governmental costs) and financial risks faced by Medicare beneficiaries five years before death. Methods. Using the nationally representative, longitudinal Health and Retirement Study, we sampled Medicare fee-for-service beneficiaries, aged 70 years or older, who died between 2005 and 2010 (N ¼ 1702). Subjects were stratified into four cohorts: individuals with high probability of dementia, or with either heart disease, cancer, or other causes of death. Measurements included total social costs and its components (Medicare, Medicaid, private insurance, outof-pocket, and informal care), measured over the last five years of life and out-of-pocket spending as a proportion of household wealth. Results. Average total cost per decedent for dementia ($287,038) was significantly greater than for those who died of heart disease ($175,136), cancer ($173,383), or other causes ($197,286), p<0.001. While Medicare expenditures were similar across groups, average outof-pocket spending for dementia patients ($61,522) was 81% higher than for non-dementia patients ($34,068); a similar pattern held for informal care. Out-of-pocket spending for the dementia group (median $36,919) represented 32% of wealth measured five years before death, compared to 11% for non-dementia decedents (p<0.001). This proportion was greater for Blacks (84%), those with less than high school education (48%), and unmarried/widowed women (58%). Conclusion. Healthcare expenditures among those with dementia were substantially larger than for other diseases, with much of those expenses uninsured, thus placing a large financial burden on families. These burdens are particularly pronounced among demographic groups least prepared for financial risk.
