Newswise, October 27, 2015-- 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 6,100 primary and specialty
care physicians; 12 minority-owned free-standing 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. Seven departments at The Mount
Sinai Hospital and one at the New York Eye and Ear Infirmary (NYEE) ranked
nationally in the top 25 in the 2015-2016 “Best Hospitals” issue of U.S. News
& World Report. Mount Sinai’s Kravis Children’s Hospital also is ranked in
seven out of ten pediatric specialties by U.S. News & World Report.
For more information, visit http://www.mountsinaihealth.org/or
find Mount Sinai on Facebook, Twitter and YouTube.
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