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J Gerontol A Biol Sci Med Sci. 2015 Nov;70(11):1448-53. doi: 10.1093/gerona/glv124. Epub 2015 Aug 26.

Medicare Utilization and Expenditures Around Incident Dementia in a Multiethnic Cohort.

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Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. James J Peters VA Medical Center, Bronx, New York.
Cognitive Neuroscience Division of the Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, New York, New York. Department of Neurology, Columbia University Medical Center, New York, New York.
The Samuel Bronfman Department of Medicine, Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York.



Few studies have examined patterns of health care utilization and costs during the period around incident dementia.


Participants were drawn from the Washington Heights-Inwood Columbia Aging Project, a multiethnic, population-based, prospective study of cognitive aging of Medicare beneficiaries in a geographically defined area of northern Manhattan. Medicare utilization and expenditure were examined in individuals with clinically diagnosed dementia from 2 years before until 2 years after the initial diagnosis. A sample of non-demented individuals who were matched on socio-demographic and clinical characteristics at study enrollment was used as controls. Multivariable regression analysis estimated effects on Medicare utilization and expenditures associated with incident dementia.


During the 2 years before incident dementia, rates of inpatient admissions and outpatient visits were similar between dementia patients and non-demented controls, but use of home health and skilled nursing care and durable medical equipment were already higher in dementia patients. Results showed a small but significant excess increase associated with incident dementia in inpatient admissions but not in other areas of care. In the 2 years before incident dementia, total Medicare expenditures were already higher in dementia patients than in non-demented controls. But we found no excess increases in Medicare expenditures associated with incident dementia.


Demand for medical care already is increasing and costs are higher at the time of incident dementia. There was a small but significant excess risk of inpatient admission associated with incident dementia.


Health care expenditures; Health care use; Incident dementia; Longitudinal follow-up; Medicare

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