“The Burden of Health Care Costs for Patients With Dementia in the Last 5 Years of Life”, 2015 (; backlinks; similar):
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 2005–5201014ya (n = 1,702), 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 ($372,261.48$287,0382015) was greater than that of those who died of heart disease ($227,135.04$175,1362015), cancer ($224,861.56$173,3832015), or other causes ($255,861.52$197,2862015) (p < 0.001). Although Medicare expenditures were similar across groups, average out-of-pocket spending for patients with dementia ($79,788.29$61,5222015) was 81% higher than that for patients without dementia ($44,183.01$34,0682015); a similar pattern held for informal care. Out-of-pocket spending for the dementia group (median, $47,880.5$36,9192015) 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.