[Vision2020] Dementia Care Cost Is Projected to Double by 2040

Art Deco art.deco.studios at gmail.com
Thu Apr 4 03:42:05 PDT 2013


  [image: The New York Times] <http://www.nytimes.com/>

------------------------------
April 3, 2013
Dementia Care Cost Is Projected to Double by 2040 By PAM
BELLUCK<http://topics.nytimes.com/top/reference/timestopics/people/b/pam_belluck/index.html>

The most rigorous study to date of how much it costs to care for Americans
with dementia<http://health.nytimes.com/health/guides/disease/dementia/overview.html?inline=nyt-classifier>found
that the financial burden is at least as high as that of heart
disease or cancer<http://health.nytimes.com/health/guides/disease/cancer/overview.html?inline=nyt-classifier>,
and is probably higher. And both the costs and the number of people with
dementia will more than double within 30 years, skyrocketing at a rate that
rarely occurs with a chronic disease.

The research <http://www.nejm.org/doi/full/10.1056/NEJMsa1204629>, led by
an economist at the RAND Corporation, financed by the federal government,
and published Wednesday in The New England Journal of Medicine, provides
the most reliable basis yet for measuring the scale of the problem. Until
now, the most-cited estimates of the condition’s cost and prevalence came
from an advocacy group, the Alzheimer’s Association.

Although some figures from the new research are lower than the
association’s projections, they are nonetheless staggering and carry new
gravity because they come from an academic research effort. Behind the
numbers is a sense that the country, facing the aging of the baby boom
generation, is unprepared for the coming surge in the cost and cases of
dementia.

“It’s going to swamp the system,” said Dr. Ronald C. Petersen, who is
chairman of the advisory panel to the federal government’s recently created
National Alzheimer’s<http://health.nytimes.com/health/guides/disease/alzheimers-disease/overview.html?inline=nyt-classifier>Plan
and was not involved in the RAND study.

If anything, Dr. Petersen said of the study’s numbers, “they’re being
somewhat conservative.” Dr. Petersen, the director of the Alzheimer’s
Disease Research Center at the Mayo Clinic, is part of another team
collecting data on dementia costs.

The RAND results show that nearly 15 percent of people aged 71 or older,
about 3.8 million people, have dementia. By 2040, the authors said, that
number will balloon to 9.1 million people.

“I don’t know of any other disease predicting such a huge increase,” said
Dr. Richard J. Hodes, director of the National Institute on Aging, which
financed the study. “And as we have the baby boomer group maturing, there
are going to be more older people with fewer children to be informal
caregivers for them, which is going to intensify the problem even more.”

The study found that direct health care expenses for dementia, including
nursing home care, were $109 billion in 2010. For heart disease, those
costs totaled $102 billion; for cancer, $77 billion.

The study also quantified the value of the sizable amount of informal care
for dementia, usually provided by family members at home. That number
ranged from $50 billion to $106 billion, depending on whether economists
valued it by the income a family member was giving up or by what a family
would have paid for a professional caregiver.

Michael D. Hurd, the lead author and a principal senior researcher at RAND,
said the team could find no research quantifying such informal care for
heart disease and cancer. But he and other experts agree that given the
intensive nature and constant monitoring required to care for people with
dementia, informal costs are probably much higher than those for most other
diseases.

Dr. Petersen said, “Clearly, dementia is going to outstrip those
dramatically.”

Without a way to prevent, cure or effectively treat these conditions yet,
the bulk of the costs — 75 to 84 percent, the study found — involves
helping patients in nursing
homes<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/nursing_homes/index.html?inline=nyt-classifier>or
at home manage the most basic activities of life as they become
increasingly impaired cognitively and then physically.

“The long-term care costs associated with people with dementia are
particularly high because of the nature of the disease,” said Donald
Moulds, acting assistant secretary for planning and evaluation at the
federal Department of Health and Human Services. “People eventually become
incapable of caring for themselves, and then in the vast majority of cases,
their loved ones become incapable of caring for them.”

Each case of dementia costs $41,000 to $56,000 a year, the study said.
Researchers project that the total costs of dementia care will more than
double by 2040, to a range of $379 billion to $511 billion, from $159
billion to $215 billion in 2010. Because the population will also increase,
Dr. Hurd said, the burden of cost per capita will not grow quite as fast,
but will still be nearly 80 percent more in 2040.

The study used information collected over almost a decade on nearly 11,000
people from a large database called the Health and Retirement Study,
considered a gold standard among researchers on aging issues. All of the
people followed were given detailed cognitive
tests<http://health.nytimes.com/health/guides/test/mental-status-tests/overview.html?inline=nyt-classifier>,
while a subset of them were more intensely evaluated for dementia and their
results used as benchmarks to rate cognitive decline for the others, Dr.
Hurd said.

Dr. Hurd noted that in addition to the estimates of people with actual
dementia, earlier analyses of the same
data<http://annals.org/article.aspx?articleid=740207>estimated that 22
percent of people aged 71 and older — about 5.4 million
people — have mild cognitive impairment that does not reach the threshold
for dementia. In the study, about 12 percent of those people developed
dementia each year, meaning that they experienced problems with memory,
concentration and daily functioning that were severe enough to meet the
medical definition.

The number of dementia cases calculated in the RAND study is smaller than that
from the Alzheimer’s
Association<http://www.alz.org/alzheimers_disease_facts_and_figures.asp>,
which used a different database and tended to count people in earlier
stages of memory
loss<http://health.nytimes.com/health/guides/symptoms/memory-loss/overview.html?inline=nyt-classifier>.
The association estimates that five million people aged 65 and older have
Alzheimer’s, the most common dementia.

The RAND cost estimates for current dementia care are similar to the
Alzheimer’s Association’s, but the association’s future cost projections
are significantly higher: $1.2 trillion in 2050.

Robert Egge, the association’s vice president for public policy, said his
group’s cost projections are based on the assumption that “more and more
people will be in severe stages of dementia” in the future because they
will be older. He said his group welcomed the RAND study, especially its
comparison of dementia to other serious illnesses. It shows that groups
using different methodologies reached the same conclusion about the high
costs of dementia care, he said.

Dr. Petersen, whose team at the Mayo Clinic will be analyzing costs using a
third distinct data set, said he suspected that “the reality is somewhere
in the middle” of the RAND numbers and the Alzheimer’s Association’s
projections.

When it comes to dementia, Dr. Hurd said, his team’s study could not
capture the full toll of the disease. “One thing we haven’t talked about,
and it’s not in the paper, is the tremendous emotional cost,” he said.
“Economists are coldhearted, but they’re not that coldhearted.”


-- 
Art Deco (Wayne A. Fox)
art.deco.studios at gmail.com
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