Aging
Healthcare Costs and Utilization Patterns Before and After Dementia Onset With and Without Clinical Recognition by the Healthcare System Bryan James* Ziwei Song Annie Chen Joya Bhattacharyya Yi Chen Francine Grodstein Bryan D. James Emma K. Stapp Melinda C. Power Ali Moghtaderi
Background: Prior research has shown substantial underdiagnosis of dementia in healthcare settings, as well as an increase in healthcare utilization and costs around the time of clinical dementia diagnosis. However, patterns around the onset of dementia—independent of clinical dementia diagnosis—remain poorly understood. This study examines healthcare utilization and costs around dementia onset among those with and without clinical recognition. Methods: Participants were from five Rush Alzheimer’s Disease Center (RADC) cohorts. Healthcare costs and utilization data were extracted from linkage to Medicare fee-for-service claims, covering the period from three years before to one year after cohort-determined dementia onset. Outcomes include total and category-specific Medicare payments (Parts A and B), emergency department (ED) visits, outpatient provider interactions, and hospitalizations. We analysed four-year healthcare utilization trajectories, from before to after dementia onset. We also identified whether persons with cohort-determined dementia had a dementia diagnosis recorded in Medicare claims within the four-year window and examined differences in healthcare utilization and cost according to clinical recognition of dementia. Results: Among 557 participants, the median age at dementia onset was 87 years, 26% were female, and 88% identified as non-Hispanic White. Inpatient and outpatient costs, ED visits, and hospitalizations increased leading up to and during the year of dementia onset, then declined in the year after. Although the overall patterns were similar irrespective of clinical recognition of dementia, the 54% of persons with clinical recognition had consistently higher costs and ED/hospitalization utilization. Conclusions: Healthcare utilization peaks at the time of dementia onset irrespective of clinical recognition of dementia. What drives this pattern and whether observed declines after dementia onset reflect improvement in care remains unclear.