Medicare costs and home time loss among fee-for-service beneficiaries by frailty and dementia status.

backgroundFrailty and dementia are associated with adverse health outcomes. Understanding their associated healthcare costs and quality of life can inform care of older adults.

objectiveTo assess Medicare costs and home time loss among Medicare fee-for-service beneficiaries across different combinations of frailty and dementia status RESEARCH

designRetrospective cohort study SUBJECTS: 5% random sample of Medicare fee-for-service beneficiaries aged 65 and older in 2019 MEASURES: Frailty and dementia were measured using validated claims-based algorithms. Annualized Medicare costs and home time loss (days) were measured in Medicare claims over one year.

resultsAmong 1,148,964 Medicare beneficiaries (mean age 75.2 years, 57.7% female), 10.0% had frailty and 4.0% had dementia. Medicare costs increased with frailty severity. Dementia's association with costs varied by frailty level: higher costs among those without frailty (dementia vs. no dementia: $14,058.1 vs. $12,342.2 and lower costs among those with mild ($24,080.4 vs. $35,166.4) and moderate-severe frailty ($38,446.5 vs. $54,344.3). Both frailty and dementia were associated with greater home time loss, except among those with moderate-to-severe frailty in which home time loss was nearly identical with or without dementia (57.1 vs. 57.2 days).

conclusionsMedicare costs and home time loss increased with the severity of frailty while dementia's association with cost and home time loss varied by frailty level. Among those with moderate-severe frailty, individuals without dementia incurred higher costs despite similar home time. These findings underscore the importance of improved frailty recognition and care strategies addressing both conditions.