Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Geriatric Research Education and Clinical Centers, James J Peters VA Medical Center, Bronx, New York, USA.
J Am Geriatr Soc. 2020 Jun;68(6):1319-1324. doi: 10.1111/jgs.16414. Epub 2020 Mar 18.
Care for older adults with dementia during the final years of life is costly, and families shoulder much of this burden. We aimed to assess the financial burden of care for those with and without dementia, and to explore differences across residential settings.
Using the Health and Retirement Study (HRS) and linked claims, we examined total healthcare spending and proportion by payer-Medicare, Medicaid, out-of-pocket, and calculated costs of informal caregiving-over the last 7 years of life, comparing those with and without dementia and stratifying by residential setting.
The HRS is a nationally representative longitudinal study of older adults in the United States.
We sampled HRS decedents from 2004 to 2015. To ensure complete data, we limited the sample to those 72 years or older at death who had continuous fee-for-service Medicare Parts A and B coverage during the 7-year period (n = 2909).
We compared decedents with dementia at last HRS assessment with those without dementia across annual and cumulative 7-year spending measures, and personal characteristics. We present annual and cumulative spending by payer, and the changing proportion of spending by payer over time, comparing those with and without dementia and stratifying results by residential setting.
We found that, consistent with prior studies, people with dementia experience significantly higher costs, with a disproportionate share falling on patients and families. This pattern is most striking among community residents with dementia, whose families shoulder 64% of total expenditures (including $176,180 informal caregiving costs and $55,550 out-of-pocket costs), compared with 43% for people with dementia residing in nursing homes ($60,320 informal caregiving costs and $105,590 out-of-pocket costs).
These findings demonstrate disparities in financial burden shouldered by families of those with dementia, particularly among those residing in the community. They highlight the importance of considering the residential setting in research, programs, and policies. J Am Geriatr Soc 68:1319-1324, 2020.
在生命的最后几年中，照顾患有痴呆症的老年人成本很高，家庭承担了大部分负担。我们旨在评估有和没有痴呆症的患者的护理经济负担，并探讨不同居住环境之间的差异。
我们使用健康与退休研究（HRS）和相关索赔数据，检查了在生命的最后 7 年中，有和没有痴呆症的患者的总医疗保健支出以及按支付方（医疗保险、医疗补助、自付和计算的非正式护理费用）的比例，并按居住环境进行分层。
HRS 是一项针对美国老年人的全国代表性纵向研究。
我们从 2004 年至 2015 年抽样了 HRS 的死者。为了确保数据完整，我们将样本限制为在死亡时年满 72 岁或以上、在 7 年期间连续享受医疗保险 A 部分和 B 部分福利的人（n = 2909）。
我们比较了最后一次 HRS 评估时患有痴呆症的死者与没有痴呆症的死者在年度和累计 7 年支出衡量标准以及个人特征方面的差异。我们按支付方报告年度和累计支出，以及随时间推移按支付方划分的支出比例变化，比较了有和没有痴呆症的患者，并按居住环境分层结果。
我们发现，与先前的研究一致，患有痴呆症的患者的费用明显更高，且患者和家庭承担了不成比例的费用。这种模式在患有痴呆症的社区居民中最为明显，他们的家庭承担了总支出的 64%（包括 176180 美元的非正式护理费用和 55550 美元的自付费用），而居住在养老院的患者的家庭仅承担 43%（60320 美元的非正式护理费用和 105590 美元的自付费用）。
这些发现表明，家庭在患有痴呆症的患者的经济负担方面存在差异，特别是在社区居住的患者中。这些发现突出了在研究、计划和政策中考虑居住环境的重要性。美国老年医学会 68:1319-1324, 2020.
