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reasons for hospitalization of individuals with Alzheimer’s Disease:

Percentage of hospitalized individuals by Admitting Diagnosis*

47

Recently, researchers evaluated the additional or “incremental” health care and caregiving costs of dementia (that is, the costs specifically attributed to dementia when comparing people with and without dementia who have the same coexisting medical conditions and demographic characteristics).196,330

One group of researchers found that the incremental health care and nursing home costs for those with dementia was $28,501 per year in 2010 dollars ($31,864 in 2014 dollars).196, A21, A23

Use AnD cOsts Of heAlth cAre services People with Alzheimer’s disease and other dementias have more than three times as many hospital stays per year as other older people.179 _{Moreover, the use of}

health care services for people with other serious medical conditions is strongly affected by the presence or absence of dementia. In particular, people with coronary artery disease, diabetes, chronic kidney disease, chronic obstructive pulmonary disease (COPD), stroke or cancer who also have Alzheimer’s and other dementias have higher use and costs of health care services than people with these medical conditions but no coexisting dementia.

Use of Health Care Services

Older people with Alzheimer’s disease and other dementias have more hospital stays, skilled nursing facility stays and home health care visits than other older people.

• Hospital. There are 780 hospital stays per 1,000 Medicare beneficiaries age 65 and older with Alzheimer’s disease and other dementias compared with 234 hospital stays per 1,000 Medicare beneficiaries age 65 and older without these conditions.179 _{The most common reasons for}

hospitalization of people with Alzheimer’s disease are syncope (fainting), fall and trauma (26 percent); ischemic heart disease (17 percent); and

gastrointestinal disease (9 percent) (Figure 12).331

• Skilled nursing facility. Skilled nursing facilities provide direct medical care that is performed or supervised by registered nurses, such as giving intravenous fluids,

changing dressings and administering tube feedings.332

There are 349 skilled nursing facility stays per 1,000 beneficiaries with Alzheimer’s and other dementias compared with 39 stays per 1,000 beneficiaries for people without these conditions.179

• Home health care. Twenty-three percent of Medicare beneficiaries age 65 and older with Alzheimer’s disease and other dementias have at least one home health care visit during the year, compared with 10 percent of Medicare beneficiaries age 65 and older without Alzheimer’s and other dementias.153

Differences in health care use between individuals with and without dementia are most prominent for those residing in the community. Based on data from the Health and Retirement Study, community-residing individuals with dementia were more likely to have a potentially preventable hospitalization, an emergency department visit that was potentially avoidable, and an emergency department visit that resulted in a hospitalization.333 _{For individuals residing in a nursing}

home, there were no differences in the likelihood of being hospitalized or having an emergency department visit.

Preventable hospitalizations are one common measure of health care quality. Preventable hospitalizations are hospitalizations for conditions that could have been avoided with better access to or quality of preventive and primary care. Based on data from the 2006 to 2008 Health and Retirement Study and Medicare, preventable hospitalizations represented 25 percent of the total hospitalizations for individuals with Alzheimer’s disease and other dementias.334 _{The proportion was substantially}

higher, however, for African-Americans, Hispanics and individuals with low incomes. Hispanic older adults had the highest proportion of preventable hospitalizations (34 percent). Healthy People 2020, the U.S. Department of Health and Human Services’ initiative to achieve 10-year goals for health promotion and disease prevention, has set a target to reduce preventable hospitalizations for people with Alzheimer’s disease and other dementias by 10 percent by 2020.334

Costs of Health Care Services

With the exception of prescription medications, average per-person payments for health care services (hospital, physician and other medical provider, nursing home, skilled nursing facility, hospice and home health care) were higher for Medicare beneficiaries with Alzheimer’s disease and other dementias than for other Medicare beneficiaries in the same age group (Table 9).179 _{The fact}

that only payments for prescription drugs were lower for those with Alzheimer’s and other dementias underscores the lack of effective treatments available to those with dementia.

Use and Costs of Health Care Services for Individuals Newly Diagnosed with Alzheimer’s Disease

Individuals newly diagnosed with Alzheimer’s disease have higher health care use and costs in the year prior to diagnosis and in the 2 subsequent years after diagnosis than those who do not receive this diagnosis, according to a study of Medicare Advantage enrollees (that is, Medicare beneficiaries enrolled in a private Medicare health insurance plan).335 _{Enrollees with a new diagnosis}

of Alzheimer’s disease had $2,529 more in health care costs (medical and pharmacy) in the year prior to diagnosis, $10,126 more in costs in the year following diagnosis, and $6,251 more in costs in the second year following diagnosis. In another study of pre-diagnosis health care costs, Medicaid enrollees with Alzheimer’s disease had $6,204 more in health care costs, with $3,713 due to additional outpatient medical care and $1,612 in additional home care and adult day care services.336

While more work is needed to understand the underlying causes of increased use of health care services

immediately prior to and after receiving a diagnosis of Alzheimer’s disease, it may be attributed to care for disability and injuries, such as falls, that might result from the early stage of the disease;337 _{treatments related}

to cognitive impairment or coexisting medical conditions; and costs of diagnostic procedures.

Average Annual Per-Person Payments for health care