LEBANON, NH – To address the burgeoning demands of Alzheimer's disease that will affect generations, new policies will have to be adopted to acknowledge the complex and unique needs of people with dementia.
The aging of the U.S. population has turned the prism to focus on the increasing number of families facing the challenge of providing care for people with dementia, said Julie P.W. Bynum, associate professor at The Dartmouth Institute for Health Policy & Clinical Practice. Writing in the April issue of Health Affairs, she says the "long reach" of Alzheimer's will have an affect on broad-based national policies that must be addressed sooner rather than later.
In one important way, Alzheimer's disease is unlike the four chronic conditions that cause more deaths – heart disease, cancer, stroke and chronic pulmonary disease, Bynum says. With Alzheimer's, there is no way to prevent or slow the disease's progression. It is estimated that cases will increase from 3 million in 2011 to more than 10 million in 2050.
The most striking implications have to do with cost. Because the majority of the cases involve people over 65, Medicare bears the brunt of the costs. And, because patients often require long-term care and outlive their assets, Medicaid ends up paying for a large part of needed nursing home care.
The annual cost of providing care for all people over the age of 70 in the U.S. is estimated at $157-$215 billion in 2010. The direct cost is estimated to be $109 billion, higher than similar costs for heart disease or cancer ($102 billion and $77 billion respectively). By 2040, spending on dementia patients is estimated to be $1.2-$1.6 trillion, if no breakthrough therapies emerge.
Additional costs are borne by informal (unpaid) caregivers, such as spouses or family members, who provide basic daily care and a safe environment. But these caregivers present their own set of policy challenges with associated loss of work productivity and declines in their own health.
Alzheimer's carries far-reaching implications for the policy community, as the impact of dementia reaches well beyond the individual patient and his or her caregivers, Bynum says.
The Policy Implications:
"Patients' complex and expensive care needs and increasing numbers of people with dementia underscore the need to pay greater attention to how society protects and provides services for this vulnerable population at a cost that is sustainable, all while continuing to pursue treatments and cures." Bynum said.
To view the abstract of the Viewpoint in Health Affairs, please go to http://content.healthaffairs.org/content/33/4/534.abstract
The Dartmouth Institute for Health Policy & Clinical Practice was founded in 1988 by Dr. John E. Wennberg as the Center for the Evaluative Clinical Sciences (CECS). Among its 25 years of accomplishments, it has established a new discipline and educational focus in the Evaluative Clinical Sciences, introduced and advanced the concept of shared decision-making for patients, demonstrated unwarranted variation in the practice and outcomes of medical treatment, developed the first comprehensive examination of US health care variations (The Dartmouth Atlas), and has shown that more health care is not necessarily better care.
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