47% of Older People Now Die With This Diagnosis

As awareness of dementia has grown, a startling fact has come to light: Nearly half of all older adults — 47% — die with a diagnosis of that condition on their medical record, according to recent research out of the University of Michigan and published in JAMA Health Forum, a journal of the American Medical Association.

That number was just 36% two decades ago. However, the 11-percentage-point increase in diagnoses does not necessarily indicate that dementia is growing more prevalent in society, researchers say.

Rather, three factors have raised the profile of the illness, bringing greater attention to dementia that is reflected in medical records. The three factors are:

• Better public awareness about dementia
• More detailed medical records
• Changes in Medicare billing practices

The researchers examined data from 3.5 million people age 67 and older whose deaths occurred between 2004 and 2017. In particular, the researchers zeroed in on bills submitted to the traditional Medicare system during the patients’ last two years of life.

In 2017, more than 47% of these billing claims contained at least one mention of dementia, and 39% had at least two medical claims noting the presence of the condition.

That is a large jump from 2004, when just 35% of those end-of-life medical records had a single mention of dementia and 25% had two mentions.

The researchers note that the largest jump in reported diagnoses of dementia occurred when Medicare first permitted providers of medical services to list additional diagnoses on their requests for payment.

As part of their research, the study authors also found end-of-life care for those with dementia has changed. In recent years, there has been a decline in the percentage of dementia patients who die in a regular hospital bed or ICU bed. In addition, fewer patients now have a feeding tube during the last six months of their lives, and a far higher percentage of dementia patients now receive hospice services than in the past.

As awareness of dementia continues to increase, the researchers say they hope growing numbers of older adults and their families will talk to health care providers about “the kind of care they want at the end of life if they do develop Alzheimer’s disease or another form of cognitive decline.”

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