Do individuals skimp on health care after spouse’s dementia diagnosis? An analysis of spillover effects of dementia

Abstract

AbstractBackgroundDementia burden imposed on family members are generally recognized as the value of caregiving time. This may understate the full impact of dementia on families if 1) dementia affects family members who are not caregivers, and 2) impacts are beyond loss of time. Considering the shocks in financial resources, time, and emotion ensuing spouse’s dementia diagnosis, individuals may ration needed health care, which in the long run will elevate downstream health care costs. However, evidence for such negative externality is limited and inconclusive. This study aims to examine the impact of spouse’s dementia onset on individual’s health care utilization.MethodUsing Health and Retirement Study linked to Medicare claims, I identified 691 older adults whose spouses had incident dementia during 1992 to 2011, and matched them to 5,073 controls whose spouses were dementia‐free. A fixed effects model was employed to compare their use of flu shot and doctor visit for managing chronic conditions, during one year before and after the index date. Other covariates included time‐varying caregiving roles, health, wealth, spouse’s function, as well as their interaction with spouse’s dementia status.ResultAfter adjustment, spouse’s dementia onset was associated with a 3.5‐percentage‐point increase in the likelihood of flu shot uptake. Effects of spouse’s dementia diagnosis did not vary by caregiving or health status. For those with pre‐existing chronic conditions, having a spouse with newly diagnosed dementia predicted more doctor visits. Conditional on transitioning into caregiving (caregiverpre=0 & caregiverpost = 1), spouses of people living with dementia (PLWD) have a marginally higher risk of reducing doctor visits than controls (p=0.053).ConclusionThere lacks evidence for rationed health care after spouse’s dementia incidence, at least from 1‐year pre‐index to post‐index period. The greater tendency of forgoing regular office visits after the onset of caregiving tasks among spouses of PLWD highlights potential strains in seeking care facing this group. Dementia burden on family are more profound and complex than deprivation of time.