Better supporting the care needs of older adults with disabilities could reduce Medicare spending

1. The results of this observational study using data from the National Health and Aging Trends Study, indicate that older adults living with disabilities were in worse health compared to those without disabilities.

2. Participants with a disability who reported inadequate support at home were found to have higher median Medicare spending.

Evidence Rating Level: 2 (Good)

Study Rundown: A significant proportion of older adults with disabilities are living in the community. The availability of community supports varies widely among adults and can impact adults’ quality of life and participation in activities. The authors of this study aimed to quantify whether there are differences in total Medicare spending between older adults with disabilities based on whether they experienced negative consequences due to inadequate support with household activities, mobility or self-care. From this observational study, the authors concluded that participants with disability had more than twice the Medicare spending than those without disability. Further, they recommended that based on the study results, more support for older adults living in the community could help reduce Medicare spending in the long-term. The main study limitations were that the results may not be generalizable to adults that are younger than 65 years of age and the study design precludes being able to establish causality.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Health Care Expenditures After Initiating Long-term Services and Supports in the Community Versus in a Nursing Facility

In-Depth [observational study]: The authors conducted an observational study to determine differences in total Medicare spending by whether older adults experienced negative consequences due to inadequate support within the home environment. A total of 3716 community-living older adults enrolled in fee-for-service Medicare who survived 12 months after being interviewed as a part of the National Health and Aging Trends Study (NHATS). NHATS is a nationally representative of U.S. adults that are aged 65 years of age or older. Participants were excluded who lived in nursing homes, residential care facilities, those who died 12 months after being interviewed and those without Medicare Part B during the observation part of the study. The researchers found community-living older adults with disabilities were in worse health than those that did not have disability (P < 0.001 for all contrasts in all domains). Median Medicare spending was also higher for adults with disability compared to those without it. Median spending was highest among those with disability who reported negative consequences due to inadequate support in household activities ($4866 vs. $4095), mobility ($7266 vs. $4115) and self-care ($10 935 vs. $4436) compared to patients that did not report negative consequences. The most common negative consequences observed in patients that did not have help were wetting or soiling oneself when toileting (39.3%), having to stay inside (27.9%), not being able to go places inside the home (24.3%) and making mistakes in taking prescription medications (22.9%).

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