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The burden of health care costs for patients with dementia in the last 5 years of life
Kelley AS, McGarry K, Gorges R, Skinner JS.. Annals of internal medicine, 2015-10-27
Topic: Risk, prevention and care in population studies
Background Common diseases, particularly dementia, have large social costs for the U.S. population. However, less is known about the end-of-life costs of specific diseases and the associated financial risk for individual households. Objective To examine social costs and financial risks faced by Medicare beneficiaries 5 years before death. Design Retrospective cohort. Setting The HRS (Health and Retirement Study). Participants Medicare fee-for-service beneficiaries, aged 70 years or older, who died between 2005 and 2010 (n = 1702), stratified into 4 groups: persons with a high probability of dementia or those who died because of heart disease, cancer, or other causes. Measurements Total social costs and their components, including Medicare, Medicaid, private insurance, out-of-pocket spending, and informal care, measured over the last 5 years of life; and out-of-pocket spending as a proportion of household wealth. Results Average total cost per decedent with dementia ($287 038) was significantly greater than that of those who died of heart disease ($175 136), cancer ($173 383), or other causes ($197 286) (P Limitation Imputed Medicaid, private insurance, and informal care costs. Conclusion Health care expenditures among persons with dementia were substantially larger than those for other diseases, and many of the expenses were uncovered (uninsured). This places a large financial burden on families, and these burdens are particularly pronounced among the demographic groups that are least prepared for financial risk. Primary funding source National Institute on Aging.
Key findings
- Results Average total cost per decedent with dementia ($287 038) was significantly greater than that of those who died of heart disease ($175 136), cancer ($173 383), or other causes ($197 286) (P Limitation Imputed Medicaid, private insurance, and informal care costs.
Why it matters
In 1,702 US Medicare fee-for-service beneficiaries aged 70 or older who died in 2005–2010, average total costs over the last five years of life were $287,038 for people likely to have dementia, compared with $175,136 for heart disease, $173,383 for cancer and $197,286 for other causes. That total includes Medicare, Medicaid, private insurance, out-of-pocket spending and unpaid family care, and the authors say "many of the expenses were uncovered (uninsured)", which places a large burden on families. This is an observational comparison, and Medicaid, private insurance and informal care costs were estimated (imputed), not directly measured.
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Study details
- Study designretrospective cohort
- Participants1,702
- Evidence strengthModerate
How this study scored 71/100
Published in a leading specialty journal, and it is a retrospective cohort study, reconstructed from past records. Scored zero for effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Annals of internal medicine) |
| Journal's citation record | 4 / 4 | Annals of Internal Medicine: journal h-index 648 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A retrospective cohort study, reconstructed from past records |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2015 — within 20 year(s) of the newest study here |
| Sample size | 3 / 4 | 1,702 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 374 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 28.8 citations a year over 13 year(s) since 2015 |
| Impact for its field and year | 6 / 6 | Cited 77.1× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 4 / 6 | Cited by 34 other studies in this library |
| Still being cited | 3 / 4 | Cited 82 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Jonathan Skinner: h-index 82 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of California, Los Angeles: institution h-index 1,923 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 26502320) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 71 / 100 | — |
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Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Kelley, A. S., McGarry, K., Gorges, R., & Skinner, J. S. (2015). The burden of health care costs for patients with dementia in the last 5 years of life. Annals of internal medicine. https://doi.org/10.7326/m15-0381
Vancouver
Kelley AS, McGarry K, Gorges R, Skinner JS. The burden of health care costs for patients with dementia in the last 5 years of life. Annals of internal medicine. 2015. doi:10.7326/m15-0381. PMID: 26502320.
BibTeX
@article{kelley2015-26502320,
author = {Kelley, A. S. and McGarry, K. and Gorges, R. and Skinner, J. S.},
title = {{The burden of health care costs for patients with dementia in the last 5 years of life}},
journal = {Annals of internal medicine},
year = {2015},
doi = {10.7326/m15-0381},
pmid = {26502320},
url = {https://doi.org/10.7326/m15-0381}
}
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