Clinical economics: Alzheimer's disease

Alzheimer’s disease is the sixth leading cause of death in the United States and one in three seniors dies with Alzheimer’s disease or another form of dementia, according to statistics from the Alzheimer’s Association.

As of this year, an estimated 5.3 million Americans of all ages have Alzheimer’s disease. This number includes an estimated 5.1 million persons age 65 and older and approximately 200,000 individuals under age 65 with younger-onset Alzheimer’s.

Almost two-thirds of Americans with Alzheimer’s are women, and about 81% of persons who have Alzheimer’s disease are age 75 or older.

As the proportion of older Americans continues to increase, so will the number of patients with Alzheimer’s disease. Over the next 10 years, every state and region in the United States is expected to experience an increase of at least 14% in the incidence of Alzheimer’s due to increases in the population aged 65 and older. These increases will have a significant impact on societies and health care systems, as well as on families and caregivers.

Of the top 10 causes of death in the United States, Alzheimer’s disease is the only one that cannot be prevented or cured. Unless a medical breakthrough facilitates the cure or prevention of the disease, the number of persons age 65 and older with Alzheimer’s disease may nearly triple, from 5.1 million to a projected 13.8 million, by 2050.

Related:Alzheimer's disease affects women more as patients and caregivers

Alzheimer’s disease confers a heavy familial and financial burden. More than 15 million Americans act as unpaid caregivers for loved ones with Alzheimer’s disease, and more than 40% of those caregivers report high levels of emotional stress associated with their roles. The value of this indirect, unpaid care has been estimated at more than $217 billion.

The direct annual costs of Alzheimer’s disease care in America, including healthcare, long-term care and hospice, are approximately $226 billion. Of this cost, Medicare and Medicaid are expected to cover $153 billion, or 68% of the total.

With the exception of prescription medications, the average per-capita payments for the total cost of care across the spectrum, including hospital, physician, other medical providers, nursing home, skilled nursing facility, hospice and home healthcare were higher for those Medicare beneficiaries with Alzheimer’s disease when compared with others in the same age group.

Alzheimer’s disease has become one of the costliest chronic diseases in the United States. “It is a devastating disease that slowly robs people of their independence and eventually their lives,” explained Harry Johns, MBA, president and chief executive officer of the Alzheimer’s Association. “Sadly, Alzheimer’s disease knows no bounds.”

The primary care physician is often the first medical point of contact for patients and caregivers, and they may be the first to recognize symptoms of Alzheimer’s disease in their patients. This underscores the importance of incorporating effective communication strategies for partnering with patients and their loved ones.

NEXT: Alzheimer's disease patient management tips

Patient management tips

First point of contact

The primary care physician is often the first point of contact when family members suspect that a loved one has Alzheimer’s disease or dementia.

Alternatively, the physician may be the first to recognize early signs of Alzheimer’s disease in their older patients at routine visits or during management of other conditions. In either case, clinicians should be prepared to initiate a discussion about dementing illness and Alzheimer’s disease with patients, family members, and caregivers.

Realistic management goals

The progression of Alzheimer’s disease cannot be stopped or reversed, although some pharmacological treatments can slow the cognitive changes associated with the condition. Positive response to treatment is defined as long-term stabilization or slowed rate of decline. Setting realistic goals for patient management and communicating these effectively to patients and caregivers are important.

Patients and caregivers may also need help identifying and understanding the aspects of disease progression that they are most concerned about. These often include preservation of personality, ability to complete activities of daily living, ability to contribute to family life, behaviors during social interaction and leisure, and delayed need for nursing home admission or in-home care.

Collaborative care models

Because of the multifaceted, chronic nature of Alzheimer’s disease, a collaborative care model may be most efficient for providing care. Components of a successful patient management program often include a care team comprised of the primary care physician, a care manager, specialists, social workers/counselors, and the patient’s caregiver. A care manager can play an important role in coordinating care with specialists, identifying educational and community resources for the patient and family, and providing support to caregivers. When using a multidisciplinary approach, all members of the patient care team should be aligned on the following points:

• Individualized treatment plan/patient goals

• Selection of pharmacotherapy

• Regular monitoring of outcomes

• Protocols for stepped care

Caregiver burden

The significant stress experienced by caregivers can impact their own health. It is crucial, therefore, to consider the caregiver’s needs in balance with those of the patient.

Primary care physicians can help caregivers get needed support by providing sufficient educational resources-such as those listed below-and recommending community resources, support groups, and psychosocial counseling as appropriate.