%0 Journal Article %J Journal of Population Ageing %D 2015 %T Future Monetary Costs of Dementia in the United States under Alternative Dementia Prevalence Scenarios. %A Michael D Hurd %A Martorell, Paco %A Kenneth M. Langa %K Dementia %K Forecasting %K Health Conditions and Status %K Older Adults %X

Population aging will likely lead to increases is health care spending and the ability of governments to support entitlement programs such as Medicare and Medicaid. Dementia is a chronic condition that is especially pertinent because of its strong association with old age and because care for dementia is labor intensive and expensive. Indeed, prior research has found that if current dementia prevalence rates persist population aging will generate very large increases in health care spending for dementia. In this study we considered two alternative assumptions or scenarios about future prevalence. The first adjusts the prevalence projections using recent research that suggests dementia prevalence may be declining. The second uses growth hypertension, obesity and diabetes, and the relationship between dementia and these conditions to adjust future prevalence rates. We find under the first scenario that if the rates of decline in age-specific dementia rates persist, future costs will be much less than previous estimates, about 40% lower. Under the second scenario, the growth in those conditions makes only small differences in costs.

%B Journal of Population Ageing %V 8 %P 101-112 %8 2015 Mar %G eng %N 1-2 %R 10.1007/s12062-015-9112-4 %0 Journal Article %J Alzheimers Dement %D 2013 %T Dementia and out-of-pocket spending on health care services. %A Delavande, Adeline %A Michael D Hurd %A Martorell, Paco %A Kenneth M. Langa %K Aged %K Dementia %K Female %K Financing, Personal %K Health Expenditures %K Humans %K Male %X

BACKGROUND: High levels of out-of-pocket (OOP) spending for health care may lead patients to forego needed services and medications as well as hamper their ability to pay for other essential goods. Because it leads to disability and the loss of independence, dementia may put patients and their families at risk for high OOP spending, especially for long-term care services.

METHODS: We used data from the Aging, Demographics, and Memory Study, a nationally representative subsample (n = 743) of the Health and Retirement Study, to determine whether individuals with dementia had higher self-reported OOP spending compared with those with cognitive impairment without dementia and those with normal cognitive function. We also examined the relationship between dementia and utilization of dental care and prescription medications-two types of health care that are frequently paid for OOP. Multivariate and logistic regression models were used to adjust for the influence of potential confounders.

RESULTS: After controlling for demographics and comorbidities, those with dementia had more than three times the yearly OOP spending compared with those with normal cognition ($8216 for those with dementia vs. $2570 for those with normal cognition, P < .01). Higher OOP spending for those with dementia was mainly driven by greater expenditures on nursing home care (P < .01). Dementia was not associated with the likelihood of visiting the dentist (P = .76) or foregoing prescription medications owing to cost (P = .34).

CONCLUSIONS: Dementia is associated with high levels of OOP spending but not with the use of dental care or foregoing prescription medications, suggesting that excess OOP spending among those with dementia does not "crowd out" spending on these other health care services.

%B Alzheimers Dement %I 9 %V 9 %P 19-29 %8 2013 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/23154049?dopt=Abstract %3 23154049 %4 Out of pocket costs/health Care/Long Term Care/Dementia/dental Care/COMORBIDITY/health care services %$ 69685 %R 10.1016/j.jalz.2011.11.003 %0 Journal Article %J N Engl J Med %D 2013 %T Monetary costs of dementia in the United States. %A Michael D Hurd %A Martorell, Paco %A Delavande, Adeline %A Kathleen J Mullen %A Kenneth M. Langa %K Aged %K Aged, 80 and over %K Cost of Illness %K Dementia %K Female %K Health Care Costs %K Home Care Services %K Home Nursing %K Humans %K Longitudinal Studies %K Male %K Medicare %K Middle Aged %K Nursing homes %K United States %X

BACKGROUND: Dementia affects a large and growing number of older adults in the United States. The monetary costs attributable to dementia are likely to be similarly large and to continue to increase.

METHODS: In a subsample (856 persons) of the population in the Health and Retirement Study (HRS), a nationally representative longitudinal study of older adults, the diagnosis of dementia was determined with the use of a detailed in-home cognitive assessment that was 3 to 4 hours in duration and a review by an expert panel. We then imputed cognitive status to the full HRS sample (10,903 persons, 31,936 person-years) on the basis of measures of cognitive and functional status available for all HRS respondents, thereby identifying persons in the larger sample with a high probability of dementia. The market costs associated with care for persons with dementia were determined on the basis of self-reported out-of-pocket spending and the utilization of nursing home care; Medicare claims data were used to identify costs paid by Medicare. Hours of informal (unpaid) care were valued either as the cost of equivalent formal (paid) care or as the estimated wages forgone by informal caregivers.

RESULTS: The estimated prevalence of dementia among persons older than 70 years of age in the United States in 2010 was 14.7%. The yearly monetary cost per person that was attributable to dementia was either $56,290 (95% confidence interval [CI], $42,746 to $69,834) or $41,689 (95% CI, $31,017 to $52,362), depending on the method used to value informal care. These individual costs suggest that the total monetary cost of dementia in 2010 was between $157 billion and $215 billion. Medicare paid approximately $11 billion of this cost.

CONCLUSIONS: Dementia represents a substantial financial burden on society, one that is similar to the financial burden of heart disease and cancer. (Funded by the National Institute on Aging.).

%B N Engl J Med %I 386 %V 368 %P 1326-34 %8 2013 Apr 04 %G eng %U http://www.nejm.org/doi/full/10.1056/NEJMsa1204629 %N 14 %1 http://www.ncbi.nlm.nih.gov/pubmed/23550670?dopt=Abstract %3 23550670 %4 ADAMS/Dementia/Cognitive Impairment/cognitive assessment/PREVALENCE/Medicare/Out of pocket costs/nursing homes/Informal care/public policy %$ 68960 %R 10.1056/NEJMsa1204629