Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr 1;3(4):e220346.
doi: 10.1001/jamahealthforum.2022.0346. eCollection 2022 Apr.

Trends in US Medicare Decedents' Diagnosis of Dementia From 2004 to 2017

Matthew A Davis  1   2   3 , Chiang-Hua Chang  3   4 , Sharon Simonton  3   4 , Julie P W Bynum  3   4
Affiliations

Trends in US Medicare Decedents' Diagnosis of Dementia From 2004 to 2017

Matthew A Davis et al. JAMA Health Forum. .

Abstract

Importance: Alzheimer disease and related dementias (ADRD) have received considerable attention among clinicians, researchers, and policy makers in recent years. Despite increased awareness, few studies have documented temporal changes in the documentation of ADRD diagnoses despite its new importance for risk adjustment for health plans in Medicare.

Objective: To assess trends in frequency of ADRD diagnosis in the last 2 years of life from 2004 to 2017, as well as any associated changes in billing practices, characteristics of the population with diagnosed ADRD, and intensity of end-of-life care.

Design setting and participants: This is a serial cross-sectional study of older adult decedents (67 years or older) from 2004 to 2017 using a 20% sample of fee-for-service Medicare decedents. An ADRD diagnosis within the last 2 years of life was identified using diagnosis codes from inpatient, professional service, home health, or hospice claims, requiring the standard claims algorithm that required at least 1 claim and a more stringent algorithm that required at least 2 claims. Trends in ADRD diagnosis among decedents were used to lessen influence of new diagnostic technologies for early stage disease. Demographic characteristics, selected comorbidities, place of death, and health service use at the end-of-life were also examined. Data were analyzed from July 9, 2020, to May 3, 2021.

Exposures: Calendar year 2004 to 2017.

Main outcome and measure: An ADRD diagnosis within 2 years of death.

Results: Among the included 3 515 329 Medicare fee-for-service decedents, when adjusted for age and sex, the percentage of older decedents with an ADRD diagnosis increased from 34.7% in 2004 to 47.2% in 2017. The trend was attenuated (25.2% to 39.2%) using a stringent ADRD definition. There was an inflection in the curve from 2011 to 2013, the time at which additional diagnoses were added to Medicare claims and the National Alzheimer Care Act was enacted. The ADRD diagnosis frequency increased considerably in inpatient (49.0% to 67.3%), hospice (12.2% to 42.0%), and home health (10.1% to 28.7%) claims. However, individual characteristics, number of visits, and hospitalizations were similar across the study period, and the intensity of end-of-life care declined on most measures.

Conclusions and relevance: In this cross-sectional study, nearly half of older Medicare decedents had a diagnosis of ADRD at the time of death. From 2004 to 2017, the percentage of older adult decedents who received an ADRD diagnosis increased substantially prior to announcement of the addition of ADRD to Medicare risk adjustment strategies.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Davis reported personal fees from Regional Anesthesia & Pain Medicine for statistical review outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Age- and Sex-Adjusted Trends in the Percentage of Older Adult Medicare Decedents With an ADRD Diagnosis Within the Last 2 Years of Life, 2004-2017
ADRD indicates Alzheimer disease and related dementias; CMS, Centers for Medicare & Medicaid Services; EHR, electronic health record. aData on EHR adoption for office-based physicians and nonfederally qualified acute care hospitals are from the Office of the National Coordinator for Health Information Technology., bADRD identified based on a single claim within the last 2 years of life. cADRD identified based on 2 diagnoses on claims occurring more than 1 week apart within the last 2 years of life.
Figure 2.
Figure 2.. ADRD Diagnosis Among Older Adult Medicare Decedents by Age Category in 2004, 2011, and 2017
Alzheimer disease and related dementias (ADRD) were identified based on a single claim within the last 2 years of life.
Figure 3.
Figure 3.. Trends in Older Adult Medicare Decedents Who Received an ADRD Diagnosis by Health Care Service and Single Health Care Service in the Last 2 Years of Life, 2004-2017
ADRD indicates Alzheimer disease and related dementias.
See this image and copyright information in PMC

References

    1. Hurd MD, Martorell P, Delavande A, Mullen KJ, Langa KM. Monetary costs of dementia in the United States. N Engl J Med. 2013;368(14):1326-1334. doi:10.1056/NEJMsa1204629 - DOI - PMC - PubMed
    1. 2021 Alzheimer’s disease facts and figures. Alzheimers Dement. 2021;17(3):327-406. doi:10.1002/alz.12328 - DOI - PubMed
    1. James BD, Leurgans SE, Hebert LE, Scherr PA, Yaffe K, Bennett DA. Contribution of Alzheimer disease to mortality in the United States. Neurology. 2014;82(12):1045-1050. doi:10.1212/WNL.0000000000000240 - DOI - PMC - PubMed
    1. Anderson RN. Deaths: leading causes for 2000. Natl Vital Stat Rep. 2002;50(16):1-85. - PubMed
    1. Xu J, Murphy SL, Kockanek KD, Arias E. Mortality in the United States, 2018. NCHS Data Brief. 2020;(355):1-8. - PubMed

Publication types