Service use and cost outcomes for persons with Alzheimer disease

Use of formal services and the associated costs of caring for people with Alzheimer disease and related disorders are expected increase into the next century. This will be driven primarily by general economic inflation, annual increases in health care costs exceeding the inflation rate, increasing numbers of people 85 years of age and older, increases in the expected life span of people at 65 years of age, increasing numbers of people in the nonelderly disabled population receiving Medicare benefits, and changes in the employment structure of the economy. Two sources of data that have been used to estimate formal health and social service utilization and costs are self-report and Medicare claims data. Self-report data are problematic in studies of people with Alzheimer disease because of the demented person's general inability to reliably report on service utilization and the necessary use of proxies to obtain information. Medicare claims are a source for both service utilization and cost data, but limitations in these data result from their use to document reimbursement claims as opposed to accurately reflecting service use histories. Given the lack of reliable and comprehensive service utilization and cost reporting systems, a variety of methods will be required to estimate service use and cost outcome data for people with dementia. These include self-reports of service use and cost, examination of claims records, and service use document abstraction, when feasible.