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IAD 05-114 – HSR&D Study

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IAD 05-114
Formal and Informal Costs of Veterans with Dementia: A Longitudinal Study
Carolyn Wei Zhu PhD
James J. Peters VA Medical Center, Bronx, NY
Bronx, NY
Funding Period: March 2006 - February 2008

BACKGROUND/RATIONALE:
The VHA faces a large and growing number of veterans with dementia, one of the most costly chronic conditions. While many studies have documented the substantial healthcare costs of dementing illnesses, there has been no systematic study in the VHA to assess the longitudinal impact of dementing illnesses on VHA. An important aspect of understanding long-term dementia care is to understand dementia disease costs within and outside the VA, disease costs compositions, and how cost trajectories and cost compositions change as dementia progresses.

OBJECTIVE(S):
The goals of this study are to estimate (1) total healthcare costs incurred by veterans with dementia and the distribution of these costs among VHA, Medicare, and informal caregivers; (2) trajectories of total and component costs and changes in the distribution of costs over a four-year period; (3) relationship between patient and caregiver characteristics and utilization and costs; and (4) effects of informal caregiving on utilization and costs to VA for providing care to patients with dementia.

METHODS:
The proposed study is an observational longitudinal study of ~2,300 informal caregivers who participated in the National Longitudinal Caregiver Study (NLCS). The care recipients of these caregivers are enrolled male veterans age 60 and over, initially lived in the community, with a formal diagnosis of Alzheimer's disease or vascular dementia. Caregivers reported detailed information on caregiving time they provided to the veteran care recipients. To obtain veterans' formal care use, survey data from NLCS will be merged using care recipients' social security numbers to VA administrative datasets for their VA use and costs, and to Medicare claims data for their Medicare use and costs. Multivariate techniques will be used to estimate the effects of patient and caregiver characteristics on costs to VA, Medicare, and informal caregivers. Effects of informal caregiving on formal care utilization and costs will be examined. Possible endogeneity of formal and informal care will be tested and controlled for to obtain consistent estimation results.

FINDINGS/RESULTS:
We do not have findings at this point. We are merging VA cost data with survey data and cleaning the files to prepare for analyses.

IMPACT:
The proposed study will improve our understanding of both formal and informal cost trajectories of older veterans with dementia. Findings from this study also will help inform VA policy makers and healthcare providers about resource utilization among patients with dementia, help VHA decision makers determine budget allocations and anticipate future resource needs. Understanding these longitudinal costs will help in identifying targets for effective interventions that may, with appropriate timing, reduce dementia disease burden. Interventions that delay institutionalization will generate substantial net benefits to the VHA, and as importantly, to the older persons and their families.

PUBLICATIONS:

Journal Articles

  1. Zhu CW, Livote EE, Ross JS, Penrod JD. A random effects multinomial logit analysis of using Medicare and VA healthcare among veterans with dementia. Home health care services quarterly. 2010 Apr 1; 29(2):91-104.
  2. Zhu CW, Penrod JD, Ross JS, Dellenbaugh C, Sano M. Use of Medicare and Department of Veterans Affairs health care by veterans with dementia: a longitudinal analysis. Journal of the American Geriatrics Society. 2009 Oct 1; 57(10):1908-14.
Conference Presentations

  1. Zhu CW, Penrod J, Ross J, Sano M. Use of Medicare and VA Health Care among Veterans with Dementia: A longitudinal analysis. Poster session presented at: AcademyHealth Annual Research Meeting; 2008 Jun 8; Washington, DC.
  2. Zhu CW, Penrod JD, Dellenbaugh C, Ross J, Sano M. A Longitudinal Analysis of the Effects of Using Data from One System for Dual VA and Medicare Users with Dementia. Paper presented at: VA HSR&D National Meeting; 2008 Feb 13; Baltimore, MD.


DRA: Aging, Older Veterans' Health and Care, Health Systems
DRE: none
Keywords: Caregivers – not professionals, Dementia, Utilization patterns
MeSH Terms: none

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