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• W2535601504 abstract "Dementia and comorbidities are independently associated with greater healthcare costs. Few studies have examined how dementia and comorbidities interact to affect healthcare use and expenditures. Medicare expenditures (1999-2010) were obtained for participants in the Washington Heights-Inwood Columbia Aging Project (WHICAP), a multiethnic, population-based, prospective study of cognitive aging in Medicare beneficiaries residing in northern Manhattan. Comprehensive clinical assessments of dementia severity were systematically carried out at ∼18 month intervals. Dementia severity was measured by Clinical Dementia Rating (CDR) at each assessment. Comorbidities were measured by Elixhauser comorbidities index using ICD-9-CM diagnosis codes. Multivariate random effects regression models examined effects of dementia severity, total number and individual comorbidities, and their interactions on log annual costs. Unit of observation is person-year. All clinical variables are included as time-varying covariates.Control variables included disability, extrapyramidal signs, age, gender, race/ethnicity, education, marital status, Medicaid eligibility, died during the year, and indicators for year. At baseline, most individuals were dementia free (91.8%, CDR=0), 5.6% had mild dementia (CDR=0.5/1), and 2.5% had moderate/severe dementia (CDR=2+). Average annual Medicare expenditures for individuals with moderate/severe dementia were more than twice as high as those who did not have dementia ($9,108 for CDR=0, $11,664 for CDR=0.5/1, $19,604 for CDR≥2). Compared to individuals without dementia, expenditures were approximately 10 times higher for those with ≥3 comorbidities than those with no comorbidities ($30,244 vs. $2,612). Multivariate estimates showed comorbidities was the most important predictor of expenditures. Mild dementia in and of itself was not associated with higher expenditures, and moderate/severe dementia (CDR≥2) was associated with 22.7% decrease in expenditures. There was a significant positive interaction between number of comorbidities and moderate/severity dementia. Increasing dementia severity and higher comorbidities are associated with increasingly higher cost of care. Care of individuals with dementia should focus on management of comorbidities, especially for those with multiple conditions. Implications of the modifying effects of dementia severity and comorbidities are highly relevant for healthcare planning, allocation of resources, and development of strategies to improve care and manage the costs of care." @default.
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• W2535601504 date "2016-07-01" @default.
• W2535601504 modified "2023-10-16" @default.
• W2535601504 title "P2-434: Cost Implications of Dementia Severity and Comorbidities" @default.
• W2535601504 doi "https://doi.org/10.1016/j.jalz.2016.06.1646" @default.
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