(Charlie Schuck/UpperCut Images/Getty Images)
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Robert Egge says the nation's looming Alzheimer's crisis is staggering, and it's partly the result of medical advances, which
have extended the average American's lifespan by three decades since the beginning of the 20th century. Age is the top risk
factor for Alzheimer's disease (AD).
As vice president of public policy and advocacy for the Alzheimer's Assn., Egge knows the numbers by heart.
"We know that based on the demographics and also, to an extent, the life expectancy, that cases are going to increase perhaps
as much as threefold," Egge says. "It's going to be a rapid increase, unlike almost any other condition or disease that healthcare
systems are going to contend with. And, compounding that, it's a very expensive disease."
As the population ages, AD is destined to become an increasing burden on the health system, including managed care. Managed
care's initial concern might center around the effects of cognitive impairment among Alzheimer's patients, which complicates
management of chronic diseases and causes higher risk for other acute hospitalizations from, for example, falling accidents.
The number of people with Alzheimer's is expected to almost triple to 14 million by 2050, up from today's 5 million. Not surprisingly,
patients with Alzheimer's disease and Alzheimer's disease-related dementias (ADRD) are heavy users of hospital and long-term
care services, especially nursing home care, with estimated annual costs reaching tens of millions of dollars.
ALZHEIMER'S ACTUALITY
The 2009 Facts and Figures report from the Alzheimer's Assn. shows how costly AD is, especially when combined with other comorbid
medical conditions. According to the report, in 2006:
- Medicare beneficiaries with diabetes and ADRD had 64% more hospital stays than those with diabetes alone, and their average
per person Medicare costs were $20,655, compared with $12,979 for beneficiaries with diabetes but no ADRD.
- Medicare beneficiaries with coronary heart disease and ADRD had 42% more hospital stays than those with coronary heart disease
alone, and their average per person Medicare costs were $20,780, compared with $14,640 for beneficiaries with coronary heart
disease but no ADRD.
Percentage Changes in Selected Causes of Death, 2000 and 2006
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Family members provide care at home for about 70% of those with AD. In 2008, nearly 10 million Alzheimer's caregivers in the
United States provided 8.5 billion hours of unpaid care, valued at $94 billion. In addition to the unpaid care families contribute,
the report also found that Alzheimer's creates high out-of-pocket health and long-term care expenses for families.
Out-of-pocket costs that are not covered by Medicare, Medicaid or other sources of insurance are 28% higher for Medicare beneficiaries
with ADRD than those without. Individuals with ADRD and other dementia living in nursing homes or assisted living facilities
incurred the highest out-of-pocket costs—an average of $16,689 a year.
Katie Maslow, the Alzheimer's Assn. associate director for quality care advocacy, says approximately one-fourth of all elderly
patients treated in a hospital also suffer from dementia—usually AD.
"People with dementia fall down more," Maslow says. "There are increased lengths of stay for people with dementia. So, with
the [diagnosis related group] payment, it costs the hospital more."
