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Background <p>Cognitive impairment is associated with higher total healthcare costs (THC) after accounting for demographic factors and comorbidity burden.</p> Objective <p>Determine the proportion of incremental THC associated with cognitive impairment that is accounted for by functional impairments and frailty.</p> Design <p>Four prospective cohort studies of community-dwelling older adults are linked with each other and Medicare claims.</p> Participants <p>Eight thousand one hundred sixty-five community-dwelling, fee-for-service Medicare beneficiaries (mean age 79 years, 53% women, 79% non-Hispanic White).</p> Main Measures <p>Cognitive impairment was defined by either abnormal cognitive tests or self-or-proxy report of a clinician diagnosis of dementia. Comorbidity was the count of claims-based chronic conditions. Functional impairments were self-reported difficulty performing four activities of daily living. Frailty was defined by the Cardiovascular Health Study phenotype or a claims-based deficit accumulation index (CFI). Annualized THC were ascertained for 36 months following an index exam. Incremental THC of cognitive impairment were mean THC in women (men) with cognitive impairment minus the mean THC in women (men) without cognitive impairment.</p> Key Results <p>Incremental THC of cognitive impairment after adjustment for age, race, geographic region, and comorbidities was $6883 (95% CI, 3461–10,305) in women and $7276 (3298–11,254) in men. A substantial proportion of incremental THC of cognitive impairment were attributable to functional impairment, phenotypic frailty, or CFI individually (range 31.1–40.2% in women and 27.6–40.1% in men), while the combination of these three domains accounted for the majority of incremental THC (63.4% in women and 58.2% in men).</p> Conclusions <p>For both women and men, after accounting for demographics and comorbidity, approximately 60% of incremental THC associated with cognitive impairment was attributable to functional impairments and frailty. Investigation is warranted to determine if addressing these geriatric syndromes will mitigate their impact on THC among community-dwelling older adults with cognitive impairment.</p> Graphical Abstract <p></p>

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Effects of Functional Impairments and Frailty on the Association of Cognitive Impairment with Total Healthcare Costs: A Prospective Multi-cohort Study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月9日

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  • Howard A. Fink,
  • Kerry M. Sheets,
  • Lisa Langsetmo,
  • John T. Schousboe,
  • Allyson M. Kats,
  • Kristine E. Ensrud

摘要

Background

Cognitive impairment is associated with higher total healthcare costs (THC) after accounting for demographic factors and comorbidity burden.

Objective

Determine the proportion of incremental THC associated with cognitive impairment that is accounted for by functional impairments and frailty.

Design

Four prospective cohort studies of community-dwelling older adults are linked with each other and Medicare claims.

Participants

Eight thousand one hundred sixty-five community-dwelling, fee-for-service Medicare beneficiaries (mean age 79 years, 53% women, 79% non-Hispanic White).

Main Measures

Cognitive impairment was defined by either abnormal cognitive tests or self-or-proxy report of a clinician diagnosis of dementia. Comorbidity was the count of claims-based chronic conditions. Functional impairments were self-reported difficulty performing four activities of daily living. Frailty was defined by the Cardiovascular Health Study phenotype or a claims-based deficit accumulation index (CFI). Annualized THC were ascertained for 36 months following an index exam. Incremental THC of cognitive impairment were mean THC in women (men) with cognitive impairment minus the mean THC in women (men) without cognitive impairment.

Key Results

Incremental THC of cognitive impairment after adjustment for age, race, geographic region, and comorbidities was $6883 (95% CI, 3461–10,305) in women and $7276 (3298–11,254) in men. A substantial proportion of incremental THC of cognitive impairment were attributable to functional impairment, phenotypic frailty, or CFI individually (range 31.1–40.2% in women and 27.6–40.1% in men), while the combination of these three domains accounted for the majority of incremental THC (63.4% in women and 58.2% in men).

Conclusions

For both women and men, after accounting for demographics and comorbidity, approximately 60% of incremental THC associated with cognitive impairment was attributable to functional impairments and frailty. Investigation is warranted to determine if addressing these geriatric syndromes will mitigate their impact on THC among community-dwelling older adults with cognitive impairment.

Graphical Abstract