Medicare costs soar with aggressive end-stage dementia care, study says

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A substantial portion of Medicare expenditures to nursing home residents with advanced dementia is spent on aggressive treatments that may be of limited benefit, researchers say.

Investigators from Harvard University studied Medicare data from 323 Boston-area nursing home residents with advanced dementia. They found that the largest percentage of Medicare expenditures was for hospitalizations (30.2%) and hospice (45.6%). Those numbers jumped by 65% in the final four quarters before death largely as a result of an increase in acute care and hospice services, according to the study. Acute care costs were lower in residents with Do Not Hospitalize orders, residents without feeding tubes and those living in dementia care units.

"Our study demonstrates that a large proportion of Medicare expenditures in advanced dementia are attributable to acute and sub-acute services that may be avoidable and may not improve clinical outcomes," said Dr. Susan Mitchell, senior author of the study, which was published in the online version of the Archives of Internal Medicine.
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