title: Medicare Utilization and Expenditures Around Incident Dementia in a Multiethnic Cohort.
abstract: BACKGROUND
  Few studies have examined patterns of health care utilization and costs during the period around incident dementia.
  
  
  METHODS
  Participants were drawn from the Washington Heights-Inwood Columbia Aging Project, a multiethnic, population-based, prospective study of cognitive aging of Medicare beneficiaries in a geographically defined area of northern Manhattan. Medicare utilization and expenditure were examined in individuals with clinically diagnosed dementia from 2 years before until 2 years after the initial diagnosis. A sample of non-demented individuals who were matched on socio-demographic and clinical characteristics at study enrollment was used as controls. Multivariable regression analysis estimated effects on Medicare utilization and expenditures associated with incident dementia.
  
  
  RESULTS
  During the 2 years before incident dementia, rates of inpatient admissions and outpatient visits were similar between dementia patients and non-demented controls, but use of home health and skilled nursing care and durable medical equipment were already higher in dementia patients. Results showed a small but significant excess increase associated with incident dementia in inpatient admissions but not in other areas of care. In the 2 years before incident dementia, total Medicare expenditures were already higher in dementia patients than in non-demented controls. But we found no excess increases in Medicare expenditures associated with incident dementia.
  
  
  CONCLUSIONS
  Demand for medical care already is increasing and costs are higher at the time of incident dementia. There was a small but significant excess risk of inpatient admission associated with incident dementia.
authors: Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. James J Peters VA Medical Center, Bronx, New York. carolyn.zhu@mssm.edu.
authors: Carolyn W
authors: CW
authors: Zhu
authors: Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, New York, New York. Department of Neurology, Columbia University Medical Center, New York, New York.
authors: Stephanie
authors: S
authors: Cosentino
authors: The Samuel Bronfman Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors: Katherine
authors: K
authors: Ornstein
authors: Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, New York, New York. Department of Neurology, Columbia University Medical Center, New York, New York.
authors: Yian
authors: Y
authors: Gu
authors: Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, New York, New York. Department of Neurology, Columbia University Medical Center, New York, New York.
authors: Nikolaos
authors: N
authors: Scarmeas
authors: Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York.
authors: Howard
authors: H
authors: Andrews
authors: Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, New York, New York. Department of Neurology, Columbia University Medical Center, New York, New York.
authors: Yaakov
authors: Y
authors: Stern
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D015331:Cohort Studies; D003704:Dementia / Q000191:economics* / Q000208:ethnology* / Q000628:therapy; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data
keywords: Health care expenditures; Health care use; Incident dementia; Longitudinal follow-up; Medicare