• Jennifer L Wolff, Lauren H Nicholas, Amber Willink, John Mulcahy, Karen Davis, and Judith D Kasper.
• Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.L.W., L.H.N., A.W., J.M., K.D., J.D.K.).
• Ann. Intern. Med. 2019 Jun 18; 170 (12): 837-844.

BackgroundIdentifying factors that affect variation in health care spending among older adults with disability may reveal opportunities to better address their care needs while offsetting excess spending.ObjectiveTo quantify differences in total Medicare spending among older adults with disability by whether they experience negative consequences due to inadequate support with household activities, mobility, or self-care.DesignObservational study of in-person interviews and linked Medicare claims.SettingUnited States, 2015.Participants3716 community-living older adults who participated in the 2015 NHATS (National Health and Aging Trends Study) and survived for 12 months.MeasurementsTotal Medicare spending by spending quartile in multivariable regression models that adjusted for individual characteristics.ResultsNegative consequences were experienced by 18.3% of participants with disability in household activities, 25.6% with mobility disability, and 20.0% with self-care disability. Median Medicare spending was higher for those who experienced negative consequences due to household ($4866 vs. $4095), mobility ($7266 vs. $4115), and self-care ($10 935 vs. $4436) disability versus those who did not. In regression-adjusted analyses, median spending did not differ appreciably for participants who experienced negative consequences in household activities ($338 [95% CI, -$768 to $1444]), but was higher for those with mobility ($2309 [CI, $208 to $4409]) and self-care ($3187 [CI, $432 to $5942]) disability. In the bottom-spending quartile, differences were observed for self-care only ($1460 [CI, $358 to $2561]). No differences were observed in the top quartile.LimitationThis observational study could not establish causality.ConclusionInadequate support for mobility and self-care is associated with higher Medicare spending, especially in the middle and lower ends of the spending distribution. Better support for the care needs of older adults with disability could offset some Medicare spending.Primary Funding SourceThe Commonwealth Fund.

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