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2024 Alzheimer's disease facts and figures. Alzheimers Dement 2024; 20:3708-3821. [PMID: 38689398 PMCID: PMC11095490 DOI: 10.1002/alz.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.
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Piersol CV, Martínez J, Chew F, Perry B, Leland NE. Understanding the Experiences of Family Caregivers of Nursing Home Residents With Dementia: A Grounded Theory Study. THE GERONTOLOGIST 2024; 64:gnad102. [PMID: 37501632 DOI: 10.1093/geront/gnad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Alzheimer's disease and related dementias progress over time and result in cognitive decline, loss of independence, and behavioral and psychiatric symptoms of dementia that can lead to nursing home placement. Research has focused on examining the effects of nursing home placement on the family caregiver; however, their experiences are less understood. We sought to investigate the experiences and perceptions of family caregivers of nursing home residents with dementia. The objective was to create a conceptual model that explains the complex nature of the family caregiver experience. RESEARCH DESIGN AND METHODS This study is part of a larger randomized controlled trial. Following a grounded theory approach, we completed 30 in-depth, one-on-one interviews with family caregivers of nursing home residents with dementia. Data analysis followed an iterative process that employed open, axial, and selective coding. RESULTS Our conceptual model depicts the interrelationship between contributing factors that interrelate and impact family caregiver satisfaction with nursing home care. Six factors contribute to family caregiver satisfaction: family caregiver interactions with nursing home staff; staff management of resident behavioral symptoms; nursing home context; family caregiver knowledge of dementia; family caregiver strain; and the resident experience. DISCUSSION AND IMPLICATIONS Our findings revealed family caregiver experiences that are unique to the institutional nursing home setting and not reflected in prior work focusing on experiences within community-based settings. Understanding family caregiver experiences and the contributors to how satisfaction in care is perceived, may foster collaboration and teamwork among families and staff.
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Affiliation(s)
- Catherine Verrier Piersol
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jenny Martínez
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Felicia Chew
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Bonnie Perry
- Wharton Communication Program, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Natalie E Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Phillips R, Durkin M, Engward H, Cable G, Iancu M. The impact of caring for family members with mental illnesses on the caregiver: a scoping review. Health Promot Int 2023; 38:daac049. [PMID: 35472137 PMCID: PMC10269136 DOI: 10.1093/heapro/daac049] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
A large number of multidisciplinary, qualitative and quantitative research suggests that providing care for family members with mental health illnesses can have both positive and negative effects on the carers' wellbeing. However, to date a comprehensive overview and synthesis of literature that compares and contrasts positive and negative effects of family-caregiving on the carer is missing. To address this gap, this scoping review examines the effects of family-caregiving on carers' wellbeing. A Boolean search generated a total of 92 relevant articles that were included in the analysis. The results suggest that, to understand the effects of family-caregiving on the carer's mental and physical wellbeing, it is necessary to take a combination of situational and sociodemographic characteristics into consideration. Elderly, female, spousal-carers and primary-carers may be a group that is at risk of suffering from a lack of positive mental and physical wellbeing as a result of caring. However, the negative effects of caregiving can be balanced by extraversion, social support and religious or spiritual beliefs. Therefore, future interventions that aim to promote family caregivers' wellbeing may need to take personality, particular circumstances as well as cultural and personal beliefs into consideration.
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Affiliation(s)
- Rita Phillips
- Robert Gordon University, Garthdee House, Garthdee Road, Aberdeen AB10 7QB, UK
| | | | - Hilary Engward
- Anglia Ruskin University, Cambridge Campus, East Rd, Cambridge CB1 1PT, UK
| | - Graham Cable
- Anglia Ruskin University, Cambridge Campus, East Rd, Cambridge CB1 1PT, UK
| | - Maria Iancu
- Anglia Ruskin University, Cambridge Campus, East Rd, Cambridge CB1 1PT, UK
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Teo H. The impact of a partner's nursing home admission on individuals' mental well-being. Soc Sci Med 2023; 327:115941. [PMID: 37182294 DOI: 10.1016/j.socscimed.2023.115941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/17/2023] [Accepted: 04/29/2023] [Indexed: 05/16/2023]
Abstract
This study analyzes the effect of a partner's nursing home admission on individuals' mental well-being. To do so, we use longitudinal data on couples from the Health and Retirement Study and a quasi-experimental difference-in-differences design to isolate the causal effect of the transition. We hypothesize that: (i) a partner's nursing home admission has a negative impact on individuals' mental well-being and (ii) the size of the negative effect is decreasing in the amount of caregiving provided by respondents pre-admission. We find that a partner's nursing home admission raises respondents' depressive symptomology scores by 0.839, corresponding to a 50 percent increase from the average pre-admission baseline. Amongst respondents providing care to their partners pre-admission, a nursing home transition raises depression scores by 0.670, corresponding to a 36.8 increase from baseline. Non-caregiving respondents experience a corresponding 1.05 increase in depression scores, representing a 67.2 percent rise from baseline. Amongst pre-admission caregivers, we find that the negative well-being impact of a partner's admission decreases in the duration and intensity of caregiving pre-admission. We also find that partners of care recipients with more severe physical and cognitive impairment pre-admission experience less deterioration in mental well-being compared to their counterparts. Overall, our findings indicate that a partner's transition into residential care can provide respite from caregiving-related stressors. However, on average, the negative well-being effects of the transition tend to outweigh this positive respite effect. The policy implications are twofold: first, there is a need for continued support to families of care recipients during the latter's transition into institutional care. Second, nursing homes and other institutions have a role in providing respite care, especially for high-intensity caregivers.
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Affiliation(s)
- Hansel Teo
- Personal Social Services Research Unit (PSSRU), University of Kent, United Kingdom.
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Abstract
This article describes the public health impact of Alzheimer's disease, including prevalence and incidence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report examines the patient journey from awareness of cognitive changes to potential treatment with drugs that change the underlying biology of Alzheimer's. An estimated 6.7 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, and Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated by the COVID-19 pandemic in 2020 and 2021. More than 11 million family members and other unpaid caregivers provided an estimated 18 billion hours of care to people with Alzheimer's or other dementias in 2022. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $339.5 billion in 2022. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the paid health care workforce are involved in diagnosing, treating and caring for people with dementia. In recent years, however, a shortage of such workers has developed in the United States. This shortage - brought about, in part, by COVID-19 - has occurred at a time when more members of the dementia care workforce are needed. Therefore, programs will be needed to attract workers and better train health care teams. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2023 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $345 billion. The Special Report examines whether there will be sufficient numbers of physician specialists to provide Alzheimer's care and treatment now that two drugs are available that change the underlying biology of Alzheimer's disease.
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Zarshenas S, Paulino C, Sénéchal I, Décary J, Dufresne A, Bourbonnais A, Aquin C, Bruneau MA, Champoux N, Belchior P, Couture M, Bier N. Application of the Person-Centered Care to Manage Responsive Behaviors in Clients with Major Neurocognitive Disorders: A Qualitative Single Case Study. Clin Gerontol 2023:1-13. [PMID: 36591952 DOI: 10.1080/07317115.2022.2162468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Our study aimed to describe "how" and "why" the person-centered care (PCC) approach was applied within a long-term care (LTC) community to manage responsive behaviors (RBs) in individuals with major neurocognitive disorders. METHODS A descriptive holistic single case study design was employed in the context of an LTC community in Quebec, using semi-structured interviews and non-participatory observations of experienced care providers working with clients with RBs, photographing the physical environment, and accessing documents available on the LTC community's public website. A thematic content analysis was used for data analysis. RESULTS The findings generated insight into the importance of considering multiple components of the LTC community to apply the PCC approach for managing RBs, including a) creating a homelike environment, b) developing a therapeutic relationship with clients, c) engaging clients in meaningful activities, and d) empowering care providers by offering essential resources. CONCLUSIONS Applying and implementing the PCC approach within an LTC community to manage clients' RBs is a long-term multi-dimensional process that requires a solid foundation. CLINICAL IMPLICATIONS These findings highlight the importance of considering multiple factors relevant to persons, environments, and meaningful activities to apply the PCC approach within LTC communities to manage RBs.
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Affiliation(s)
- Sareh Zarshenas
- Occupational Science and Occupational Therapy Department, University of Toronto, Toronto, Canada
| | - Carmela Paulino
- School of rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Isabelle Sénéchal
- School of rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Josianne Décary
- School of rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Audrey Dufresne
- School of rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Anne Bourbonnais
- Faculty of Nursing, Université de Montréal, Montréal, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-sud-de-l'île-de-Montréal, Montréal, Canada
| | - Chloé Aquin
- Institut universitaire de gériatrie de Montréal, CIUSSS Centre-sud-de-l'île-de-Montréal, Montréal, Canada
| | - Marie-Andrée Bruneau
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-sud-de-l'île-de-Montréal, Montréal, Canada
- Department of Psychiatry and Addictology, Université de Montréal, Montréal, Canada
| | - Nathalie Champoux
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-sud-de-l'île-de-Montréal, Montréal, Canada
- Department of Family Medicine, Université de Montréal, Montréal, Canada
| | - Patricia Belchior
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-sud-de-l'île-de-Montréal, Montréal, Canada
- School of Physical and Occupational Therapy, McGill University, Montréal, Canada
| | - Melanie Couture
- Centre for Research and Expertise in Social Gerontology, CIUSSS West-Central Montreal, Cote Saint-Luc, Canada
| | - Nathalie Bier
- School of rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, CIUSSS Centre-sud-de-l'île-de-Montréal, Montréal, Canada
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Liu C, Guo X, Chang X. Intestinal Flora Balance Therapy Based on Probiotic Support Improves Cognitive Function and Symptoms in Patients with Alzheimer's Disease: A Systematic Review and Meta-analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4806163. [PMID: 36017397 PMCID: PMC9398783 DOI: 10.1155/2022/4806163] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/22/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022]
Abstract
Objective The clinical value of intestinal flora balance therapy based on probiotic support in improving cognitive function and symptoms of patients with Alzheimer's disease was to systematically evaluate, so as to provide evidence-based medicine basis for the promotion and use of this therapy. Methods The randomized controlled trials (RCTs) were searched for the improvement of cognitive function and symptoms of patients with Alzheimer's disease by intestinal flora balance therapy supported mainly by probiotics in PubMed, EMBASE, ScienceDirect, Cochrane Library, China Knowledge Network Database (CNKI), China VIP database, Wanfang database, and China Biomedical Literature Database (CBM) online database (RCT). Data were extracted independently by two researchers, and the literature was assessed for risk of bias according to the Cochrane Handbook 5.1.0 criteria. The data were meta-analyzed using RevMan 5.4 statistical software. Results Finally, 5 randomized controlled trials were included, with a total sample size of 386 cases. The results of meta-analysis showed that Chi2 = 13.14, df = 2, P = 0.001, and I 2 = 85% showed significant heterogeneity in the inclusion of the study data. Probiotic-supported intestinal microflora balance therapy improves cognitive function in patients with Alzheimer's disease. Through meta-analysis of transient memory scores, it is concluded that intestinal flora balance therapy based on probiotic support can improve transient memory in patients with Alzheimer's disease. Meta-analysis of ADAS-COG score showed that intestinal flora balance therapy supported by probiotics could improve the cognitive function of patients with Alzheimer's disease. The ADL score was analyzed by meta, and the heterogeneity test result was Chi2 = 0.79, df = 1, P = 0.37 > 0.05, and I 2 = 0%, indicating that the intestinal flora balance therapy supported by probiotics can improve the ability of daily living of patients with Alzheimer's disease. Conclusion Intestinal flora balance therapy based on probiotic support can effectively improve cognitive function, instantaneous memory, and ability of daily life in patients with Alzheimer's disease. However, more studies and long-term follow-up studies with higher methodological quality are needed to further verify.
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Affiliation(s)
- Changxing Liu
- Shaanxi University of Traditional Chinese Medicine, Xianyang 712046, China
| | - Xinyi Guo
- Shaanxi University of Traditional Chinese Medicine, Xianyang 712046, China
| | - Xiang Chang
- Xi'an Hospital of Traditional Chinese Medicine, Shaanxi Province 710016, China
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Tsai CF, Huang MH, Lee JJ, Jhang KM, Huang LC, Huang LK, Lee WJ, Sung PS, Liu YC, Ouyang WC, Cheng CM, Hsu CC, Fuh JL. Factors associated with burden among male caregivers for people with dementia. J Chin Med Assoc 2022; 85:462-468. [PMID: 35286289 DOI: 10.1097/jcma.0000000000000704] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is a dearth of information on male dementia caregivers in Asia and, in particular, on the factors relating to caregiver burden. We aimed to identify factors that may be associated with burden among male caregivers of people with dementia (PWD). METHODS Data were collected from a national dementia registration survey. The caregiver burden was measured with the short version of the Zarit Burden Interview (ZBI). We analyzed the correlation between ZBI scores and variables, such as demographic data of PWD and their male caregivers, caregivers' monthly income, the relationship between PWD and caregivers, the severity of dementia, physical comorbidities and activities of daily living (ADL) of PWD, and neuropsychiatric symptoms assessed by the Neuropsychiatric Inventory (NPI). RESULTS A total of 509 PWD and their male caregivers were included. The majority of caregivers were sons (72.1%) and husbands (22.0%). Sons had higher ZBI scores than husbands (28.5 ± 15.2 vs 22.0 ± 17.0; p < 0.001). Multivariable linear regression showed that sons as caregivers (β = 7.44, p = 0.034), ADL (β = 0.52, p = 0.002), and NPI_severity subscore of apathy (β = 2.74, p = 0.001) were positively associated with ZBI scores. CONCLUSION Poor ADL and apathy in PWD and being a patient's son were associated with higher levels of burden among male dementia caregivers. Effective interventions are needed to assist male caregivers in accomplishing their caregiving role and at the same time to alleviate their caregiver burden.
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Affiliation(s)
- Chia-Fen Tsai
- Department of Psychiatry, Division of Geriatric Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Mao-Hsuan Huang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Psychiatry, Suao and Yuanshan Branches of Taipei Veterans General Hospital, Ilan, Taiwan, ROC
| | - Jun-Jun Lee
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan, ROC
- Department of Information Management, National Sun Yat-sen University, Kaohsiung, Taiwan, ROC
| | - Kai-Ming Jhang
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan, ROC
| | - Ling-Chun Huang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Li-Kai Huang
- Department of Neurology, Shuang Ho Hospital, Taipei, Taipei Medical University, New Taipei City, Taiwan, ROC
- Graduate Institute of Humanities in Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan, ROC
| | - Wei-Ju Lee
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Pi-Shan Sung
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | - Yi-Chien Liu
- Neurological Center of Cardinal Tien Hospital, Taipei, Taiwan, ROC
- Fu Jen University School of Medicine, Taipei, Taiwan, ROC
| | - Wen-Chen Ouyang
- Department of Geriatric Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan, ROC
- Departemnt of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC
| | - Chih-Ming Cheng
- Department of Psychiatry, Division of Geriatric Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan, ROC
| | - Jong-Ling Fuh
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of General Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Abstract
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report discusses consumers' and primary care physicians' perspectives on awareness, diagnosis and treatment of mild cognitive impairment (MCI), including MCI due to Alzheimer's disease. An estimated 6.5 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available. Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States in 2019 and the seventh-leading cause of death in 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. More than 11 million family members and other unpaid caregivers provided an estimated 16 billion hours of care to people with Alzheimer's or other dementias in 2021. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $271.6 billion in 2021. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the dementia care workforce have also been affected by COVID-19. As essential care workers, some have opted to change jobs to protect their own health and the health of their families. However, this occurs at a time when more members of the dementia care workforce are needed. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2022 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $321 billion. A recent survey commissioned by the Alzheimer's Association revealed several barriers to consumers' understanding of MCI. The survey showed low awareness of MCI among Americans, a reluctance among Americans to see their doctor after noticing MCI symptoms, and persistent challenges for primary care physicians in diagnosing MCI. Survey results indicate the need to improve MCI awareness and diagnosis, especially in underserved communities, and to encourage greater participation in MCI-related clinical trials.
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Harvey PD. Understanding the Course and Correlates of Depression in Older People Undergoing Caregiving Stress. Am J Geriatr Psychiatry 2022; 30:158-160. [PMID: 34266751 DOI: 10.1016/j.jagp.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Philip D Harvey
- University of Miami, Miami, FL; Research Service Bruce W. Cater VA Medical Center, Miami, FL; iFunction, Inc. Miami, FL
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Abstract
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the challenges of providing equitable health care for people with dementia in the United States. An estimated 6.2 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available, making Alzheimer's the sixth-leading cause of death in the United States and the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated in 2020 by the COVID-19 pandemic. More than 11 million family members and other unpaid caregivers provided an estimated 15.3 billion hours of care to people with Alzheimer's or other dementias in 2020. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $256.7 billion in 2020. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2021 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $355 billion. Despite years of efforts to make health care more equitable in the United States, racial and ethnic disparities remain - both in terms of health disparities, which involve differences in the burden of illness, and health care disparities, which involve differences in the ability to use health care services. Blacks, Hispanics, Asian Americans and Native Americans continue to have a higher burden of illness and lower access to health care compared with Whites. Such disparities, which have become more apparent during COVID-19, extend to dementia care. Surveys commissioned by the Alzheimer's Association recently shed new light on the role of discrimination in dementia care, the varying levels of trust between racial and ethnic groups in medical research, and the differences between groups in their levels of concern about and awareness of Alzheimer's disease. These findings emphasize the need to increase racial and ethnic diversity in both the dementia care workforce and in Alzheimer's clinical trials.
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Dadalto EV, Cavalcante FG. The place of family caregivers for older adults with Alzheimer's disease: a literature review in Brazil and the United States. CIENCIA & SAUDE COLETIVA 2020; 26:147-157. [PMID: 33533835 DOI: 10.1590/1413-81232020261.38482020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/07/2020] [Indexed: 01/02/2023] Open
Abstract
This is a review of the literature on family caregivers of patients with Alzheimer's disease from 2013 to 2017 available in the BVS, Scopus, and PubMed databases. The descriptors used (translated from Portuguese) were Alzheimer's disease, caregivers, elderly health, by combination. Of the 163 papers analyzed, after applying the relevance test, we selected 26 papers presented from five thematic units: 1- Literature reviews; 2- Prevalence profiles of AD caregivers; 3- Qualitative research that analyzes the feelings and sufferings of caregivers; 4- Comparative studies and objective tests; 5- Evaluation studies of intervention programs. The comprehensive and comparative analysis of the investigations highlighted differences and similarities, advantages, and disadvantages of the samples and methodologies adopted in Brazil and the US. The articles analyzed factors that influence family caregivers' impact with Alzheimer's disease, identifying the affective bonds involved, the expected reciprocity, the physical, emotional, and social costs associated with a prolonged chronic illness and requiring increasingly complex care. Family caregivers and older adults with AD require a broad, accessible, or articulated support network inside and outside the family.
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Affiliation(s)
- Eliane Varanda Dadalto
- Centro de Ciências da Saúde, Universidade Federal do Espírito Santo. Av. Marechal Campos 1468, Maruípe. 29102-770 Vitória ES Brasil.
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Chang CH, Ming Y, Chang TH, Yen YY, Lan SJ. The Needs and Utilization of Long-Term Care Service Resources by Dementia Family Caregivers and the Affecting Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17166009. [PMID: 32824871 PMCID: PMC7460079 DOI: 10.3390/ijerph17166009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 01/15/2023]
Abstract
This study was to evaluate the utilization of long-term care service resources by caregivers of patients with dementia (PWD) and to determine affecting factors. In this cross-sectional study, a total of 100 dyads were enrolled and caregivers responded to the questionnaires. We found 40% of caregivers not using any care resources. Between those caregivers using and not-using care resources, we found differences (p < 0.05) in their health status and living conditions; the difference (p < 0.05) was also found in patients’ behavior and psychological symptoms of dementia (BPSD). The frequency of BPSD (OR = 1.045, p = 0.016, 95% CI = 1.001–1.083) and the living conditions (OR = 3.519, p = 0.007, 95% CI = 1.414–8.759) were related to their use of care resources. Particular BPSDs, such as anxiety or restlessness, throwaway food, aggressive behavior, tearing of clothes, and sexual harassment of patients were related to the caregivers’ use of care resources (p < 0.01). Health professionals have to evaluate the patients’ BPSD and identify the caregivers’ essential needs. Individualized medical care and BPSD-related care resources should be provided for patients and caregivers for taking off their care burden and improving patient care.
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Affiliation(s)
- Chia-Hui Chang
- Department of Nursing, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Yung Ming
- Central Office of Administration, Antai Medical Corporation Antai Tian-Sheng Memorial Hospital, Pingtung County 92842, Taiwan
- Correspondence:
| | - Tsung-Hung Chang
- Central Office of Administration, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Yea-Yin Yen
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Shou-Jen Lan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40447, Taiwan;
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Abstract
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the future challenges of meeting care demands for the growing number of people living with Alzheimer's dementia in the United States with a particular emphasis on primary care. By mid-century, the number of Americans age 65 and older with Alzheimer's dementia may grow to 13.8 million. This represents a steep increase from the estimated 5.8 million Americans age 65 and older who have Alzheimer's dementia today. Official death certificates recorded 122,019 deaths from AD in 2018, the latest year for which data are available, making Alzheimer's the sixth leading cause of death in the United States and the fifth leading cause of death among Americans age 65 and older. Between 2000 and 2018, deaths resulting from stroke, HIV and heart disease decreased, whereas reported deaths from Alzheimer's increased 146.2%. In 2019, more than 16 million family members and other unpaid caregivers provided an estimated 18.6 billion hours of care to people with Alzheimer's or other dementias. This care is valued at nearly $244 billion, but its costs extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2020 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $305 billion. As the population of Americans living with Alzheimer's dementia increases, the burden of caring for that population also increases. These challenges are exacerbated by a shortage of dementia care specialists, which places an increasing burden on primary care physicians (PCPs) to provide care for people living with dementia. Many PCPs feel underprepared and inadequately trained to handle dementia care responsibilities effectively. This report includes recommendations for maximizing quality care in the face of the shortage of specialists and training challenges in primary care.
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Haverstock NB, Ruthig JC, G Chipperfield J. Primary and secondary control strategies and psychological well-being among familial caregivers of older adults with dementia. The Journal of Social Psychology 2019; 160:61-74. [PMID: 30947620 DOI: 10.1080/00224545.2019.1592095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Caring for an older family member with dementia can be extremely challenging, often resulting in diminished psychological well-being. A wide range of both internally and externally directed behavioral strategies may serve to protect well-being among caregivers. Specifically, primary control strategies involve direct attempts to change one's current situation, while secondary control strategies are attempts to inwardly adjust cognitions to align with the current situation. This study examined the use of multiple primary and secondary control strategies among familial caregivers (n = 110), as well as their associations with several indices of psychological well-being. Results showed that the most common primary and secondary control strategies, namely task persistence and positive reappraisal, were used with approximately equal frequency. Furthermore, the specific strategy of positive reappraisal seemed to bolster psychological well-being among caregivers. Findings indicate that primary control strategies might be less effective than secondary control strategies within the context of caregiving for a person with dementia.
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Abreu W, Tolson D, Jackson GA, Costa N. A cross-sectional study of family caregiver burden and psychological distress linked to frailty and functional dependency of a relative with advanced dementia. DEMENTIA 2018; 19:301-318. [DOI: 10.1177/1471301218773842] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Psychological health of caregivers of people with dementia is a major public concern. This study sought to determine the relationship between caregiver burden, psychological distress, frailty and functional dependency of a relative with advanced dementia. Persons with dementia and their caregivers (102 dyads) participated in this Portuguese community based cross-sectional study. Data were collected using the Clinical Dementia Rating Scale, a sociodemographic questionnaire, the Zarit Burden Interview, the Brief Symptoms Inventory and the Edmonton Frail Scale. Alzheimer's disease was the most common type of dementia among the recipients of care, who showed moderate (42.2%) to severe (52.9%) dementia. Among them 35.3% exhibited moderate and 45.1% severe frailty. Family caregivers reported moderate (76.5%) to severe burden (18.6%). Psychological distress was very high among family caregivers. Results show that people with dementia exhibited moderate (35.3%) or severe frailty (45.1%) and that a severe frailty was found in people with moderate dementia. A one-way ANOVA was conducted between the Global Severity Index and some sociodemographic variables. ANOVA reached p < .01 for employment status of the caregiver, assistance and professional support, and psychiatric history; and p = 0.01 for caregiver age and years of caregiving. Although caregivers reported benefit from the supportive approach offered by the multidisciplinary home care team, high levels of distress and associated burden were found, which might decrease their capacity to care for the person with dementia and their own health and well-being.
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Affiliation(s)
- Wilson Abreu
- Porto School of Nursing/CINTESIS (Center for Research in Health Technologies and Services), Portugal
| | | | | | - Nilza Costa
- University of Aveiro - Campus Universitário de Santiago, Portugal
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20
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Abstract
This report describes the public health impact of Alzheimer's disease, including incidence and prevalence, mortality rates, costs of care, and the overall impact on caregivers and society. It also examines in detail the financial impact of Alzheimer's on families, including annual costs to families and the difficult decisions families must often make to pay those costs. An estimated 5.4 million Americans have Alzheimer's disease. By mid-century, the number of people living with Alzheimer's disease in the United States is projected to grow to 13.8 million, fueled in large part by the aging baby boom generation. Today, someone in the country develops Alzheimer's disease every 66 seconds. By 2050, one new case of Alzheimer's is expected to develop every 33 seconds, resulting in nearly 1 million new cases per year. In 2013, official death certificates recorded 84,767 deaths from Alzheimer's disease, making it the sixth leading cause of death in the United States and the fifth leading cause of death in Americans age ≥ 65 years. Between 2000 and 2013, deaths resulting from stroke, heart disease, and prostate cancer decreased 23%, 14%, and 11%, respectively, whereas deaths from Alzheimer's disease increased 71%. The actual number of deaths to which Alzheimer's disease contributes is likely much larger than the number of deaths from Alzheimer's disease recorded on death certificates. In 2016, an estimated 700,000 Americans age ≥ 65 years will die with Alzheimer's disease, and many of them will die because of the complications caused by Alzheimer's disease. In 2015, more than 15 million family members and other unpaid caregivers provided an estimated 18.1 billion hours of care to people with Alzheimer's and other dementias, a contribution valued at more than $221 billion. Average per-person Medicare payments for services to beneficiaries age ≥ 65 years with Alzheimer's disease and other dementias are more than two and a half times as great as payments for all beneficiaries without these conditions, and Medicaid payments are 19 times as great. Total payments in 2016 for health care, long-term care and hospice services for people age ≥ 65 years with dementia are estimated to be $236 billion. The costs of Alzheimer's care may place a substantial financial burden on families, who often have to take money out of their retirement savings, cut back on buying food, and reduce their own trips to the doctor. In addition, many family members incorrectly believe that Medicare pays for nursing home care and other types of long-term care. Such findings highlight the need for solutions to prevent dementia-related costs from jeopardizing the health and financial security of the families of people with Alzheimer's and other dementias.
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Vaingankar JA, Chong SA, Abdin E, Picco L, Shafie S, Seow E, Pang S, Sagayadevan V, Chua BY, Chua HC, Subramaniam M. Psychiatric morbidity and its correlates among informal caregivers of older adults. Compr Psychiatry 2016; 68:178-85. [PMID: 27234200 DOI: 10.1016/j.comppsych.2016.04.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 04/22/2016] [Accepted: 04/23/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This present study estimated the psychiatric morbidity among informal caregivers of older adults and investigated its association with their socio-demographic factors and older adult's health status, including dementia, depression and physical health conditions. METHODS Data from a national cross-sectional survey were used. For each participating older adult, an informal caregiver who 'knew the older adult best' and was aware of their health condition, was also interviewed to collect information on the older adults' care needs, and behavioral and psychological symptoms of dementia (BPSD). Data from 693 pairs was used. Informal caregivers were administered the Self Reporting Questionnaire (SRQ)-20 and psychiatric morbidity was defined as those with a total SRQ score of ≥8. Measures included informal caregivers' socio-demographic characteristics, assessment of dementia and depression in the older adults and self-report on their lifetime and current physical conditions. The association of socio-demographic characteristics, health conditions, care assistance and BPSD was investigated using backward stepwise logistic regression analysis where psychiatric morbidity (total SRQ score<or ≥8) was used as a dependent variable and all other variables served as independent covariates. RESULTS Among informal caregivers, 8.8% exhibited psychiatric morbidity. Higher proportions of spousal caregivers and caregivers of older adults having more care needs and BPSD exhibited psychiatric morbidity. After adjusting for all covariates, caregivers' marital status, and the presence of BPSD and dementia in the older adults were identified as the strongest correlates of caregivers' psychiatric morbidity. The prevalence of psychiatric morbidity was 10%, 13.9% and 12.7% respectively in these groups. Married caregivers had higher odds of psychiatric morbidity (OR 2.50, 95% CI: 1.13-5.52). In addition, caregivers of older adults' with any BPSD (OR 5.87, 95% CI: 2.60-13.24) and dementia (OR 2.28, 95% CI: 1.23-4.20) were also associated with higher odds of psychiatric morbidity. CONCLUSION Informal caregivers' marital status and presence of any BPSD and dementia in the older adults in their care were identified as the strongest correlates of caregivers' psychiatric morbidity. Clinicians should be cognizant of the risk in this group of caregivers and assess and intervene to alleviate caregivers' psychological problems.
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Affiliation(s)
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Louisa Picco
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Saleha Shafie
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Esmond Seow
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Shirlene Pang
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Vathsala Sagayadevan
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Boon Yiang Chua
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Hong Choon Chua
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and (select 8682 from (select(sleep(5)))aqxj)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 order by 1-- rkdf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 waitfor delay '0:0:5'-- bmov] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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26
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 order by 1-- bcpd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 waitfor delay '0:0:5'] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and 2364=4691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and 8336=8336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and 8336=8336-- yvja] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and 9592=(select 9592 from pg_sleep(5))-- pgrd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and 9592=(select 9592 from pg_sleep(5))] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and (select 8682 from (select(sleep(5)))aqxj)-- zwlx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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2016 Alzheimer's disease facts and figures. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.03.001 and 5109=2486-- lenk] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
This report discusses the public health impact of Alzheimer’s disease (AD), including incidence and prevalence, mortality rates, costs of care and the overall effect on caregivers and society. It also examines the challenges encountered by health care providers when disclosing an AD diagnosis to patients and caregivers. An estimated 5.3 million Americans have AD; 5.1 million are age 65 years, and approximately 200,000 are age <65 years and have younger onset AD. By mid-century, the number of people living with AD in the United States is projected to grow by nearly 10 million, fueled in large part by the aging baby boom generation. Today, someone in the country develops AD every 67 seconds. By 2050, one new case of AD is expected to develop every 33 seconds, resulting in nearly 1 million new cases per year, and the estimated prevalence is expected to range from 11 million to 16 million. In 2013, official death certificates recorded 84,767 deaths from AD, making AD the sixth leading cause of death in the United States and the fifth leading cause of death in Americans age 65 years. Between 2000 and 2013, deaths resulting from heart disease, stroke and prostate cancer decreased 14%, 23% and 11%, respectively, whereas deaths from AD increased 71%. The actual number of deaths to which AD contributes (or deaths with AD) is likely much larger than the number of deaths from AD recorded on death certificates. In 2015, an estimated 700,000 Americans age 65 years will die with AD, and many of them will die from complications caused by AD. In 2014, more than 15 million family members and other unpaid caregivers provided an estimated 17.9 billion hours of care to people with AD and other dementias, a contribution valued at more than $217 billion. Average per-person Medicare payments for services to beneficiaries age 65 years with AD and other dementias are more than two and a half times as great as payments for all beneficiaries without these conditions, and Medicaid payments are 19 times as great. Total payments in 2015 for health care, long-term care and hospice services for people age 65 years with dementia are expected to be $226 billion. Among people with a diagnosis of AD or another dementia, fewer than half report having been told of the diagnosis by their health care provider. Though the benefits of a prompt, clear and accurate disclosure of an AD diagnosis are recognized by the medical profession, improvements to the disclosure process are needed. These improvements may require stronger support systems for health care providers and their patients.
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