Cognitive disability and direct care costs for elderly people

Background: Population ageing and the high costs of health and social care support for elderly people with mental health problems have concentrated growing attention on economic issues. There is, however, little evidence on the<p><p>association between costs and cognitive disability. Methods: Secondary analysis of data from the OPCS Disability Surveys was used to compare service utilisation and costs for more than 8000 elderly people with differing degrees of cognitive disability. Cost estimates were constructed for all health and social care services. Comparison was also made between people living in households and in communal establishments (NHS, local authority, private, voluntary). Results: A much greater proportion of people at higher levels of cognitive disability lived in communal establishments, where their (direct) costs were much higher than when supported in households. Service utilisation patterns varied by cognitive disability level, as did direct costs. There was considerable variation in the costs of care for people at any given level of disability. Conclusions: It is important to look at the full range of living arrangements and support services when comparing costs for elderly people with cognitive disability. For example, the potential cost advantages of pharmacotherapies, other treatments or new community care arrangements cannot be fully appreciated without such a broad perspective.