A new study has shown that almost 50% of all older adults now die with a diagnosis of dementia mentioned on their medical record, up 36% from two decades ago, according to Science Daily.

The study’s researchers, however, said that the sharp rise could be due to better public awareness, detailed medical records, and Medicare billing practices.

Even so, the authors noted that the study findings, published in JAMA Health Forum, offer a chance for older adults to talk in advance with their families and medical providers about the kind of care they want if they develop Alzheimer’s or another form of dementia or cognitive decline.

The study, conducted by the University of Michigan researchers, used data from 3.5 million people over the age of 67 who died between 2004 and 2017. It analyzed the bills their medical providers submitted to the traditional Medicare system in the last two years of the patients’ lives.

In 2004, nearly 35% of these billing claims contained at least one mention of dementia. However, by 2017, it had increased to more than 47%.

The researchers found that the biggest jump in the percentage of people dying from a dementia diagnosis occurred around the time Medicare allowed hospitals, hospices, and doctors’ offices to mention more diagnoses on their requests for payment.

Patients with dementia who received end-of-life care changed over time, including a drop in the percentage who died in a regular hospital/ICU bed, or who had a feeding tube in their last six months.

The percentage who received hospice services rose dramatically, from 36% to nearly 63%, though the authors note this is in line with a national trend toward more hospice care by the late 2010s, according to Science Daily.

The study’s senior author Dr. Julie Bynum said, “This shows we have far to go in addressing end-of-life care preferences proactively with those who are recently diagnosed, and their families. Where once the concern may have been underdiagnosis, now we can focus on how we use dementia diagnosis rates in everything from national budget planning to adjusting how Medicare reimburses Medicare Advantage plans.”