Medical and nursing home costs: From cognitively unimpaired through dementia

Kirsten Hall Long, Carin Smith, Ronald Petersen, Jane Emerson, Jeanine Ransom, Michelle M. Mielke, Steven Hass, Cynthia Leibson

Research output: Contribution to journalArticlepeer-review


Introduction: Efforts to model the cost-effectiveness of managing/modifying cognitive impairment lack reliable, objective, baseline medical, and nursing-home (NH) costs. Methods: A stratified-random sample of Olmsted County, MN, residents ages 70–89 years (N = 3545), well-characterized as cognitively unimpaired, mild cognitive impairment (MCI), or dementia, were followed forward ≤1 year in provider-linked billing data and the Centers for Medicare & Medicaid Services NH assessments. Direct medical/nursing home/medical + NH costs were estimated. Costs were stratified by vital status and NH-use intensity (NH days/follow-up days [0%, 1% to 24%, 25% to 99%, and 100%]). Between-category mean-annual cost differences were adjusted for patient characteristics and follow-up days. Results: Costs/follow-up day distributions differed significantly across cognitive categories. Mean costs/follow-up days were 2.5 to 18 times higher for decedents versus survivors. Among all persons with MCI, <9% with any NH use accounted for 18% of all total annual medical + NH costs. Adjusted-between-category comparisons revealed significantly higher medical and medical + NH costs for MCI versus cognitively unimpaired. Discussion: Cost-effectiveness for managing/modifying both MCI and dementia should consider end-of-life costs and NH-use intensity. Results can help inform cost-effectiveness models, predict future-care needs, and aid decision-making by individuals/providers/payers/policymakers.

Original languageEnglish (US)
Pages (from-to)393-407
Number of pages15
JournalAlzheimer's and Dementia
Issue number3
StatePublished - Mar 2022


  • cognitive status
  • cost
  • dementia
  • economics
  • mild cognitive impairment
  • nursing home

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Developmental Neuroscience
  • Clinical Neurology
  • Geriatrics and Gerontology
  • Cellular and Molecular Neuroscience
  • Psychiatry and Mental health


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