Medicare costs and home time loss among fee-for-service beneficiaries by frailty and dementia status

BACKGROUND: Frailty and dementia are associated with adverse health outcomes. Understanding their associated healthcare costs and quality of life can inform care of older adults. OBJECTIVE: To assess Medicare costs and home time loss among Medicare fee-for-service beneficiaries across different combinations of frailty and dementia status RESEARCH DESIGN: Retrospective cohort study SUBJECTS: 5% random sample of Medicare fee-for-service beneficiaries aged 65 and older in 2019 MEASURES: Frailty and dementia were measured using validated claims-based algorithms. Annualized Medicare costs and home time loss (days) were measured in Medicare claims over one year. RESULTS: Among 1,148,964 Medicare beneficiaries (mean age 75.2 years, 57.7% female), 10.0% had frailty and 4.0% had dementia. Medicare costs increased with frailty severity. Dementia's association with costs varied by frailty level: higher costs among those without frailty (dementia vs. no dementia: $14,058.1 vs. $12,342.2 and lower costs among those with mild ($24,080.4 vs. $35,166.4) and moderate-severe frailty ($38,446.5 vs. $54,344.3). Both frailty and dementia were associated with greater home time loss, except among those with moderate-to-severe frailty in which home time loss was nearly identical with or without dementia (57.1 vs. 57.2 days). CONCLUSIONS: Medicare costs and home time loss increased with the severity of frailty while dementia's association with cost and home time loss varied by frailty level. Among those with moderate-severe frailty, individuals without dementia incurred higher costs despite similar home time. These findings underscore the importance of improved frailty recognition and care strategies addressing both conditions.