ASSOCIATION BETWEEN INSURANCE CARE LEVEL IN COMMUNITY-LIVING ALZHEIMER’S DISEASE AND RELATED DEMENTIAS PATIENTS

摘要

Prevalence of Alzheimer’s Disease and related dementias (ADRD) is increasing as the US population ages. The objective of this analysis was to examine the association between type of care and insurance type among US community-living patients with ADRD.This was a secondary analysis of Medicare Current Beneficiary Survey (MCBS) 2013. Any beneficiary/proxy respondent reporting diagnosis of ADRD was included. Type of care (dependent variable) was characterized into ordinal levels as independent living, at-home living utilizing informal care, home health aide utilization, or skilled nursing facility (SNF) stay. SNF was used as predictor of long-term care (LTC) based on literature. The independent variable of interest was insurance type: Medicare FFS only, Medicare Advantage or FFS+Medigap insurance with and without LTC coverage, and Medicare+Medicaid dual-eligibles. A multivariate ordered logistic regression model was run, adjusting for potential confounders (age, gender, marital status, mental disorders, functional limitations measured by activities of daily living, and overall health). 822 community-living ADRD patients were identified. Those with Medicare Advantage or FFS+Medigap utilized more informal services (odds ratio (OR) 0.46 [0.29, 0.74] versus 0.42 [0.22, 0.82] respectively). Presence of LTC insurance did not have an impact on type of care (OR: 0.91 [0.76, 1.18]), nor did being a dual-eligible; however, age greater than 75 years or considerable functional limitations were associated with greater intensity of care (OR: 2.84 [1.96, 4.13] and 6.13 [3.8, 9.9], respectively). The analysis did not account for income as a potential mediator. Given the increasing prevalence of ADRD, strategies to support informal care are needed.