The cost of care for patients with dementia in their last five years of life is significantly higher than for patients who die from heart disease, cancer, or other causes, according to a study published online ahead of print October 27 in Annals of Internal Medicine. In addition, out-of-pocket spending was 81% higher for patients with dementia than for patients who died of other causes. Dementia patients’ out-of-pocket spending totaled 32% of their wealth in the last five years of life, compared with 11% for those in the nondementia group. In subgroups who were black, unmarried or widowed women, or those with less than a high school education, spending made up even larger proportions of patients’ wealth.
“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,” stated Amy Kelley, MD, Associate Professor of Geriatrics and Palliative Medicine at Icahn School of Medicine at Mount Sinai in New York.
Dr. Kelley and colleagues analyzed data from 1,702 Medicare beneficiaries, age 70 or older, who died between 2005 and 2010. The group was then sorted into the following four categories: individuals with high probability of dementia and individuals who died of heart disease, cancer, or other causes. Findings indicated that the average total cost for deceased patients with dementia was $287,038 in the last five years of life, compared with $175,136 for patients who died of heart disease, $173,383 for patients with cancer, and $197,286 for other causes of death.
Average cost of informal care of decedents with dementia was more than double the costs of those without dementia. These implicit costs differed between various sociodemographic subgroups. Black households were given more informal care ($117,496) than nonblack households ($80,038) in both high- and low-risk dementia groups, but out-of-pocket costs of black decedents were much lower ($23,425) than costs in nonblack decedents ($64,819). The lower out-of-pocket cost most likely results from decreased financial resources, but out-of-pocket cost and cost of informal care balanced out to similar levels for both racial groups. A similar pattern was found between groups with and without high school diplomas.
“The discussion of health care 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,” Dr. Kelley said.
—Evelyn Tran