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Residential Setting And The Cumulative Financial Burden Of Dementia In The 7 Years Before Death.

Amy S Kelley, Kathleen McGarry, Evan Bollens-Lund, Omari-Khalid Rahman, Mohammed Husain, Katelyn B Ferreira, Jonathan S. Skinner
Published 2020 · Medicine
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OBJECTIVES Care for older adults with dementia during the final years of life is costly, and families shoulder much of this burden. We aimed to assess the financial burden of care for those with and without dementia, and to explore differences across residential settings. DESIGN Using the Health and Retirement Study (HRS) and linked claims, we examined total healthcare spending and proportion by payer-Medicare, Medicaid, out-of-pocket, and calculated costs of informal caregiving-over the last 7 years of life, comparing those with and without dementia and stratifying by residential setting. SETTING The HRS is a nationally representative longitudinal study of older adults in the United States. PARTICIPANTS We sampled HRS decedents from 2004 to 2015. To ensure complete data, we limited the sample to those 72 years or older at death who had continuous fee-for-service Medicare Parts A and B coverage during the 7-year period (n = 2909). MEASUREMENTS We compared decedents with dementia at last HRS assessment with those without dementia across annual and cumulative 7-year spending measures, and personal characteristics. We present annual and cumulative spending by payer, and the changing proportion of spending by payer over time, comparing those with and without dementia and stratifying results by residential setting. RESULTS We found that, consistent with prior studies, people with dementia experience significantly higher costs, with a disproportionate share falling on patients and families. This pattern is most striking among community residents with dementia, whose families shoulder 64% of total expenditures (including $176,180 informal caregiving costs and $55,550 out-of-pocket costs), compared with 43% for people with dementia residing in nursing homes ($60,320 informal caregiving costs and $105,590 out-of-pocket costs). CONCLUSION These findings demonstrate disparities in financial burden shouldered by families of those with dementia, particularly among those residing in the community. They highlight the importance of considering the residential setting in research, programs, and policies.
This paper references
Produced and distributed by the University of Michigan with funding from the National Institute on Aging (grant number NIA U01AG009740) and the Social Security Administration
Retirement Health (2004)
The impact of serious illness on patients' families. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment.
Kenneth E. Covinsky (1994)
Widow(er) poverty and out-of-pocket medical expenditures near the end of life.
Kathleen McGarry (2005)
US Prevalence And Predictors Of Informal Caregiving For Dementia.
Esther M. Friedman (2015)
Understanding Economic and Other Burdens of Terminal Illness: The Experience of Patients and Their Caregivers
Ezekiel J. Emanuel (2000)
Office of the Assistant Secretary for Planning and Evaluation. National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers
Department of Health & Human Services. Office of the Assistant Secretary for Planning and Evaluation (ASPE)
N T Thach (2018)
The Impact of Serious Illness on Patients' Families
Kenneth E. Covinsky (1994)
Out-of-Pocket Spending in the Last Five Years of Life
Amy S Kelley (2012)
Out-of-pocket health care expenditures at the end of life.
Amy S Kelley (2010)
Caregiving as a risk factor for mortality: the Caregiver Health Effects Study.
Richard Schulz (1999)
Community-Dwelling Older Adults with Dementia and their Caregivers: Key Indicators from the National Health and Aging Trends Study
W Chi (2019)
Supplementary Table S1: Characteristics of decedents by Medicare fee-for-service (FFS) status
Widow(er) poverty and out of pocket medical expenses near end of life
K McGarry (2005)
Genworth Cost of Care Survey
The Real-World Medicare Costs of Alzheimer Disease: Considerations for Policy and Care.
Bruce S. Pyenson (2019)
Families Caring for an Aging America Need Palliative Care.
Katherine A. Ornstein (2017)
The Disproportionate Impact Of Dementia On Family And Unpaid Caregiving To Older Adults.
Judith D. Kasper (2015)
Monetary costs of dementia in the United States.
Michael Dale Hurd (2013)
Prevalence of Dementia in the United States: The Aging, Demographics, and Memory Study
Brenda L. Plassman (2007)
The Burden of Health Care Costs for Patients With Dementia in the Last 5 Years of Life
Amy S Kelley (2015)
Alzheimer’s disease facts and figures
J Gaugler (2019)
The Aging, Demographics, and Memory Study: Study Design and Methods
Kenneth M. Langa (2005)

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