Longitudinal analysis of dementia diagnosis and specialty care among racially diverse Medicare beneficiaries

Abstract

Introduction: There is insufficient understanding of diagnosis of etiologic dementia subtypes and contact with specialized dementia care among older Americans.

Methods: We quantified dementia diagnoses and subsequent health care over five years by etiologic subtype and physician specialty among Medicare beneficiaries with incident dementia diagnosis in 2008/09 (226,604 persons/714,015 person-years).

Results: Eighty-five percent of people were diagnosed by a nondementia specialist physician. Use of dementia specialists within one year (22%) and five years (36%) of diagnosis was low. "Unspecified" dementia diagnosis was common, higher among those diagnosed by nondementia specialists (33.2%) than dementia specialists (21.6%). Half of diagnoses were Alzheimer's disease.

Discussion: Ascertainment of etiologic dementia subtype may inform hereditary risk and facilitate financial and care planning. Use of dementia specialty care was low, particularly for Hispanics and Asians, and associated with more detection of etiological subtype. Dementia-related professional development for nonspecialists is urgent given their central role in dementia diagnosis and care.

Keywords: Alzheimer's disease; Dementia specialist; Dementia subtype; Diagnosis; Disparities; Unspecified dementia.

Figure 1.

Distribution of health care follow-up visit for Medicare beneficiaries with a dementia diagnosis by physician specialty and mortality over time Sample is 226,604 Medicare beneficiaries with incident dementia diagnosis in 2008 or 2009.

Figure 2.

Distribution of health care follow-up visit for Medicare beneficiaries with a dementia diagnosis by physician specialty, sex and by race at one-year and five-years post diagnosis Sample is 226,604 beneficiaries with incident dementia diagnosis in 2008 or 2009. Includes both beneficiaries who survive and those who die.

Figure 3:

Percent of Medicare beneficiaries with Alzheimer’s disease diagnosis, non-Alzheimer’s disease diagnosis and unspecified dementia diagnosis one to five-years after diagnosis, by physician specialty Sample is 226,604 (34,920 + 191,684 diagnosed by specialist, non-specialist respectively) beneficiaries with incident dementia diagnosis in 2008 or 2009. Includes both beneficiaries who survive and those who die.

Figure 4.

Follow-up diagnosis of dementia subtype after initial diagnosis of unspecified dementia by non-specialist, by physician specialty at post-diagnostic health care visit Sample is 77,502 beneficiaries with incident unspecified dementia diagnosis in 2008 or 2009, initially diagnosed by a non-dementia specialist physician who had a follow-up health care visit for dementia.