Alzheimer's Can Wreak Financial Havoc Years Before Diagnosis
By Ezra Golberstein, PhD
February 5, 2021
Ezra Golberstein is an associate professor of health policy and management at the University of Minnesota School of Public Health. His work focuses on mental health economics and policy, financing health care for low-income populations and clinician behavior.
The FDA announced last week that it’s delaying its decision on whether to approve aducanumab, an Alzheimer’s drug that its manufacturer Biogen argues could slow down the cognitive decline that makes the disease so crushing. The disease takes not only a physical and emotional toll on people and their loved ones, but also a financial toll. On top of the costly long-term care that Alzheimer’s often requires, cognitive impairment can make older adults even more susceptible to financial exploitation, and bad money management is often a first indication that someone may be suffering from dementia.
That is where a fascinating and clever new paper published in JAMA Internal Medicine by Lauren Hersch Nicholas and colleagues comes in. The authors linked claims data for more than 80,000 Medicare beneficiaries in single-person households with consumer credit data from the Federal Reserve Bank of New York/Equifax Consumer Credit Panel. Pairing such data requires a lot of time and careful work, which makes this kind of rich, linked data source rare. With these data, the authors could identify when Medicare beneficiaries were first diagnosed with Alzheimer’s disease or related dementia (ADRD), and then identify trends in financial outcomes before and after an initial diagnosis. They examined two negative financial outcomes: missing a credit payment and having a subprime credit score. These outcomes can indicate a generally bad financial situation and also have serious implications for the ability to use credit in the future.
Unsurprisingly, after an initial ADRD diagnosis, the likelihood of negative financial outcomes increases compared to Medicare beneficiaries who never had an ADRD diagnosis. And the authors found the relationship between ADRD diagnosis and negative financial outcomes is stronger for people who live in areas with lower average levels of educational attainment. But what really fascinated me is the study showed that the likelihood of negative financial outcomes starts to increase several years before an initial ADRD diagnosis — 2.5 years before for subprime credit scores and a full 6 years before diagnosis for missed payments. The authors noted they only studied Medicare beneficiaries who lived alone, a group for whom these concerns are likely heightened, and they did not look at other negative financial outcomes like missing utility or rent payments or going into medical debt.
This paper is a great example of how we can glean new insights by putting together data sources that are rarely combined. It also illustrates the pernicious toll ADRD can take on people’s financial health and suggests financial data could play a role in helping to catch and diagnose this disease much earlier. Without any effective cures for ADRD, it is important to catch the disease as early as possible to help people, their families and their clinicians mitigate the toll ADRD takes on physical, cognitive and financial wellbeing.