Researchers from Duke-NUS Medical School and the NUS Yong Loo Lin School of Medicine utilised population-based Singapore Chinese Health Study data. They discovered that individuals with cognitive impairment spend, on average, 17 per cent more per year on healthcare compared to peers without cognitive impairment of the same age. Published in the Annals of the Academy of Medicine Singapore, the study underscores that these increased costs primarily stem from emergency department visits and subsequent admissions.
Health economist Assistant Professor Chay Junxing, from the Lien Centre for Palliative Care at Duke-NUS, who led the study, emphasised the significance of these findings: “This study provides the first quantification of additional healthcare expenditures among patients with cognitive impairment in Singapore. Emergency department visits and subsequent admissions emerge as the major cost drivers. Armed with this knowledge, we can develop strategies to mitigate these admissions.”
In 2019, an estimated 44,000 individuals in Singapore were living with some form of cognitive impairment, a number expected to rise with the ageing population. The Ministry of Health projects that by 2030, the number of people with dementia alone could reach 152,000, increasing further to 187,000 by 2050. As observed by the researchers, these projections suggest additional healthcare spending of S$106 million and S$131 million during these years.
The study’s projections underscore the urgency for novel approaches to manage the escalating burden of unplanned healthcare utilisation. Recommendations from the authors include proactive monitoring of individuals with cognitive impairment to mitigate risk factors for high-cost medical events.
Senior author Professor Eric Finkelstein, Executive Director of the Lien Centre for Palliative Care at Duke-NUS, highlighted the impending strain on healthcare resources: “Rising rates of cognitive impairment, coupled with Singapore’s ageing population, foreshadow increased pressure on healthcare services. Planners must anticipate this exponential growth in burden, focusing efforts on identifying at-risk patients and intervening before crises arise.”
The researchers advocate for collaborative efforts with nursing homes and other care facilities to enhance care across the illness continuum, yielding health and economic benefits. The study also reveals that individuals with cognitive impairment frequently utilise emergency services. Previous research has identified common reasons for these visits, such as pneumonia, heart failure, urinary tract infections, and fall-related injuries. Factors contributing to heightened emergency service use include increased susceptibility to injuries and infections, lower treatment adherence, and challenges in post-discharge care continuity.
Professor Patrick Tan, Senior Vice-Dean for Research at Duke-NUS, underscored the study’s insights into healthcare service utilisation: “Understanding patterns of healthcare service use provides critical insights into delivering not only cost-effective care but also improving patients’ quality of life. These findings underscore the need for expanded services targeting early identification of individuals at risk of cognitive impairment and better education for caregivers to support proactive management.”
The study highlights the escalating healthcare costs associated with cognitive impairment in Singapore, mainly driven by unplanned healthcare utilisation. Addressing these challenges requires innovative strategies for early intervention, enhanced caregiver education, and collaborative care approaches across healthcare settings.
More information: Junxing Chay et al, Healthcare burden of cognitive impairment: Evidence from a Singapore Chinese health study, Annals of the Academy of Medicine Singapore. DOI: 10.47102/annals-acadmedsg.2023253
Journal information: Annals of the Academy of Medicine Singapore Provided by Duke-NUS Medical School
