Frequency of Dementia Diagnosis at Death Increased Among Older Adults

Nearly half of all older adults now die with a diagnosis of Alzheimer disease and related dementias (ADRD), according to results of a cross-sectional study.

Researchers utilized the Medicare database from 2004 to 2017 to include 3,515,329 adults aged 67 years or older. Also included was a 20% sample of fee-for-service Medicare decedents. The primary measure was a ADRD diagnosis within 2 years of death.  

The results indicated that the number of older adults who died with an ADRD diagnosis increased from 34.7% in 2004, to 47.2% in 2017. After using a stricter ADRD definition, the trend was reduced from 25.2% to 39.2%. Between 2011 to 2013, additional diagnoses were added to Medicare claims, and the National Alzheimer Care Act began, likely contributing to the inflection in the curve observed during this time period.

Several types of claims had significant increases in ADRD diagnosis frequency, including inpatient (49.0% to 67.3%), hospice (12.2% to 42.0%), and home health (10.1% to 28.7%). Individual characteristics, number of visits, and hospitalizations remained similar throughout the study period. The intensity of end-of-life care declined across most measures.

“These findings indicate that diagnosis of ADRD has become more common among older US decedents,” researchers concluded. “Although these analyses are unable to fully explain such increases, it may be owing to increased awareness among patients, families, and/or health care professionals, as well as temporal changes in billing practices.”

—Leigh Precopio

Reference:

Davis MA, Chiang-Hua C, Simonton S, Bynum JPW. Trends in US Medicare decedents’ diagnosis of dementia from 2004 to 2017. JAMA Health Forum. 2022;3(4);e220346. doi:10.1001/jamahealthforum.2022.0346