Alzheimer’s Disease: The Health Care Crisis of the 21st Century

Alzheimer’s disease has reached crisis proportions in the United States, with incidence, prevalence, and mortality all on the rise, according to the 2007 Alzheimer’s Disease Facts and Figures report that was released in March by the Alzheimer’s Association at the organization’s annual public policy forum.

According to the report, there are now more than five million people with Alzheimer’s disease, a 10% increase from five years ago, and the Alzheimer’s Association has projected an increase of 16 million cases by 2050, unless preventive measures are taken.

“Soon, Alzheimer’s disease will touch everyone in this country in some form or another, so the need to redouble our research efforts is greater than ever before,” according to Samuel Gandy, MD, PhD, Chairman of the Alzheimer’s ­Association’s Medical and Scientific Advisory Council.

“We must have better treatments, earlier detection, and effective strategies to prevent Alzheimer’s. Scientists have made tremendous strides in the last two decades, but the clock is ticking.”

FIGHTING AGE

The report cites increasing age as the greatest risk factor in Alzheimer’s disease,­ ­particularly for people 65 and older. According to statistical breakdown, there are currently 300,000 patients with Alzheimer’s disease who are between ages 65 and 74, nearly 2.4 million people ages 75 to 84, and 2.2 million people 85 and older. By 2010, the Alzheimer’s Association expects new cases of Alzheimer’s disease to increase to 454,000, up from 411,000 in 2000. And with 78 million baby boomers set to approach their mid-60s by 2011, it’s anticipated that prevalence will continue to increase with the aging population. It’s projected that new cases will increase to 615,000 by 2030 and to 959,000 by 2050. By then, the Alzheimer’s Association estimates that more than 60% of those with Alzheimer’s disease will be 85 years or older and that someone will develop Alzheimer’s disease every 33 seconds. It’s currently estimated that someone in the US develops Alzheimer’s disease about every 72 seconds.

ALZHEIMER'S DISEASE, STATE BY STATE

In addition to its prevalence nationwide, the impact of Alzheimer’s disease was examined in a state-by-state breakdown of prevalence projected out to 2010. The findings revealed that six in 10 states will experience double-digit growth in Alzheimer’s disease prevalence, with only New York and the District of Columbia expected to experience a decline in residents with Alzheimer’s disease. This projection was compared with data from 2000. In contrast, Colorado and Alaska are predicted to experience a 47% increase in residents with Alz­heimer’s disease, compared with data from 2000, and Utah and Wyoming are expected to follow closely behind at 45% and 43%, respectively.

The Alzheimer’s Association noted in the report that the national and state prevalence figures are based on published studies conducted by researchers from the Rush Institute on Healthy Aging and the Rush Alzheimer’s Disease Center in Chicago, in addition to the CDC in Atlanta.

At the request of the Alzheimer’s Association, the Chicago-based research team analyzed incidence of Alzheimer’s disease among residents 65 and older in a biracial Chicago community consisting of three adjacent neighborhoods. The residents were studied over a four-year period. Data consisted of an in-home interview for all participants, in addition to a diagnostic evaluation for a stratified random sample of the participants.

 Incidence was measured in 3,838 persons free of Alzheimer’s disease at baseline, and 835 people underwent a diagnostic evaluation for Alzheimer’s disease. The incidence figures were converted to prevalence estimates, adjusted for education and other factors, and applied to the US Census Bureau population figures for 2000 and US Census Bureau projections for 2010, 2020, 2030, 2040, and 2050.

COST TO TREAT

As prevalence grows, so does the cost to treat patients with Alz­heimer’s disease. The fact that the number of Alzheimer’s cases is growing at an epidemic rate could mean an immense burden on the US health care system, and especially to Medicaid and Medicare.

“The dramatic rise in Alzheimer’s underscores that this disease has the ability to undermine the entire US health care system. Looking just at Medicare and Medicaid, if we could find an intervention that could delay onset or slow progression of the disease, in short order spending on Alzheimer’s could decline by more than $60 billion with even larger savings every year thereafter,” said Stephen McConnell, PhD, Vice President of Advocacy and Public Policy for the Alzheimer’s Association.

Thus far, the direct and indirect costs of Alzheimer’s disease and other dementias amount to more than $148 billion annually, according to the report, with Medicare spending nearly three times as much for patients with Alzheimer’s disease or other dementias as for the average Medicare beneficiary. Medicare costs are projected to double from $91 billion in 2005 to more than $189 billion in 2015. Medical costs associated with Alzheimer’s disease and comorbidities such as coronary artery disease or diabetes double those of people who have these conditions but do not have dementia. The report revealed that about 60% of patients with Alzheimer’s disease have hypertension and 30% have coronary artery disease. About 95% of such patients have at least one comorbidity.

In addition to the staggering medical costs, 70% of patients with Alzheimer’s disease are cared for at home by friends and family, with only a small percentage of patients being cared for at hospitals and nursing homes. According to a special section on the burden of caregiving that was included in the report, there are nearly 10 million Americans who care for a person with Alzheimer’s disease or other dementias. The report noted that unpaid caregivers provide an estimated 8.5 billion hours of care, which was valued at nearly $83 billion in 2006.

 “A million of these caregivers in California, for example, provided an estimated $8.5 billion of care that year,” the report noted. “Even Rhode Island, the smallest state, had almost 37,000 caregivers of people with Alzheimer’s and other dementias, and those caregivers provided 32 million hours of care worth $310.7 million.”

HIGH MORTALITY RATE

Alzheimer’s disease is now the seventh leading cause of death in the US and the fifth leading cause of death for those older than 65. According to the report, the total number of deaths attributable to Alzheimer’s disease had increased by 32% from 2000 to 2004. The researchers maintained that this increase did not account for the number of deaths in which Alzheimer’s disease was an underlying factor. In addition, the researchers noted that many patients with Alzheimer’s disease have a shortened life expectancy in comparison to those without Alzheimer’s disease or other dementias. Meanwhile, deaths from heart disease, breast and prostate cancers and stroke all declined within the same time period examined.

LOOKING FOR THE CURE

As the statistical data continue to climb, there is an even greater sense of urgency to find an effective treatment to curb the symptoms of Alzheimer’s disease. According to Harry Johns, President and CEO of the Alzheimer’s Association, there are nine drugs in phase III clinical trials for Alzheimer’s disease, “several of which show great promise to slow or stop the progression. This, combined with advancements in diagnostic tools, has the potential to change the landscape of Alzheimer’s.”

 “We must make the fight against Alzheimer’s a national priority before it’s too late,” Johns continued. “The absence of effective disease-modifying drugs, coupled with an aging population, makes Alzheimer’s the health care crisis of the 21st century.”

 In the meantime, the focus will be on managing the disease. Despite the lack of disease-modifying therapies available to patients with Alzheimer’s disease, studies have shown that active medical management, including use of available treatment options, effective integration of coexisting conditions into the treatment plan, and use of programs and support services, have resulted in improved quality of life for many patients with Alzheimer’s disease.          

NR