Effects of cognition, function, and behavioral and psychological symptoms on out-of-pocket medical and nursing home expenditures and time spent caregiving for persons with dementia

Abstract

Introduction: Clinical features of dementia (cognition, function, and behavioral and psychological symptoms) may differentially affect out-of-pocket medical and nursing home (NH) expenditures and informal care received (outcomes).

Methods: We used cross-sectional data (Aging, Demographics, and Memory Study) to estimate probabilities of experiencing outcomes by clinical features. For those experiencing an outcome, we estimated effects of clinical features on the amount of the outcome.

Results: No clinical feature predicted the probability of having out-of-pocket medical expenditures. For those with medical expenditures, higher cognition and poorer function were associated with more spending. Poorer function predicted having out-of-pocket NH expenditures. For those with NH expenditures, no clinical feature predicted the amount. Poorer function and a greater number of behavioral and psychological symptoms predicted the probability of receiving caregiving. For those receiving care, poorer function was associated with more caregiving.

Conclusions: Clinical features differentially impact outcomes with poorer function associated with all types of costs and caregiving received.

Keywords: Alzheimer's disease costs; Caregiving; Dementia care; Out-of-pocket costs; Time caregiving.

Fig. 1

Participation Cohort, Aging, Demographics, and Memory Study. (Panel A) The sample size in Panel A is for those included in the out-of-pocket expenditure analyses. Among those in the out-of-pocket medical and nursing home expenditure analyses 155 and 43 persons with dementia had expenditures >$0, respectively. (Panel B) The sample size in Panel B is for those included in the informal time receiving caregiving analyses (active care and supervision combined). Among those in the informal time receiving caregiving analyses 91 persons with dementia received >0 hours of active help and supervision combined. The time receiving caregiving analyses were limited to community-dwelling persons with dementia that had a caregiver and provide information on time caregiving.