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  5. The Economics of Aging and Long-Term Care
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The Economics of Aging and Long-Term Care

Paper Session

Friday, Jan. 5, 2024 10:15 AM - 12:15 PM (CST)

Grand Hyatt, Bonham E
Hosted By: Health Economics Research Organization
  • Chair: Kosali Simon, Indiana University

Genes and the Risk of Alzheimer’s Disease: Cognitive Decline, Diagnosis, and Economic Outcomes

Yeongmi Jeong
,
Purdue University
Nicholas Papageorge
,
Johns Hopkins University
Meghan Skira
,
University of Georgia
Kevin Thom
,
University of Wisconsin-Milwaukee

Abstract

The increasing availability of genetic data make it possible to study the evolution of outcomes and behaviors for individuals with different observed genetic markers. We examine the rich genetic architecture of Alzheimer's disease (AD). While genetic factors contribute substantially to AD risk, they are not deterministic, which allows us to examine people at genetic risk for AD who may not be diagnosed with a memory-related disease. This prompts us to ask whether such individuals are in some way protected from cognitive decline despite genetic risk or, alternatively, are insulated from its economic consequences, both of which could explain a lack of diagnosis. Using data from the Health and Retirement Study (HRS), we find evidence of the opposite. Genetic risk for AD predicts worse cognitive performance for both the full sample and among individuals who are never diagnosed. Individuals at higher risk also experience worse economic outcomes on a variety of dimensions, including work, income, and wealth. We also find that individuals at high genetic risk for AD are less likely to engage in planning activities that could mitigate the consequences of cognitive decline (e.g., assigning durable power of attorney), compared to individuals at lower AD risk, likely since they are unaware of their risk. Our findings suggest there is a large population of under-diagnosed and presumably under-treated and under-prepared people. They also raise concerns of selection bias in analyses of AD that focus solely on diagnosed individuals. Finally, they suggest there is clinically-valuable and policy-relevant information in AD genetic measures, which we demonstrate have predictive power beyond standard measures currently in use.

“Learning by Doing” in Home Health Care and Implications for Dementia Populations

Jun Li
,
Syracuse University
Bo Zheng
,
Syracuse University
Geoffrey Hoffman
,
University of Michigan

Abstract

Many people living with dementia rely on skilled home health care to manage their health needs. However, efforts to improve home health care quality for dementia populations are constrained, because there is a lack of understanding of how home health agencies influence patient outcomes. We evaluate the role of “learning by doing” in home health care, by examining whether home health agencies that predominantly serve dementia patients produce better patient outcomes, such as reduced hospitalizations, lower rates of institutionalization, and decreased mortality. We use differential distance between patient residences and home health agency administrative locations to instrument for each Medicare beneficiary’s exposure to high-dementia-share agencies. Using the census of home health care patient data from 2018 to 2019, we estimate that high-dementia-share agencies reduced hospitalizations and nursing home entry by nearly 30 percent for Medicare beneficiaries. Moreover, effects increased with the size of an agency’s dementia population, while effects were smaller for patients without, compared to patients with, a dementia diagnosis, suggesting that care delivery in high-dementia-share agencies may be tailored to the modal patient. Together, these results indicate that provider care experience is a crucial determinant of quality of care, particularly for patients with complex needs.

Family Caregiving and Labor Supply: Evidence from ADRD-Related Deaths in Denmark

Yulya Truskinovsky
,
Wayne State University
Onur Altindag
,
Bentley College
Jane Greve
,
Danish Center for Social Science Research
Matvei Andersen
,
Danish Center for Social Science Research

Abstract

ADRD is one of the costliest diseases in high-income countries, due in part to highly demanding, inflexible, and round the clock long-term care requirements of patients. Much of the need for care is met by family members and a full accounting of the economic burden of ADRD must include the substantial spill-overs in the form of economic and health impacts on family members who may be called upon to provide care. We study the labor supply response to ADRD-related caregiving among adult men and women in Denmark using linked national vital statistics records and tax registries. We find no evidence of economic impact among the children of older adults who die of ADRD-related causes, suggesting that the care needs of older adults with ADRD may be sufficient met in a country with high long-term care spending and a robust social safety net. However, we find evidence of large and sustained mental health impacts of having a parent with ADRD for women.

Discussant(s)
Nicole Maestas
,
Harvard University
Momotazur Rahman
,
Brown University
Laura Dague
,
Texas A&M University
JEL Classifications
  • I1 - Health
  • L1 - Market Structure, Firm Strategy, and Market Performance