• Elizabeth Crouch, Janice C Probst, Kevin Bennett, and Jan M Eberth.
• 1 South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
• J Palliat Med. 2019 Feb 1; 22 (2): 126-131.

BackgroundPrevious research has not focused on differences at the end of life among Medicare beneficiaries with, and without, a diagnosis of Alzheimer's disease and related disorders (ADRDs).ObjectiveThe purpose of this study was to examine differences in utilization of inpatient services and Medicare expenditures (overall and by category) in the last six months of life for patients with, versus those without, a diagnosis of ADRD.DesignThe study used 2013 Medicare Research Identifiable Files (5% sample) to study utilization and expenditures for a full six months before death (n = 7895 for ADRD; n = 30,639 for non-ADRD). A generalized linear model with a gamma distribution was used to examine the association of ADRD with end-of-life service utilization and expenditures.ResultsADRD patients were overall less expensive than their non-ADRD peers through reduced use of high-cost services, and urban patients were more likely than rural patients to use hospice and other services among both the ADRD and non-ADRD groups. After controlling for age, gender, race, dual eligibility, residence, region, chronic conditions, and type of service utilization, ADRD beneficiaries cost Medicare 11% less than non-ADRD beneficiaries (p < 0.01).ConclusionsFuture research should examine the informal caregiving costs of caring, which is a significant part of care for an ADRD patient, as the residential setting of the beneficiary highly influences costs.

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