Care More Expensive for Dementia Patients and Families in Last Years of Life
The cost of care over the last five years of life for patients with dementia is significantly higher than for patients who die from heart disease, cancer, or other causes, according to a study led by researchers at the Icahn School of Medicine at Mount Sinai, Dartmouth College and University of California, Los Angeles, and published online today in the journal Annals of Internal Medicine. The study was funded by the National Institute on Aging.
In addition to higher total end-of-life costs, the study found that out-of-pocket spending for patients with dementia was 81 percent higher than for those who died from other causes. The burden of this spending, measured as the proportion of household wealth devoted to out-of-pocket costs, was particularly high for dementia patients who were black, had less than a high school education, or were unmarried or widowed women.
This is the first national study which looks at total costs (patient and family expenses, as well as Medicare and Medicaid expenditures) over the last five years of life for those with dementia in comparison to those without, according to the study authors. It also estimated the cost of family caregiving for patients with dementia, which is defined as a decline in mental ability severe enough to interfere with daily life. Symptoms can include memory loss, as well as declines in language, problem-solving and other cognitive skills. People with Alzheimer’s Disease represent the majority of dementia cases.
“Our study shows that all households, regardless of disease, face substantial financial risks during the last years of life; however, households of those with dementia face an even greater burden of costs, particularly with regard to out-of-pocket expenses and the costs of caregiving,” said Amy Kelley, MD, Associate Professor of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai and lead author of the study. “Many costs related to daily care for patients with dementia are not covered by health insurance, and these care needs--from supervision, to bathing and feeding--may span several years.
While Medicare provides nearly universal coverage for U.S. adults over age 65, it does not cover health-related expenses most valuable to those with chronic diseases or a life-limiting illness, such as homecare services, equipment and non-rehabilitative nursing home care. People living with dementia often face many years of progressive functional decline and require long-term, supportive care.
Researchers analyzed data from 1,702 Medicare beneficiaries, aged 70 years or older, who died between 2005 and 2010. The group was then subdivided into four main categories: individuals with high probability of dementia, and individuals who died of heart disease, cancer, or other causes. Findings indicated the average total cost for deceased patients with dementia was $287,038 in the last five years of life. This was significantly higher than for those who died of heart disease ($175,136), cancer ($173,383), or other causes ($197,286).
“The families of patients with dementia have more expenses than other families, and the financial burden is greatest among families that may be least able to manage it,” said Dr. Kelley. “The discussion of healthcare reform must include the significant uninsured care needs of older adults with dementia and examine ways to mitigate the financial risk currently faced by Medicare beneficiaries.”
The study was supported by the National Institute on Aging. The study’s data was supplied by the Health and Retirement Study (HRS), a national sample of U.S. adults age 50 linked to Medicare claims. The HRS includes detailed information on out-of-pocket spending and total Medicare spending, as well as information about insurance coverage, socioeconomic status, health and cognitive status, and cause of death.
Collaborators of the study include researchers from the Geriatric Research Education and Clinical Centers at the James J Peters VA Medical Center, the University of California Los Angeles Department of Economics, Dartmouth College Department of Economics and The Dartmouth Institute for Health Policy and Clinical Practice at the Dartmouth Medical School.
About the Mount Sinai Health System
The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. Structured around seven hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services—from community-based facilities to tertiary and quaternary care.
The System includes approximately 7,100 primary and specialty care physicians; 12 joint-venture ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai, which is ranked among the highest in the nation in National Institutes of Health funding per investigator. The Mount Sinai Hospital is in the "Honor Roll" of best hospitals in America, ranked No. 15 nationally in the 2016-2017 "Best Hospitals" issue of U.S. News & World Report. The Mount Sinai Hospital is also ranked as one of the nation's top 20 hospitals in Geriatrics, Gastroenterology/GI Surgery, Cardiology/Heart Surgery, Diabetes/Endocrinology, Nephrology, Neurology/Neurosurgery, and Ear, Nose & Throat, and is in the top 50 in four other specialties. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 10 nationally for Ophthalmology, while Mount Sinai Beth Israel, Mount Sinai St. Luke's, and Mount Sinai West are ranked regionally. Mount Sinai's Kravis Children's Hospital is ranked in seven out of ten pediatric specialties by U.S. News & World Report in "Best Children's Hospitals."