Diagnosis of Alzheimer’s disease and related dementias and outmigration of older Puerto Rican Medicare Fee-for-Service beneficiaries, 2012–2019

Objectives: There is limited research on whether receiving a dementia diagnosis could prompt later-life migration, particularly among older Medicare beneficiaries in Puerto Rico. Prior research shows older Puerto Ricans are migrating to the mainland United States, which may include those with an Alzheimer’s Disease and Related Dementias (ADRD) diagnosis. This study examined yearly outmigration trends among older Puerto Ricans by exploring their movement patterns in 2011–2019. Methods: We used data from the Medicare Master Beneficiary Summary File and the Puerto Rican Community Survey and focused on Medicare Fee-for-Service enrollees aged 65 and older. The Chronic Conditions Warehouse algorithm was used to ascertain ADRD diagnosis, and migration was defined as the change of (end-of-year) residence from one year to the next. A linear probability model was used to calculate differences in the rate of outmigration between beneficiaries with and without ADRD. Results: Across the study period, the sample averaged 53,294 beneficiaries per year (43,819 [2019] to 66,625 [2012]), with 15% having a previous ADRD diagnosis each year. Overall, older Puerto Ricans previously diagnosed with ADRD were slightly more likely to move to the U.S. mainland compared to those without a diagnosis across the years (adjusted differences of b = 0.14%–0.42%), though differences were statistically significant in some years. For example, outmigration spiked (over 2.5%) among all older adults in the year of Hurricane Maria, regardless of health status. Discussion: Our results suggest that older Puerto Ricans with ADRD are more likely to migrate as they face challenges in aging in place.