Characterizing financial risk from out-of-pocket expenditures across dementia stages

Older adults with dementia incur considerable out-of-pocket (OOP) health care expenses, but it is unclear how their financial burden differs by dementia stage.

We identified 2939 respondents aged ≥65 with dementia in the 2018 Health and Retirement Study, representing 9.8 million individuals on weighted analysis. We grouped respondents into four severity stages and examined their OOP expenditures, prevalence of financial risk (i.e., catastrophic or impoverishing levels of health care spending), and factors associated with financial risk.

Individuals with severe dementia had significantly higher OOP costs, with 21% experiencing catastrophic expenditures and 12% falling below poverty thresholds due to these costs. Regression analyses indicated nursing home residence, poor subjective health, advanced age, and other factors are associated with an increased odds of financial risk.

Financial risk increases in advanced dementia stages, likely reflecting more complex care needs and poorer overall health.

Out-of-pocket health care costs increase with dementia severity. Twenty-one percent of people with severe dementia spend at least 40% of their income on health care. The risk of impoverishment from health care costs increases in severe dementia. Care needs, poor health, and nursing home residence may contribute to financial risk.