June 20, 2016

No News Is Bad News

Every year since 2007, I’ve been commenting on the annual update to the report, Alzheimer’s Disease Facts and Figures. The report came out at the very end of March this year, as it usually does, but I didn’t notice. April was a busy month for me. May was even busier and June shows little indication of letting up, but I suddenly remembered that I hadn’t seen the latest report, let alone commented on it. Here are a few highlights.

Both the current prevalence of Alzheimer’s disease and predictions about the future remain stable—and grim. We’re at 5.2 million people over age 65, with 11 percent of those over age 65 and 32 percent of those over 85 afflicted. By 2025, unless something changes very soon, the number of Americans with Alzheimer’s will be 7.1 million and by 2050, it will be 13.8 million, reflecting both the graying and the growth of the population.

People with dementia continue to have other medical conditions and it is the combination that drives up hospitalization rates and health care costs. Among people with Alzheimer’s, 38 percent also have coronary artery disease, 37 percent also have diabetes, 29 percent have chronic kidney disease, 28 percent have heart failure, 25 percent have chronic obstructive pulmonary disease, and 22 percent have stroke. There are, of course, other concomitant conditions—13 percent have cancer—but these are the big six. And because it’s so much harder to diagnose and to treat people who have an acute medical problem and also dementia, the hospitalization rate among older people with Alzheimer’s (plus whatever is sending them to the hospital) is now 538/1000, compared to just about half that, or 266/1000 among people who are over 65 but don’t have Alzheimer’s.

The cost of care for people with dementia is mind boggling. It’s always a bit tricky to compute a single number, but the best estimates are that the combination of health care costs, including hospice, and long term care costs is now $236 billion a year, of which Medicare and Medicaid pay 68 percent ($160 billion) and patients and families pay 19 percent ($46 billion) out of pocket.

To provide a little variety to the reports, which are otherwise depressingly similar every year, the Alzheimer’s Association always includes a special section on a new topic. This year’s special report is on the financial impact of Alzheimer’s disease on families, who provide over 80 percent of the personal help that people with dementia require. The conclusion from in depth interviews of a sample of caregivers is that taking care of someone with dementia can jeopardize the ability of the caregivers to buy food, it can jeopardize their personal health, and it threatens their financial security.

Is there a take home message from this sad saga? There are the usual cautions: Alzheimer’s disease is not going to disappear tomorrow so we better come up with better institutional arrangements today; caregivers have a crucial and under-appreciated role in providing and supervising the medical care of their family members with dementia; and long term care insurance is currently inadequate to shield families from potentially devastating financial burdens. But what struck me in reading through this year’s version of the report was one statistic I had not previously noticed: the reason families are so financially burdened is that 50 percent of Medicare beneficiaries have an annual income of less than $24,000 and less than $63,000 in total savings. That's a paltry amount. No wonder Alzheimer's is a financial burden on family members! For the young old, not to mention those who aren’t old by anyone’s definition, it’s time to start saving.

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