Dementia is a terrible condition for those who have it and for those who care for sufferers. It also is increasing rapidly in prevalence as the population ages, with as many as 10% of Americans over age 65 having some stage of the disease. There are about a half a million new cases every year. About two-thirds of patients are women, but this is not necessarily reflective of greater inherent susceptibility. African-Americans and Hispanics also have higher rate of Alzheimer’s. A report from the Alzheimer’s Association details some of the costs imposed on the health system by dementia. (Alz. Fndtn. Rpt.) Alzheimer’s tends to follow a relatively well-defined course and can last for many years; it truly is a chronic disease. It currently has no good treatments to slow or control the condition, much less cure it, so a future of rapidly increasing spending seems inevitable. The report provides a useful summary of the causes, progression, and symptoms of Alzheimer’s.
Deaths from Alzheimer’s are rising rapidly, primarily due to sufferers living longer. It is the fifth leading cause of death, although its contribution may be understated. Between 2000 and 2014 annual deaths attributable to Alzheimer’s rose 89%. Alzheimer’s is a major reason for informal caregiving, which imposes very significant burdens on the caregivers. 15 million Americans are estimated to be providing informal care to an Alzheimer’s patient, at a total of over 18 billion hours of unpaid care annually. This caregiving imposes significant work, financial, mental health and physical health burdens on the caregivers. Primary tasks include help with activities of daily living, managing finances and managing health care. In the later stages of Alzheimer’s such caregiving becomes particularly difficult as the patient suffers from delusions, may not recognize caregivers and may even be violent. A whole industry is growing up around providing support for these informal caregivers. Health care payers will spend around $259 billion in 2017 in providing services related to Alzheimer’s. About half of that will be paid by Medicare. Medicare incurs about three times at the average annual expense for a beneficiary with Alzheimer’s than it does for one without the disease. Medicaid programs also are incurring a substantial increase in Alzheimer’s costs, particularly related to long-term care. Alzheimer’s patients have much greater use of hospitalizations, skilled nursing facilities and home health care. This is truly a frightening disease, both in its tragic personal effects and its potential impact on our already stressed national health care finances.