Adverse financial events begin years before dementia diagnosis, increase after diagnosis
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Alzheimer’s disease and related dementias correlated with adverse financial events years before clinical diagnosis, according to findings published in JAMA Internal Medicine.
The study results also showed that these adverse financial outcomes, including greater rates of payment delinquency and subprime credit scores, became more predominant after a formal diagnosis of AD or dementia was made and occurred more often among patients in census tracts with lower levels of educational attainment.
“[AD] and related dementias (ADRD), currently incurable neurodegenerative diseases, can threaten patients’ financial status owing to memory deficits and changes in risk perception,” the researchers wrote. “Deteriorating financial capabilities are among the earliest signs of cognitive decline, but the frequency and extent of adverse financial events before and after diagnosis have not been characterized.”
Lauren Hersch Nicholas, PhD, associate professor in the department of health policy and management at Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins School of Medicine, and colleagues aimed to describe the financial presentation of ADRD through administrative claims data. They conducted a retrospective secondary data analysis of consumer credit report outcomes between 1999 and 2018 that were linked to Medicare claims data. Specifically, they examined the incidence of adverse financial events — including missed payments on credit accounts of 30 or more days and subprime credit scores — in participants with and those without a diagnosis of ADRD and the timing of the adverse financial events from the ADRD diagnosis.
The analysis included 81,364 Medicare beneficiaries living in single-person households. Most of these individuals (n = 54,062; 33.1% men; mean age, 74 years) never received a diagnosis of ADRD during the study period, while 27,302 participants (31.4% men; mean age, 79.4 years) had a diagnosis of ADRD for at least one quarter of the observation period.
Study findings showed that single Medicare beneficiaries diagnosed with ADRD were more likely to miss payments on credit accounts as early as 6 years before a clinical diagnosis compared with demographically similar beneficiaries with no ADRD diagnosis (7.7% vs. 7.3%; absolute difference, 0.4 percentage points; 95% CI, 0.07-0.70). The researchers also found that participants diagnosed with ADRD were more likely to develop subprime credit scores 2.5 years before a diagnosis (8.5% vs. 8.1%; absolute difference, 0.38 percentage points; 95% CI, 0.04-0.72).
By the quarter after their diagnosis, patients with ADRD remained more likely to miss payments than similar beneficiaries without an ADRD diagnosis (7.9% vs. 6.9%; absolute difference, 1 percentage point; 95% CI, 0.67-1.40) and were more likely to have subprime credit scores than those without an ADRD diagnosis (8.2% vs. 7.5%; absolute difference, 0.7 percentage points; 95% CI, 0.34-1.1). Nicholas and colleagues found that beneficiaries with ADRD remained at greater risk for missed payments and subprime credit scores for at least 3.5 years after their diagnosis, according to the study results.
Payment delinquency rates increased among ADRD beneficiaries in the lower education tracts starting as early as 7 years before a diagnosis compared with 2.5 years before a diagnosis among participants in the higher education tracts.
“Coefficients in the lower education models are generally outside the CIs of the higher education models, indicating a significantly larger adverse financial impact of ADRD among beneficiaries in low education census tracts,” Nicholas and colleagues wrote.
The existence of adverse credit events years prior to an ADRD diagnosis and the persistence of these following a diagnosis, have “important implications” for the financial security of patients and their families, according to the researchers.
“The extended period between financial indicators of ADRD and its diagnosis raises concerns about catastrophic financial events resulting from preclinical or undiagnosed ADRD for older adults,” Nicholas and colleagues wrote. “Rates of adverse financial events continued to increase for single adults after diagnosis, suggesting a role for financial guidance following diagnosis.”
Findings from the present study add to the growing body of literature that shows correlations between consumer behavior and underlying health status, the researchers noted.
“Tools for screening patients for financial self-management difficulty could be useful to improve detection of dementia in clinical practice,” Nicholas and colleagues wrote. “Even without effective medical treatments, earlier detection of cognitive impairment might help protect older adults and their families from adverse financial outcomes. Families should be counseled about the potential need to help with financial management following ADRD diagnosis.”