Advance care planning in Medicare beneficiaries with Alzheimer's disease and related dementias

Introduction Alzheimer's disease and related dementias (ADRD) often involve goal‐discordant end‐of‐life (EOL) care, partially due to progressively declining cognitive capacity. Advance care planning (ACP) may help, but evidence in ADRD is limited. Methods We conducted a retrospective cohort study of 104,366 Medicare decedents with ADRD (2016 to 2022). Beneficiaries with any ACP encounter 2 years before death were matched to non‐ACP decedents (1:10). Models estimated associations with healthcare utilization and expenditures 30 days before death. Results Billed ACP receipt (8.4%) was associated with lower expenditures (ratio of expected mean cost: 0.88, 95% confidence interval [CI]: 0.85 to 0.90), reduced inpatient (odds ratio [OR]: 0.76, 95% CI: 0.72 to 0.79) but greater outpatient use (OR: 2.76, 95% CI: 2.63 to 2.89). Multiple ACP encounters amplified associations (e.g., ratio of expected total expenditures 0.74, 95% CI: 0.68 to 0.80). Discussion ACP is linked to lower EOL spending and a shift from inpatient to outpatient ADRD care; structured ACP delivery should be considered.