The long reach of Alzheimer's disease

April 8, 2014

To address the burgeoning demands of Alzheimer's disease that will affect generations, new policies will have to be adopted to acknowledge the complex and unique needs of people with dementia.

The aging of the U.S. population has turned the prism to focus on the increasing number of families facing the challenge of providing care for people with , said Julie P.W. Bynum, associate professor at The Dartmouth Institute for Health Policy & Clinical Practice. Writing in the April issue of Health Affairs, she says the "long reach" of Alzheimer's will have an affect on broad-based national policies that must be addressed sooner rather than later.

In one important way, Alzheimer's disease is unlike the four chronic conditions that cause more deaths – , cancer, stroke and , Bynum says. With Alzheimer's, there is no way to prevent or slow the disease's progression. It is estimated that cases will increase from 3 million in 2011 to more than 10 million in 2050.

The most striking implications have to do with cost. Because the majority of the cases involve people over 65, Medicare bears the brunt of the costs. And, because patients often require long-term care and outlive their assets, Medicaid ends up paying for a large part of needed nursing home care.

The annual cost of providing care for all people over the of 70 in the U.S. is estimated at $157-$215 billion in 2010. The direct cost is estimated to be $109 billion, higher than similar costs for heart disease or cancer ($102 billion and $77 billion respectively). By 2040, spending on dementia patients is estimated to be $1.2-$1.6 trillion, if no breakthrough therapies emerge.

Additional costs are borne by informal (unpaid) caregivers, such as spouses or family members, who provide basic daily care and a safe environment. But these caregivers present their own set of policy challenges with associated loss of work productivity and declines in their own health.

Alzheimer's carries far-reaching implications for the policy community, as the impact of dementia reaches well beyond the individual patient and his or her caregivers, Bynum says.

The Policy Implications:

  • Science and technology. Funding policies are critical for research to close gaps in scientific knowledge about pathophysiological cause of the disease, how to prevent it, detect it early and accurately, and how to slow it, if not cure it.
  • Health care. Payment policy and regulatory functions in Medicare have direct implications for people living with dementia who are heavy users of hospital-based care.
  • Long-term services and supports. Payment policy for nursing homes and strategies to support community living are fundamental for people with late disease. About 75 percent of people with dementia will spend time in a nursing home at some point in their disease. Medicaid is the primary payer for two-thirds' nursing home expenditures, which cause budgetary issues, especially for states.
  • Public health. Addressing healthy lifestyle and risk factors as well as community readiness are important for a population approach to managing the growing burden of dementia.
  • Housing and community services. Critically important to support for those who wish to remain in their homes, are services such as those related to the rights of the elderly, Meals on Wheels, caregiver support, adult day care and senior centers. These community services are less costly than nursing home care, but less visible to federal policy makers because they are organized on the local level.
  • Labor. New policies may be required to address the challenge of ensuring a competent and adequate workforce, especially for hands-on caregivers, such as personal care assistants, home health aides, and nursing assistants.
  • Justice and law enforcement. Relevant policies in the legal and law enforcement arena address issues that arise with substituted judgment and the need to provide protection from exploitation, abuse and neglect.

"Patients' complex and expensive care needs and increasing numbers of people with dementia underscore the need to pay greater attention to how society protects and provides services for this vulnerable population at a cost that is sustainable, all while continuing to pursue treatments and cures." Bynum said.

Explore further: Cognitive impairment common among community and nursing-home resident elderly

More information: To view the abstract of the Viewpoint in Health Affairs, please go to content.healthaffairs.org/cont … nt/33/4/534.abstract

Related Stories

Cognitive impairment common among community and nursing-home resident elderly

April 7, 2014
More than 70% of elderly Medicare beneficiaries experience cognitive impairment or severe dementia near the end-of-life and may need surrogate decision makers for healthcare decisions. Advance care planning for older adults ...

Living at home with dementia

December 19, 2013
Most people with dementia who live at home have multiple unmet health and welfare needs, any number of which could jeopardize their ability to remain home for as long as they desire, new Johns Hopkins research suggests.

Alzheimer's 'epidemic' straining caregiver, community resources: report

September 19, 2013
(HealthDay)—The so-called global Alzheimer's epidemic is leading to a shortage of caregivers for seniors and a lack of support for family members who look after elderly relatives, according to a new report.

Dementia costs top those for heart disease or cancer, study finds

April 3, 2013
The monetary cost of dementia in the United States ranges from $157 billion to $215 billion annually, making the disease more costly to the nation than either heart disease or cancer, according to a new RAND Corporation study.

Alzheimer's strikes women harder than men, report finds

March 19, 2014
(HealthDay)—A 65-year-old American woman has a 1 in 6 chance of developing Alzheimer's disease later in life, while a man the same age has about a 1 in 11 chance.

Back to basics: Redesigning systems of care for older adults with Alzheimer's disease

April 8, 2014
The number of older adults with dementia in the United States is forecast to more than double over the next 40 years. Caring for these individuals will have a significant impact on caregivers as well as the health care system ...

Recommended for you

Noninvasive eye scan could detect key signs of Alzheimer's years before patients show symptoms

August 17, 2017
Cedars-Sinai neuroscience investigators have found that Alzheimer's disease affects the retina—the back of the eye—similarly to the way it affects the brain. The study also revealed that an investigational, noninvasive ...

Could olfactory loss point to Alzheimer's disease?

August 16, 2017
By the time you start losing your memory, it's almost too late. That's because the damage to your brain associated with Alzheimer's disease (AD) may already have been going on for as long as twenty years. Which is why there ...

New Machine Learning program shows promise for early Alzheimer's diagnosis

August 15, 2017
A new machine learning program developed by researchers at Case Western Reserve University appears to outperform other methods for diagnosing Alzheimer's disease before symptoms begin to interfere with every day living, initial ...

Brain scan study adds to evidence that lower brain serotonin levels are linked to dementia

August 14, 2017
In a study looking at brain scans of people with mild loss of thought and memory ability, Johns Hopkins researchers report evidence of lower levels of the serotonin transporter—a natural brain chemical that regulates mood, ...

Alzheimer's risk linked to energy shortage in brain's immune cells

August 14, 2017
People with specific mutations in the gene TREM2 are three times more likely to develop Alzheimer's disease than those who carry more common variants of the gene. But until now, scientists had no explanation for the link.

Scientists reveal role for lysosome transport in Alzheimer's disease progression

August 7, 2017
Researchers from Yale University School of Medicine have discovered that defects in the transport of lysosomes within neurons promote the buildup of protein aggregates in the brains of mice with Alzheimer's disease. The study, ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.