Out-of-Pocket Health Expenditures and Health Care Services Use Among Older Americans With Cognitive Impairment: Results From the 2008–2016 Health and Retirement Study
Abstract Background and Objectives The evidence base on health services use and cost burdens associated with transition to severe cognitive impairment (SCI) and dementia is underdeveloped. We examine how the change in cognitive impairment status influences nursing home use, hospitalizations, and out...
Gespeichert in:
Veröffentlicht in: | The Gerontologist 2022-07, Vol.62 (6), p.911-922 |
---|---|
Hauptverfasser: | , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | 922 |
---|---|
container_issue | 6 |
container_start_page | 911 |
container_title | The Gerontologist |
container_volume | 62 |
creator | Jenkins, Derek Stickel, Ariana González, Hector M Tarraf, Wassim |
description | Abstract
Background and Objectives
The evidence base on health services use and cost burdens associated with transition to severe cognitive impairment (SCI) and dementia is underdeveloped. We examine how the change in cognitive impairment status influences nursing home use, hospitalizations, and out-of-pocket (OOP) expenditures.
Research Design and Methods
We use prospective data from the Health and Retirement Study (2007/2008–2015/2016) on adults 70 years and older meeting research criteria for cognitive impairment not dementia (CIND) at baseline (unweighted n = 1,692) to fit 2-part models testing how reversion to normal cognition, stability (CIND maintenance), and transition into SCI/dementia influence change in yearly nursing home use, hospitalizations, and OOP expenditures.
Results
Over 8 years, 5.9% reverted, 15.9% remained CIND, 14.9% transitioned to SCI/dementia, and 63.3% died. We observed substantial increases in the propensity of any nursing home use which were particularly pronounced among those who transitioned or died during follow-up and similar but less pronounced differences in patterns of inpatient hospitalizations. Average baseline OOP spending was similar among reverters ($1156 [95% confidence interval = 832–1,479]), maintainers ($1,145 [993–1,296]), and transitioners ($1,385 [1,041–1,730]). Individuals who died during follow-up spent $2,529 (2,101–2,957). By the eighth year of follow-up, spending among reverters increased to $1,402 (869–1,934) and $2,188 (1,402–2,974) and $8,988 (5,820–12,157) for maintainers and transitioners, respectively. Average spending at the wave preceding death was $7,719 (4,345–11,094). Estimates were only partly attenuated through adjustment to covariables.
Discussion and Implications
A better understanding of variations in health services use and cost burdens among individuals with mild cognitive impairment can help guide targeted care and financial planning. |
doi_str_mv | 10.1093/geront/gnab160 |
format | Article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9290880</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/geront/gnab160</oup_id><sourcerecordid>2695089504</sourcerecordid><originalsourceid>FETCH-LOGICAL-c452t-a395727c24c260df115a1d67b298547cf71ea0fa739ab3f4e678a74853a2a633</originalsourceid><addsrcrecordid>eNqFks1u1DAQxyMEokvhyhFZ4gKHtP6I44QDUrVqaaVKi9oijpbXmWRdEjvYzore-g59CZ6LJ8Gr3a2ACwfLH_Ob_39Gnix7TfARwTU77sA7G487q5akxE-yGRG8yjkryNNshjEp8xoTdpC9COEWpzul4nl2wApBKl7Ws-znYoq5a_PPTn-DiM5B9XGFTn-MYBsTJw8BKdvs3-fKA7oGvzY6Bb4EQCeDsx1a9A34dAZvtLIBfTUb2HXWRLMGdDGMyvgBbPyAriBMfQzozLsBxRUginH16_6Bplr3NhvHK4jGwyYHXcepuXuZPWtVH-DVbj_Mbs5Ob-bn-eXi08X85DLXBacxV6zmggpNC01L3LSEcEWaUixpXfFC6FYQULhVgtVqydoCSlEpUVScKapKxg6zj1vZcVoO0Ojk71UvR28G5e-kU0b-HbFmJTu3ljWtcVXhJPBuJ-Dd9wlClIMJGvpeWXBTkJTXhBJe0jKhb_9Bb93kbepO0rLmuEqrSNTRltLeheChfSyGYLmZAbmdAbmbgZTw5s8WHvH9pyfg_RZw0_g_sd_VMb-X</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2695089504</pqid></control><display><type>article</type><title>Out-of-Pocket Health Expenditures and Health Care Services Use Among Older Americans With Cognitive Impairment: Results From the 2008–2016 Health and Retirement Study</title><source>MEDLINE</source><source>Sociological Abstracts</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>Alma/SFX Local Collection</source><creator>Jenkins, Derek ; Stickel, Ariana ; González, Hector M ; Tarraf, Wassim</creator><contributor>Meeks, Suzanne</contributor><creatorcontrib>Jenkins, Derek ; Stickel, Ariana ; González, Hector M ; Tarraf, Wassim ; Meeks, Suzanne</creatorcontrib><description>Abstract
Background and Objectives
The evidence base on health services use and cost burdens associated with transition to severe cognitive impairment (SCI) and dementia is underdeveloped. We examine how the change in cognitive impairment status influences nursing home use, hospitalizations, and out-of-pocket (OOP) expenditures.
Research Design and Methods
We use prospective data from the Health and Retirement Study (2007/2008–2015/2016) on adults 70 years and older meeting research criteria for cognitive impairment not dementia (CIND) at baseline (unweighted n = 1,692) to fit 2-part models testing how reversion to normal cognition, stability (CIND maintenance), and transition into SCI/dementia influence change in yearly nursing home use, hospitalizations, and OOP expenditures.
Results
Over 8 years, 5.9% reverted, 15.9% remained CIND, 14.9% transitioned to SCI/dementia, and 63.3% died. We observed substantial increases in the propensity of any nursing home use which were particularly pronounced among those who transitioned or died during follow-up and similar but less pronounced differences in patterns of inpatient hospitalizations. Average baseline OOP spending was similar among reverters ($1156 [95% confidence interval = 832–1,479]), maintainers ($1,145 [993–1,296]), and transitioners ($1,385 [1,041–1,730]). Individuals who died during follow-up spent $2,529 (2,101–2,957). By the eighth year of follow-up, spending among reverters increased to $1,402 (869–1,934) and $2,188 (1,402–2,974) and $8,988 (5,820–12,157) for maintainers and transitioners, respectively. Average spending at the wave preceding death was $7,719 (4,345–11,094). Estimates were only partly attenuated through adjustment to covariables.
Discussion and Implications
A better understanding of variations in health services use and cost burdens among individuals with mild cognitive impairment can help guide targeted care and financial planning.</description><identifier>ISSN: 0016-9013</identifier><identifier>EISSN: 1758-5341</identifier><identifier>DOI: 10.1093/geront/gnab160</identifier><identifier>PMID: 34718569</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Aged ; Cognition ; Cognition & reasoning ; Cognitive ability ; Cognitive Dysfunction ; Dementia ; Health care expenditures ; Health Expenditures ; Health services ; Healthcare Access and Utilization ; Hospitalization ; Humans ; Nursing homes ; Older people ; Prospective Studies ; Research design ; Retirement ; United States</subject><ispartof>The Gerontologist, 2022-07, Vol.62 (6), p.911-922</ispartof><rights>The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 2021</rights><rights>The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><rights>Copyright Oxford University Press Aug 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c452t-a395727c24c260df115a1d67b298547cf71ea0fa739ab3f4e678a74853a2a633</citedby><cites>FETCH-LOGICAL-c452t-a395727c24c260df115a1d67b298547cf71ea0fa739ab3f4e678a74853a2a633</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1584,27924,27925,33774</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34718569$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Meeks, Suzanne</contributor><creatorcontrib>Jenkins, Derek</creatorcontrib><creatorcontrib>Stickel, Ariana</creatorcontrib><creatorcontrib>González, Hector M</creatorcontrib><creatorcontrib>Tarraf, Wassim</creatorcontrib><title>Out-of-Pocket Health Expenditures and Health Care Services Use Among Older Americans With Cognitive Impairment: Results From the 2008–2016 Health and Retirement Study</title><title>The Gerontologist</title><addtitle>Gerontologist</addtitle><description>Abstract
Background and Objectives
The evidence base on health services use and cost burdens associated with transition to severe cognitive impairment (SCI) and dementia is underdeveloped. We examine how the change in cognitive impairment status influences nursing home use, hospitalizations, and out-of-pocket (OOP) expenditures.
Research Design and Methods
We use prospective data from the Health and Retirement Study (2007/2008–2015/2016) on adults 70 years and older meeting research criteria for cognitive impairment not dementia (CIND) at baseline (unweighted n = 1,692) to fit 2-part models testing how reversion to normal cognition, stability (CIND maintenance), and transition into SCI/dementia influence change in yearly nursing home use, hospitalizations, and OOP expenditures.
Results
Over 8 years, 5.9% reverted, 15.9% remained CIND, 14.9% transitioned to SCI/dementia, and 63.3% died. We observed substantial increases in the propensity of any nursing home use which were particularly pronounced among those who transitioned or died during follow-up and similar but less pronounced differences in patterns of inpatient hospitalizations. Average baseline OOP spending was similar among reverters ($1156 [95% confidence interval = 832–1,479]), maintainers ($1,145 [993–1,296]), and transitioners ($1,385 [1,041–1,730]). Individuals who died during follow-up spent $2,529 (2,101–2,957). By the eighth year of follow-up, spending among reverters increased to $1,402 (869–1,934) and $2,188 (1,402–2,974) and $8,988 (5,820–12,157) for maintainers and transitioners, respectively. Average spending at the wave preceding death was $7,719 (4,345–11,094). Estimates were only partly attenuated through adjustment to covariables.
Discussion and Implications
A better understanding of variations in health services use and cost burdens among individuals with mild cognitive impairment can help guide targeted care and financial planning.</description><subject>Aged</subject><subject>Cognition</subject><subject>Cognition & reasoning</subject><subject>Cognitive ability</subject><subject>Cognitive Dysfunction</subject><subject>Dementia</subject><subject>Health care expenditures</subject><subject>Health Expenditures</subject><subject>Health services</subject><subject>Healthcare Access and Utilization</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Nursing homes</subject><subject>Older people</subject><subject>Prospective Studies</subject><subject>Research design</subject><subject>Retirement</subject><subject>United States</subject><issn>0016-9013</issn><issn>1758-5341</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BHHNA</sourceid><recordid>eNqFks1u1DAQxyMEokvhyhFZ4gKHtP6I44QDUrVqaaVKi9oijpbXmWRdEjvYzore-g59CZ6LJ8Gr3a2ACwfLH_Ob_39Gnix7TfARwTU77sA7G487q5akxE-yGRG8yjkryNNshjEp8xoTdpC9COEWpzul4nl2wApBKl7Ws-znYoq5a_PPTn-DiM5B9XGFTn-MYBsTJw8BKdvs3-fKA7oGvzY6Bb4EQCeDsx1a9A34dAZvtLIBfTUb2HXWRLMGdDGMyvgBbPyAriBMfQzozLsBxRUginH16_6Bplr3NhvHK4jGwyYHXcepuXuZPWtVH-DVbj_Mbs5Ob-bn-eXi08X85DLXBacxV6zmggpNC01L3LSEcEWaUixpXfFC6FYQULhVgtVqydoCSlEpUVScKapKxg6zj1vZcVoO0Ojk71UvR28G5e-kU0b-HbFmJTu3ljWtcVXhJPBuJ-Dd9wlClIMJGvpeWXBTkJTXhBJe0jKhb_9Bb93kbepO0rLmuEqrSNTRltLeheChfSyGYLmZAbmdAbmbgZTw5s8WHvH9pyfg_RZw0_g_sd_VMb-X</recordid><startdate>20220715</startdate><enddate>20220715</enddate><creator>Jenkins, Derek</creator><creator>Stickel, Ariana</creator><creator>González, Hector M</creator><creator>Tarraf, Wassim</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7U3</scope><scope>7U4</scope><scope>ASE</scope><scope>BHHNA</scope><scope>DWI</scope><scope>FPQ</scope><scope>K6X</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>WZK</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20220715</creationdate><title>Out-of-Pocket Health Expenditures and Health Care Services Use Among Older Americans With Cognitive Impairment: Results From the 2008–2016 Health and Retirement Study</title><author>Jenkins, Derek ; Stickel, Ariana ; González, Hector M ; Tarraf, Wassim</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c452t-a395727c24c260df115a1d67b298547cf71ea0fa739ab3f4e678a74853a2a633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Cognition</topic><topic>Cognition & reasoning</topic><topic>Cognitive ability</topic><topic>Cognitive Dysfunction</topic><topic>Dementia</topic><topic>Health care expenditures</topic><topic>Health Expenditures</topic><topic>Health services</topic><topic>Healthcare Access and Utilization</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Nursing homes</topic><topic>Older people</topic><topic>Prospective Studies</topic><topic>Research design</topic><topic>Retirement</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jenkins, Derek</creatorcontrib><creatorcontrib>Stickel, Ariana</creatorcontrib><creatorcontrib>González, Hector M</creatorcontrib><creatorcontrib>Tarraf, Wassim</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Social Services Abstracts</collection><collection>Sociological Abstracts (pre-2017)</collection><collection>British Nursing Index</collection><collection>Sociological Abstracts</collection><collection>Sociological Abstracts</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Sociological Abstracts (Ovid)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Gerontologist</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jenkins, Derek</au><au>Stickel, Ariana</au><au>González, Hector M</au><au>Tarraf, Wassim</au><au>Meeks, Suzanne</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Out-of-Pocket Health Expenditures and Health Care Services Use Among Older Americans With Cognitive Impairment: Results From the 2008–2016 Health and Retirement Study</atitle><jtitle>The Gerontologist</jtitle><addtitle>Gerontologist</addtitle><date>2022-07-15</date><risdate>2022</risdate><volume>62</volume><issue>6</issue><spage>911</spage><epage>922</epage><pages>911-922</pages><issn>0016-9013</issn><eissn>1758-5341</eissn><abstract>Abstract
Background and Objectives
The evidence base on health services use and cost burdens associated with transition to severe cognitive impairment (SCI) and dementia is underdeveloped. We examine how the change in cognitive impairment status influences nursing home use, hospitalizations, and out-of-pocket (OOP) expenditures.
Research Design and Methods
We use prospective data from the Health and Retirement Study (2007/2008–2015/2016) on adults 70 years and older meeting research criteria for cognitive impairment not dementia (CIND) at baseline (unweighted n = 1,692) to fit 2-part models testing how reversion to normal cognition, stability (CIND maintenance), and transition into SCI/dementia influence change in yearly nursing home use, hospitalizations, and OOP expenditures.
Results
Over 8 years, 5.9% reverted, 15.9% remained CIND, 14.9% transitioned to SCI/dementia, and 63.3% died. We observed substantial increases in the propensity of any nursing home use which were particularly pronounced among those who transitioned or died during follow-up and similar but less pronounced differences in patterns of inpatient hospitalizations. Average baseline OOP spending was similar among reverters ($1156 [95% confidence interval = 832–1,479]), maintainers ($1,145 [993–1,296]), and transitioners ($1,385 [1,041–1,730]). Individuals who died during follow-up spent $2,529 (2,101–2,957). By the eighth year of follow-up, spending among reverters increased to $1,402 (869–1,934) and $2,188 (1,402–2,974) and $8,988 (5,820–12,157) for maintainers and transitioners, respectively. Average spending at the wave preceding death was $7,719 (4,345–11,094). Estimates were only partly attenuated through adjustment to covariables.
Discussion and Implications
A better understanding of variations in health services use and cost burdens among individuals with mild cognitive impairment can help guide targeted care and financial planning.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>34718569</pmid><doi>10.1093/geront/gnab160</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0016-9013 |
ispartof | The Gerontologist, 2022-07, Vol.62 (6), p.911-922 |
issn | 0016-9013 1758-5341 |
language | eng |
recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9290880 |
source | MEDLINE; Sociological Abstracts; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
subjects | Aged Cognition Cognition & reasoning Cognitive ability Cognitive Dysfunction Dementia Health care expenditures Health Expenditures Health services Healthcare Access and Utilization Hospitalization Humans Nursing homes Older people Prospective Studies Research design Retirement United States |
title | Out-of-Pocket Health Expenditures and Health Care Services Use Among Older Americans With Cognitive Impairment: Results From the 2008–2016 Health and Retirement Study |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T01%3A46%3A55IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Out-of-Pocket%20Health%20Expenditures%20and%20Health%20Care%20Services%20Use%20Among%20Older%20Americans%20With%20Cognitive%20Impairment:%20Results%20From%20the%202008%E2%80%932016%20Health%20and%20Retirement%20Study&rft.jtitle=The%20Gerontologist&rft.au=Jenkins,%20Derek&rft.date=2022-07-15&rft.volume=62&rft.issue=6&rft.spage=911&rft.epage=922&rft.pages=911-922&rft.issn=0016-9013&rft.eissn=1758-5341&rft_id=info:doi/10.1093/geront/gnab160&rft_dat=%3Cproquest_pubme%3E2695089504%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2695089504&rft_id=info:pmid/34718569&rft_oup_id=10.1093/geront/gnab160&rfr_iscdi=true |