Predictors of costs in dementia in a longitudinal perspective

Abstract

Objective: To analyse predictors of costs in dementia from a societal perspective in a longitudinal setting.

Method: Healthcare resource use and costs were assessed retrospectively using a questionnaire in four waves at 6-month intervals in a sample of dementia patients (N = 175). Sociodemographic data, dementia severity and comorbidity at baseline, cognitive impairment and impairment in basic and instrumental activities of daily living were also recorded. Linear mixed regression models with random intercepts for individuals were used to analyse predictors of total and sector-specific costs.

Results: Impairment in activities of daily living significantly predicted total costs in dementia patients, with associations between basic activities of daily living and formal care costs on the one and instrumental activities of daily living and informal care costs on the other hand. Nursing home residence was associated with lower total costs than residence in the community. There was no effect of cognition on total or sector-specific costs.

Conclusion: Cognitive deficits in dementia are associated with costs only via their effect on the patients' capacity for activities of daily living. Transition into a nursing home may reduce total costs from a societal perspective, owing to the fact that a high amount of informal care required by severely demented patients prior to transition into a nursing home may cause higher costs than inpatient nursing care.

Figure 1. Sample sizes and drop-outs across waves.

* These are patients who were unavailable for interview due to reasons such as illness for the respective assessment wave, but remained in the study and were interviewed in subsequent waves.

Figure 2. Sample proportions with resource use: baseline vs. 1.5 years.