We are excited to introduce the new Policy and Economics of Aging, Disability, and Long Term Care (PEDAL) lab Twitter. Our handle is @lab_pedal. We look forward to sharing information on our mission to improve aging in America through social media.
Dr. Coe spoke at the 2019 Milken Institute Global Conference on the price of dementia. Dr. Coe’s comments focused on the effect that Alzheimer’s disease and related dementias have on individuals and their families and how this then affects our economy.
Providing unpaid care for an older parent has costs that go well beyond a caregiver’s lost wages. A new estimate suggests that the median direct and indirect costs of caregiving are $180,000 over two years, about the same as full-time institutional care. This estimate accounts for lost earnings as well as non-tangible factors, such as lost leisure time and changes to the caregiver’s well-being. It suggests that informal care cost caregivers at least $277 billion in 2011, which is 20 percent higher than estimates that only consider lost wages.
About 5.5 million older adults are living with dementia, a chronic, progressive disease characterized by severe cognitive decline. This number will likely grow significantly as the U.S. population ages, which has cost implications for the Medicare program. A full accounting of these additional expenses will help policymakers plan for them in their Medicare budgets.
End of life care is intensive, expensive, and highly dependent on where one lives. This poses quality, economic, and equity concerns. Intensive care near the end of life (EOL) is a quality concern because most patients do not want intensive interventions at the EOL. It is an economic problem because 25 percent of health care spending is on the six percent of patients who die each year, yet intensive care at the EOL is not associated with better outcomes or greater satisfaction with care.
Nursing homes are an integral part of our long-term care delivery system, but they also are a vital location for post-acute care (PAC) services. Research questions posed under this topic include:
How are patient outcomes and Medicare spending affected by the decision to discharge patients to home with home health care vs to a skilled nursing facility for post-acute care?
Who is discharged on day 20 of a skilled nursing facility (SNF) stay, when the Medicare benefit drops from 100% to 80% coverage?
The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study is the largest randomize clinical trial (N = 2802) to examine whether cognitive training enhanced both cognitive abilities and everyday functioning in normal older adults. Subjects trained on memory, reasoning, or processing speed performed significantly above controls at 5- and 10-year follow-ups. In addition, trained subjects reported less difficulty in performing IADL tasks at 10-year follow-up. Speed and reasoning training was associated with reduction in auto crashes and in driving cessation.
The current debate about how best to meet the growing demand for patient-centered, high-quality long-term care for persons with ADRD in the least restrictive setting possible has centered almost solely on the direct and indirect costs of each type of care. A crucial missing piece is a comparison of the benefits. While receiving informal care may seem intuitively appealing, we currently know surprisingly little about the implications of this choice for outcomes of the individuals receiving the care.
Dementia care has substantial economic costs, with consequences for health care systems and for the health and welfare of the families who provide the majority of their care. There are many studies of the costs of dementia, but they lead to widely varying estimates of the costs due to differences in the time-frame studied, the comprehensiveness of the costs included, differences in the quality of the data used, and the differences in the definition of dementia onset.