Incremental Healthcare Costs of Dementia and Cognitive Impairment in Community-Dwelling Older Adults: A Prospective Cohort Study
Year: 2025
Type: article
Abstract: BACKGROUND: Cognitive impairment and dementia are associated with higher healthcare costs; whether these increased costs are attributable to a greater comorbidity burden is unknown. We sought to determine associations of cognitive impairment and dementia with subsequent total and sector-specific healthcare costs after accounting for comorbidities and to compare costs by method of case ascertainment. METHODS: Index examinations (2002-2011) of 4 prospective cohort studies linked with Medicare claims. 8 165 community-dwelling Medicare fee-for-service beneficiaries (4 318 women; 3 847 men). Cognitive impairment identified by self-or-proxy report of dementia and/or abnormal cognitive testing. Claims-based dementia and comorbidities derived from claims using Chronic Condition Warehouse algorithms. Annualized healthcare costs (2023 dollars) were ascertained for 36 months following index examinations. RESULTS: 521 women (12.1%) and 418 men (10.9%) met the criteria for cognitive impairment; 388 women (9%) and 234 men (6.1%) met the criteria for claims-based dementia. After accounting for age, race, geographic region, and comorbidities, mean incremental costs of cognitive impairment versus no cognitive impairment in women (men) were $6 883 ($7 276) for total healthcare costs, $4 160 ($4 047) for inpatient costs, $1 206 ($1 587) for skilled nursing facility (SNF) costs, and $689 ($668) for home healthcare (HHC) costs. Mean adjusted incremental total and inpatient costs associated with claims-based dementia were smaller in magnitude and not statistically significant. Mean adjusted incremental costs of claims-based dementia versus no claims-based dementia in women (men) were $759 ($1 251) for SNF costs and $582 ($535) for HHC costs. CONCLUSIONS: Cognitive impairment is independently associated with substantial incremental total and sector-specific healthcare expenditures not fully captured by claims-based dementia or comorbidity burden.
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G1101846420, G1439824551, G1549444152, Peripheral nerve decline: an underappreciated cause of injurious falls, G2060701114, G2091924775, G2226056058, G274021517, G2741792843, G3178576828, G3723061141, G373744689, G4276072587, Study of Osteoporotic Fractures, G430788307, Study of Osteoporotic Fractures (SOF)-Pittsburgh Clinic, G585648573, G624497702, G6311601004, G6358916479, G6566566152, G6567779045, G659495149, End of Life in the Very Old, Osteoporotic Fractures in Men_MrOS Renewal_Birmingham, G76550502, G870119955, G8827260454, G88327988, The National Health and Aging Trends Study and National Study of Caregiving
OpenAlex ID: W4407593655