BIMS; medication use and adherence including pain and rescue medications, Botox, CGRP monoclonal antibodies, and CGRP receptor antagonists – also known as gepants -- plus route and dose; symptoms and observations; and a full comorbidity picture through ICD-10 listings.

Andie Cartwright

Okay, "gepants" is one of those words that sounds made up, but the important part for me is you just said route and dose. In a population dealing with polypharmacy, route and dose are not trivia. That's the whole ballgame sometimes. What can they tolerate? What are they already taking? What creates friction?

Anthony Pero

And that is why "better data" can't just mean bigger spreadsheets. It has to mean clinically usable evidence. If you're looking at medication orders, adherence, symptoms, comorbidities, and function together, then you can actually study who responds, who doesn't, and whether treatment gaps map to specific patient characteristics or care settings.

Andie Cartwright

Including the patients who are easiest to miss. The dataset includes SDOH and DEI profiles. And from a communications standpoint, that matters because "older adults with migraine" is not one audience. It's a whole set of lived realities inside one label.

Anthony Pero

Exactly. Pharmaceutical companies, government bodies, independent investigators -- they all need slightly different evidence, but the core question is the same: can we prove what happens in the care environments where vulnerable patients actually live and receive treatment? Long-term and post-acute care are not edge settings. For many older adults, that's the setting.

Andie Cartwright

Let me try to say it back, and you tell me where I'm off. We're not using data just to count migraines in older adults. We're using regulatory-grade, specially curated migraine data to connect the symptom burden to outcomes, utilization, adherence, function, comorbidities, and social context... so evidence can finally look more like the patient does.

Anthony Pero

That's almost perfect. I'd make one tweak: not "finally look more like the patient" -- prove which therapies can work, for WHICH patient, and in WHICH care setting. Because in this population, setting changes everything. A treatment that makes sense on paper may land very differently in post-acute care than it would somewhere else.

Andie Cartwright

And that feels like the practical challenge for June. Awareness is the door, but evidence is what gets somebody through it. If an older adult is managing headache disease on top of multiple meds, multiple diagnoses, and functional vulnerability, then better data isn't a nice-to-have. It's how you stop guessing.

Anthony Pero

Yeah. And once you stop guessing, you can start being fairer -- about access, about treatment decisions, about whose suffering counts enough to study. That's the part I hope sticks.

Andie Cartwright

Same here! Before we sign off from this episode, I want to remind our listeners that accessing our data is as easy as signing up for free access to Study Buddy, our new AI-powered research tool!

Anthony Pero

That’s right, Andie. Right now, our listeners can access Study Buddy for free! Simply click the link in today’s episode description and sign up for free access! Alright, this brings us to the end of today’s episode. Thanks for the chat, Andie.

Andie Cartwright

Thanks, Anthony! Bye Everyone!