Significant financial concerns associated with individuals with Alzheimer’s Disease and related dementias

1. Single Medicare beneficiaries with Alzheimer’s disease and related dementias (ADRD) were more likely to make late credit account payments and develop suboptimal credit scores compared to those without ADRD.

2. Adverse financial events among those with ADRD occurred as early as six months prior to diagnosis, worsening over time following diagnosis.

Evidence Rating Level: 2 (Good)

Study Rundown: Alzheimer’s disease and related dementias (ADRD) are associated with functional decline, such forgetting to pay bills on time, due to memory and attention deficits. Given the prevalence of these amnestic disorders, it is important to understand the full extent of financial difficulties that arise in the context of symptom presentation. This study aimed to determine the degree to which ADRD are associated with adverse financial outcomes both before and subsequent to diagnosis.

This cohort study utilized data from 81,364 Medicare beneficiaries within single-person households. Consumer credit report outcomes between 1999 and 2018 linked to Medicare claims were analyzed both before and after diagnosis among those with documented ADRD as well as healthy controls. Individuals with ADRD were associated with adverse financial events, which occurred prior to clinical diagnosis and became more severe after diagnosis.

Overall, this study demonstrated that ADRD are associated with significant financial concerns that extend months before diagnosis and continue to worsen following diagnosis. In caring for these individuals, it is important to consider the cognitive and functional decline pathognomonic to these neurodegenerative processes. These deficits can result in adverse financial events that negatively impact quality of life and may further impact accessibility to quality care. This study focused on Medicare beneficiaries and, while it did not compare these participants to those with commercial insurance coverage, these findings are highly relevant to a broad range of Medicare recipients with ADRD who require comprehensive care.

Click to read the study in JAMA Internal Medicine

Relevant Reading: Dementia, Help with Financial Management, and Financial Well-Being

In-Depth [ retrospective cohort]:

Functional decline, such as forgetting to pay bills, is considered an early sign of degenerative processes, often a byproduct of cognitive decline in prospective memory, attention, and other important domains. This retrospective, secondary analysis of consumer credit report data focused on financial outcomes between 1999 and 2018 that were linked to Medicare claims. A total of 81,364 Medicare beneficiaries living in single-person households were included. Of these, 54,062 (33.1%; M [SD] age = 74 [7.3] years) were never diagnosed with ADRD during the study period. A total of 27,302 participants were diagnosed with ADRD for at least one quarter of the observation period (M [SD] age = 79.4 [7.5] years). Through the analysis of consumer credit reports and Medicare claims, this study was able to capture the occurrence of negative financial events in individuals with and without ADRD. Main outcomes included missed payments on credit accounts (≥30 days late) and suboptimal credit scores.

Single beneficiaries of Medicare who were diagnosed with ADRD were more likely to miss payments on credit accounts up to six months prior to diagnosis compared to demographically-matched individuals without ADRD (absolute difference, 0.4 percentage points [pp]; 95% CI 0.07 to 0.70). This trend continued through the quarter after diagnosis, with ADRD participants being more likely to miss credit payments (absolute difference 1.0 pp; 95% CI 0.67 to 1.40). Those with ADRD were also significantly more likely to develop suboptimal credit scores up to 2.5 years prior to diagnosis (absolute difference 0.38 pp; 95% CI 0.04 to 0.72), with this trend also remaining through the first quarter after diagnosis (absolute difference 0.70 pp; 95% CI 0.34 to 1.1). These adverse financial events were more common among participants with ADRD, with the most common occurrences being among those with ADRD and lower educational attainment. Financial event trends among those with ADRD were unique compared to other medical conditions such as hip fracture and glaucoma.

Image: PD

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