Frequency and Implications of Co-occurring Serious Illness in Older Adults (S544)

Outcomes 1. Describe how frequently the three categories of serious illness (dementia, functional impairment, advanced medical conditions) overlap in older adults 2. List two ways health service use or caregiving needs differ by type of serious illness Original Research Background Serious illness is a condition with high risk of mortality that negatively affects function or quality of life or excessively strains caregivers. In older adults, serious illness predominantly comprises three overlapping categories: dementia, functional impairment, and other advanced medical conditions. Research Objectives We estimate the frequency and co-occurrence of three categories of serious illness in older adults and describe differences in health service use and caregiving hours by category. Methods Using 2016 data from the nationally representative Health and Retirement Study, we selected those with 12 months of linked fee-for-service Medicare claims pre- and post-interview. Dementia status was determined by a survey-based algorithm, functional impairment by self-report of help with ≥1 activity of daily living, and advanced medical condition by claims-based ICD10 codes. Results We included 4,503 adults >65 years. Approximately 27% were seriously ill (9% dementia, 13% functional impairment, 16% advanced medical condition). Approximately 70% of persons with dementia (PWDs) and 65% with functional impairment had another category of serious illness, whereas only 31% with an advanced medical condition did. Functional impairment and advanced medical condition in combination increased prevalence of hospitalization compared to either alone (52% combined, 32% functional impairment, 30% advanced medical condition), but combining dementia with another serious illness category did not meaningfully change hospitalization (39% alone, 33% with functional impairment, 39% with advanced medical condition). PWDs and those with functional impairment reported more than twice the caregiving hours per month (113 and 130 hours, respectively) than those with an advanced medical condition (51 hours). Conclusion Older adults with serious illness due to dementia or functional impairment are more likely than those with an advanced medical condition to have another category of serious illness and have higher caregiving needs. Implications for Research, Policy, or Practice Caregiving policies and interventions for older adults with serious illness may need to be tailored by category of serious illness.