Medicare Utilization and Expenditures Around Incident Dementia in a Multiethnic Cohort

J Gerontol A Biol Sci Med Sci. 2015 Nov;70(11):1448-53. doi: 10.1093/gerona/glv124. Epub 2015 Aug 26.


Background: Few studies have examined patterns of health care utilization and costs during the period around incident dementia.

Methods: Participants were drawn from the Washington Heights-Inwood Columbia Aging Project, a multiethnic, population-based, prospective study of cognitive aging of Medicare beneficiaries in a geographically defined area of northern Manhattan. Medicare utilization and expenditure were examined in individuals with clinically diagnosed dementia from 2 years before until 2 years after the initial diagnosis. A sample of non-demented individuals who were matched on socio-demographic and clinical characteristics at study enrollment was used as controls. Multivariable regression analysis estimated effects on Medicare utilization and expenditures associated with incident dementia.

Results: During the 2 years before incident dementia, rates of inpatient admissions and outpatient visits were similar between dementia patients and non-demented controls, but use of home health and skilled nursing care and durable medical equipment were already higher in dementia patients. Results showed a small but significant excess increase associated with incident dementia in inpatient admissions but not in other areas of care. In the 2 years before incident dementia, total Medicare expenditures were already higher in dementia patients than in non-demented controls. But we found no excess increases in Medicare expenditures associated with incident dementia.

Conclusions: Demand for medical care already is increasing and costs are higher at the time of incident dementia. There was a small but significant excess risk of inpatient admission associated with incident dementia.

Keywords: Health care expenditures; Health care use; Incident dementia; Longitudinal follow-up; Medicare.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • African Americans / statistics & numerical data
  • Aged
  • Aged, 80 and over
  • Ambulatory Care / economics
  • Ambulatory Care / statistics & numerical data*
  • Case-Control Studies
  • Cohort Studies
  • Dementia / economics*
  • Dementia / ethnology*
  • Dementia / therapy
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Health Expenditures / statistics & numerical data*
  • Hispanic Americans / statistics & numerical data
  • Hospitalization / economics
  • Hospitalization / statistics & numerical data*
  • Humans
  • Incidence
  • Male
  • Medicare / statistics & numerical data*
  • Socioeconomic Factors
  • United States