The burden of health care costs for patients with dementia in the last 5 years of life.
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.


METHODS
Retrospective cohort.


METHODS
The HRS (Health and Retirement Study).


METHODS
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.


METHODS
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%).


CONCLUSIONS
Imputed Medicaid, private insurance, and informal care costs.


CONCLUSIONS
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.


BACKGROUND
National Institute on Aging.
Amy S
AS
Kelley
Kathleen
K
McGarry
Rebecca
R
Gorges
Jonathan S
JS
Skinner
D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D003704:Dementia / Q000191:economics*; D005260:Female; D005102:Health Expenditures; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008297:Male; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013727:Terminal Care; D014481:United States