Synnott Patricia G, Zhu Yingying, Rodday Angie Mae, Lin Pei-Jung
Tufts Medical Center, Boston, Massachusetts, USA.
Alzheimers Dement. 2025 Sep;21(9):e70666. doi: 10.1002/alz.70666.
Older adults with dementia incur considerable out-of-pocket (OOP) health care expenses, but it is unclear how their financial burden differs by dementia stage.
We identified 2939 respondents aged ≥65 with dementia in the 2018 Health and Retirement Study, representing 9.8 million individuals on weighted analysis. We grouped respondents into four severity stages and examined their OOP expenditures, prevalence of financial risk (i.e., catastrophic or impoverishing levels of health care spending), and factors associated with financial risk.
Individuals with severe dementia had significantly higher OOP costs, with 21% experiencing catastrophic expenditures and 12% falling below poverty thresholds due to these costs. Regression analyses indicated nursing home residence, poor subjective health, advanced age, and other factors are associated with an increased odds of financial risk.
Financial risk increases in advanced dementia stages, likely reflecting more complex care needs and poorer overall health.
Out-of-pocket health care costs increase with dementia severity. Twenty-one percent of people with severe dementia spend at least 40% of their income on health care. The risk of impoverishment from health care costs increases in severe dementia. Care needs, poor health, and nursing home residence may contribute to financial risk.
患有痴呆症的老年人需承担相当大的自付医疗费用，但目前尚不清楚他们的经济负担在痴呆症不同阶段有何差异。
我们在2018年健康与退休研究中确定了2939名年龄≥65岁的痴呆症受访者，加权分析后代表980万人。我们将受访者分为四个严重程度阶段，并研究了他们的自付支出、财务风险发生率（即医疗支出达到灾难性或致贫水平）以及与财务风险相关的因素。
重度痴呆症患者的自付费用显著更高，21%的患者经历了灾难性支出，12%的患者因这些费用而低于贫困线。回归分析表明，入住养老院、主观健康状况差、高龄以及其他因素与财务风险增加的几率相关。
在痴呆症晚期，财务风险增加，这可能反映了更复杂的护理需求和更差的整体健康状况。
自付医疗费用随痴呆症严重程度增加。21%的重度痴呆症患者将至少40%的收入用于医疗保健。在重度痴呆症中，因医疗费用致贫的风险增加。护理需求、健康状况差和入住养老院可能导致财务风险。
