@article {8242, title = {The burden of health care costs for patients with dementia in the last 5 years of life.}, journal = {Ann Intern Med}, volume = {163}, year = {2015}, month = {2015 Nov 17}, pages = {729-36}, publisher = {163}, abstract = {

BACKGROUND: Common diseases, particularly dementia, have large social costs for the U.S. population. However, less is known about the end-of-life costs of specific diseases and the associated financial risk for individual households.

OBJECTIVE: To examine social costs and financial risks faced by Medicare beneficiaries 5 years before death.

DESIGN: Retrospective cohort.

SETTING: The HRS (Health and Retirement Study).

PARTICIPANTS: Medicare fee-for-service beneficiaries, aged 70 years or older, who died between 2005 and 2010 (n~= 1702), stratified into 4 groups: persons with a high probability of dementia or those who died because of heart disease, cancer, or other causes.

MEASUREMENTS: Total social costs and their components, including Medicare, Medicaid, private insurance, out-of-pocket spending, and informal care, measured over the last 5 years of life; and out-of-pocket spending as a proportion of household wealth.

RESULTS: Average total cost per decedent with dementia ($287~038) was significantly greater than that of those who died of heart disease ($175~136), cancer ($173~383), or other causes ($197~286) (P~< 0.001). Although Medicare expenditures were similar across groups, average out-of-pocket spending for patients with dementia ($61~522) was 81\% higher than that for patients without dementia ($34~068); a similar pattern held for informal care. Out-of-pocket spending for the dementia group (median, $36~919) represented 32\% of wealth measured 5 years before death compared with 11\% for the nondementia group (P~< 0.001). This proportion was greater for black persons (84\%), persons with less than a high school education (48\%), and unmarried or widowed women (58\%).

LIMITATION: Imputed Medicaid, private insurance, and informal care costs.

CONCLUSION: Health care expenditures among persons with dementia were substantially larger than those for other diseases, and many of the expenses were uncovered (uninsured). This places a large financial burden on families, and these burdens are particularly pronounced among the demographic groups that are least prepared for financial risk.

PRIMARY FUNDING SOURCE: National Institute on Aging.

}, keywords = {Aged, Aged, 80 and over, Cost of Illness, Dementia, Female, Health Expenditures, Humans, Insurance, Health, Male, Medicaid, Medicare, Retrospective Studies, Socioeconomic factors, Terminal Care, United States}, issn = {1539-3704}, doi = {10.7326/M15-0381}, author = {Amy Kelley and Kathleen McGarry and Rebecca Jean Gorges and Jonathan S Skinner} }