How Well Can Medicare Records Identify Seniors with Cognitive Impairment Needing Assistance with Financial Management?



Aging countries should have an interest in policies to assist older beneficiaries in managing finances when there is a need. This project investigated the value of Medicare records as a guide to identifying persons with cognitive impairment in need of assistance with financial management. It used data from the Health and Retirement Study (HRS) on persons 65 and older, who consented to linkage to Medicare records at a rate of approximately 90 percent. Sampling weights were adjusted to account for linkage rates. The HRS survey data provided direct evidence on cognitive impairment and difficulty managing finances. The Medicare records are an imperfect guide to cognitive impairment as a medical diagnosis. About 40 percent of persons with impairment consistent with dementia are not identified in Medicare, and about 40 percent of persons with a diagnosis in Medicare records do not have impairment that severe. The records are even worse as a guide to who perceives or is perceived by others as needing assistance with financial management. Outside of institutional settings, Medicare records identify fewer than half the people needing assistance with financial management, and point to a substantial number of people who say they do not. The use of Medicare records alone to identify older beneficiaries in need of assistance with financial management would lead to substantial errors in coverage.

Key Findings

  • RAND Cognitive impairment is a large and growing problem in the older population
  • Policies to assist SSA beneficiaries with financial management require a capacity to identify those in need
  • Medicare records offer a relatively low-cost source of information
  • Medicare records miss many persons in need of assistance and identify many who do not as having dementia


Weir, David and Kenneth Langa. 2018. “How Well Can Medicare Records Identify Seniors with Cognitive Impairment Needing Assistance with Financial Management?” University of Michigan Retirement Research Center (MRRC) Working Paper, WP 2018-391. Ann Arbor, MI.

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Paper ID

WP 2018-391

Publication Type

Working Paper

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