Association of Sensory and Cognitive Impairment With Healthcare Utilization and Cost in Older Adults

J Am Geriatr Soc. 2019 Aug;67(8):1617-1624. doi: 10.1111/jgs.15891. Epub 2019 Mar 29.


Objectives: To examine the association between self-reported vision impairment (VI), hearing impairment (HI), and dual-sensory impairment (DSI), stratified by dementia status, on hospital admissions, hospice use, and healthcare costs.

Design: Retrospective analysis.

Setting: Medicare Current Beneficiary Survey from 1999 to 2006.

Participants: Rotating panel of community-dwelling Medicare beneficiaries, aged 65 years and older (N = 24 009).

Measurements: VI and HI were ascertained by self-report. Dementia status was determined by self-report or diagnosis codes in claims data. Primary outcomes included any inpatient admission over a 2-year period, hospice use over a 2-year period, annual Medicare fee-for-service costs, and total healthcare costs (which included information from Medicare claims data and other self-reported payments).

Results: Self-reported DSI was present in 30.2% (n = 263/871) of participants with dementia and 17.8% (n = 4112/23 138) of participants without dementia. In multivariable logistic regression models, HI, VI, or DSI was generally associated with increased odds of hospitalization and hospice use regardless of dementia status. In a generalized linear model adjusted for demographics, annual total healthcare costs were greater for those with DSI and dementia compared to those with DSI without dementia ($28 875 vs $3340, respectively). Presence of any sensory impairment was generally associated with higher healthcare costs. In a model adjusted for demographics, Medicaid status, and chronic medical conditions, DSI compared with no sensory impairment was associated with a small, but statistically significant, difference in total healthcare spending in those without dementia ($1151 vs $1056; P < .001) but not in those with dementia ($11 303 vs $10 466; P = .395).

Conclusion: Older adults with sensory and cognitive impairments constitute a particularly prevalent and vulnerable population who are at increased risk of hospitalization and contribute to higher healthcare spending. J Am Geriatr Soc 67:1617-1624, 2019.

Keywords: dementia; healthcare cost; hearing impairment; sensory impairment; vision impairment.

Publication types

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

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cognitive Dysfunction / economics*
  • Dementia / economics*
  • Female
  • Health Care Costs / statistics & numerical data*
  • Hearing Loss / economics
  • Hospices / economics
  • Hospitalization / statistics & numerical data
  • Humans
  • Independent Living
  • Logistic Models
  • Male
  • Medicare / statistics & numerical data
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Retrospective Studies
  • Sensation Disorders / economics*
  • United States
  • Vision Disorders / economics