Residential Setting and the Cumulative Financial Burden of Dementia in the 7 Years Before Death
| Autor: | Jonathan Skinner, Evan Bollens-Lund, Mohammed Husain, Kathleen McGarry, Omari-Khalid Rahman, Katelyn B. Ferreira, Amy S. Kelley |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
Longitudinal study Time Factors Medicare Burden of care Article Insurance Claim Review 03 medical and health sciences 0302 clinical medicine Cost of Illness Surveys and Questionnaires Health care medicine Humans Dementia Longitudinal Studies 030212 general & internal medicine Aged Aged 80 and over Finance Medicaid business.industry 030503 health policy & services Health and Retirement Study medicine.disease Home Care Services United States Nursing Homes Falling (accident) Caregivers Female Health Expenditures Geriatrics and Gerontology medicine.symptom 0305 other medical science Nursing homes business |
| Zdroj: | J Am Geriatr Soc |
| ISSN: | 1532-5415 0002-8614 |
| Popis: | Objectives Care for older adults with dementia during the final years of life is costly, and families shoulder much of this burden. We aimed to assess the financial burden of care for those with and without dementia, and to explore differences across residential settings. Design Using the Health and Retirement Study (HRS) and linked claims, we examined total healthcare spending and proportion by payer-Medicare, Medicaid, out-of-pocket, and calculated costs of informal caregiving-over the last 7 years of life, comparing those with and without dementia and stratifying by residential setting. Setting The HRS is a nationally representative longitudinal study of older adults in the United States. Participants We sampled HRS decedents from 2004 to 2015. To ensure complete data, we limited the sample to those 72 years or older at death who had continuous fee-for-service Medicare Parts A and B coverage during the 7-year period (n = 2909). Measurements We compared decedents with dementia at last HRS assessment with those without dementia across annual and cumulative 7-year spending measures, and personal characteristics. We present annual and cumulative spending by payer, and the changing proportion of spending by payer over time, comparing those with and without dementia and stratifying results by residential setting. Results We found that, consistent with prior studies, people with dementia experience significantly higher costs, with a disproportionate share falling on patients and families. This pattern is most striking among community residents with dementia, whose families shoulder 64% of total expenditures (including $176,180 informal caregiving costs and $55,550 out-of-pocket costs), compared with 43% for people with dementia residing in nursing homes ($60,320 informal caregiving costs and $105,590 out-of-pocket costs). Conclusion These findings demonstrate disparities in financial burden shouldered by families of those with dementia, particularly among those residing in the community. They highlight the importance of considering the residential setting in research, programs, and policies. J Am Geriatr Soc 68:1319-1324, 2020. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Plný text