Implications of Longer Life Expectancies

Implications of Longer Life Expectancies-AD Part VIII of a XXVIII Article

(2/3/21)-Tony Bennet, the 94-year-old singing legend was revealed by his wife Susan, and oldest son Danny, to have Alzheimer’s disease, The news appeared in an article in AARP The magazine. The first sign of the disease began to appear in 2015, according to the article.

“He’s not the old Tony anymore”, Susan related in the article, “But when he sings, he’s the old Tony.”

(4/29/14)- Of approximately 5.2 million people with AD in the United States, only 200,000 are younger than 65 years. By the year 2050, the anticipated incidence is 1 million new cases per year, with a total estimated prevalence of 13.8 million. In 2010, AD was the sixth leading cause of death in the United States overall and the fifth leading cause of death in persons 65 years or older.

According to the new 2014 Alzheimer's Association Alzheimer's Disease Facts and Figures report, at age 65 years, a woman's estimated lifetime risk for the development of AD is 1 in 6, which is approximately twice the risk of contracting breast cancer.

This risk is also much higher than the AD risk for men. A man's estimated lifetime risk for the development of AD at age 65 years is approximately 1 in 11.

One in 9 older people in the United States has AD. This includes 4% of those younger than 65 years, 15% of those 65 to 74 years old, 44% of those 75 to 84 years old, and 38% of those 85 years and older.

(4/3/13)- The NCHS Data Brief, #116, March 2013 reports that a total of 83,494 deaths were attributed to Alzheimer's disease and "was classified as a contributing cause for an additional 26,488 deaths in the year 2010. "Mortality attributed to Alzheimer's disease has been steadily increasing during the last 30 years. It is the 6th leading cause of death in USA and the 5th leading cause of death in individuals over 65. People over 85 have a 5.4 times greater risk of dying from Alzheimer's disease than people aged 75-84 years."

The death rate is higher for women than for men and higher for the non-Hispanic white population than for the non-Hispanic black population and the Hispanic origin population.

The NCHS Data Brief reports that "[T]he age-adjusted death rate from Alzheimer's disease increased by 39% from 2000 through 2010 in the United States". The most reliable estimate of the incidence of Alzheimer's disease indicates that 5.4 million people have the disease. There is no known cure for this disease.

The cost of health care for all forms of dementia appears to have reached the 200 million dollar level and with the baby boomers reaching the age when dementia begins to manifest themselves, will reach over one trillion dollars by 2050. The cost to Medicare and Medicaid for dementia is estimated at 140 million dollars in 2012.

How serious is Alzheimer's disease compared to other disease is reflected in figures on the percentage change in age-adjusted death rates for selected causes of deaths in the United States between 2000 and 2010. Indications are that while Alzheimer's disease rose about 39%, cancer dropped 31.6%, heart disease dropped 30.5%, stroke dropped 35.8% and diabetes mellitus dropped 4.5%. The challenge is out there for our scientific community to do something about this disease before it has even more devastating effects on our nation.

(3/25/13)- Data from the Centers for Disease Control and Prevention (CDC) indicated that the risk of death from degenerative brain disease rose 39% from 2000 to 2010, even though mortality rates for other diseases like cancer, heart disease and stroke fell significantly.

A report from the Alzheimer's Association based on death rate data from the CDC found that the mortality rate was up 68% over the decade from 2000 to 2010.

(3/10/12)- The report issued by the Alzheimer's Association on 3/8/12 estimates that as many as 800,000 Americans have Alzheimer's disease and live alone out of a total of 4.5 million with AD.

As many as half of these people don't have specific arrangements to help them get care. The Alzheimer's Association's "2012 Alzheimer's Disease Facts and Figures" finds that the cost of caring for patients with Alzheimer's and other dementias will total $200 billion this year and is projected to increase to $1.1 trillion a year by 2050.

(6/22/09)- On March 24, 2009, against a backdrop of global financial turmoil, the Alzheimer's Association released its Alzheimer's Disease Facts and Figures Report. Among the alarming statistics is an estimate that care for people with dementia costs more than US $148 billion per year in the USA alone.

The report indicated that 5.3 million people have Alzheimer's disease; that a new case occurs every 70 seconds and that Alzheimer's disease is the 6th leading cause of death.

(8/7/08) The Medical Research Council (MRC) Cognitive Function and Aging Study (CFAS) is a large UK-based longitudinal multicoated study looking at the health and cognitive function of older people. The study started in the late 1980s with the initial aim of investigating dementia and cognitive decline in a representative sample of more than 18,000 people aged over 65 years.

CFAS investigated a number of potential risk factors for dementia. Data on these risk factors was collected at the first interviews with participants (baseline). Any association with the development of dementia in the population was analyzed after 2 years and 6 years. (a nested case-control analysis of a population-based cohort study)

Findings

The study found that female sex and particularly increasing age were more strongly associated with dementia
More years of education were associated with lower levels of dementia.
Poor self-perceived health increased the risk for incident dementia
Alcohol and smoking (never, past and current) were neither strongly protective nor predictive.
Stroke was strongly related to incident dementia as was Parkinson’s disease
Exposure to general anesthesia (GA) was inversely associated with dementia development with a trend with increasing GA exposure.
The median survival time for persons aged 65 years and older who developed incident dementia is 4.5 years from onset.
The significant factors that predicted mortality in the presence of dementia include sex, age of onset and disability.
Survival among those with dementia who were between ages of 65 and 69 at onset was 10.7 years, compared with 3.8 years for those aged 90 years and older.

(This information was published online before print Jan. 10, 2008: BJM)

(6/24/07)- Estimates presented at the recent Alzheimer's Association conference in Washington are that more that 26 million people worldwide have Alzheimer's disease, and a forecast says the number will more than quadruple by 2050.

Researchers at Johns Hopkins University conclude that one in 85 people will have the disease in 40-years.

The biggest jump is projected for Asia, where there are a currently estimated 12.6 million cases of Alzheimer's. By 2050 Asia will have 62.8 million of the world's 106 million Alzheimer's patients. In this country it is estimated that there are 3.1 million current cases, and 8.8 million by 2050. This new estimate is lower than the 5 million estimate present cases that was the accepted number up until now.

(3/26/07)- More than 5 million Americans have Alzheimer's disease, which is a 10% increase from the last official total from 5 years ago. With an aging population this number will continue to grow, since the disease now afflicts 13% of the population over 65 years of age, and 42% of those older than 85 years of age.

These were the latest figures that were released by the Alzheimer's Association, along with a compilation of other figures about the disease.

There are only 5 drugs that are currently approved by the FDA to deal with the disease. None of the drugs can cure it. There are presently 9 other drugs in late-stage Phase III trials.

The Rush Alzheimer's Disease Center in Chicago provided some estimates at a Congressional hearing in Washington, where the federal legislative branch is considering a bipartisan bill to increase research funding for the disease.

The report itemizes the cost to the federal government in Medicare spending. Care for a patient with the disease costs three times as much as care for the average Medicare beneficiary- $13,207 a year versus $2,454. The Rush estimate was based on local information which was then extrapolated to national prevalence using census population figures and census projections.

(7/17/06)- The Alzheimer's Association has a new Web site which includes sections on planning ahead, care options, coordinating care and support and resources. The site can be found at www.alz.org/carefinder

There is also an interactive tool on the site that recommends care options for individuals and generates questions to ask when screening care providers or facilities.

According to statistics released by the City of New York, Alzheimer's is now the leading cause of death among individuals 75 and older for first time. To view these statistics go to: www.nyc.gov/html/doh/pdf/vs/2003sum.pdf , and you will be led to the correct site from there.

(10/2002)-Along with the good news that most Americans are living longer comes the sobering data that older people are at high risk for both stroke and Alzheimer’s disease. Under the new cause-of-death classification system initiated by the Center for Disease Control, there was a substantial increase in the ranking for Alzheimer's disease as the cause of death. In 1998, Alzheimer's disease ranked 12th among leading causes of death but it jumped to 8th in 1999, due mainly to the inclusion of a cause of death formerly classified separately as "presenile dementia," which accounted for the substantial number of additional Alzheimer's deaths in 1999. The 44,507 deaths from Alzheimer's disease in 1999 surpassed the totals for other major causes of death, including motor vehicle accidents and breast cancer.

Long-term care issues are becoming more of a major problem in our society. Results from the Gothenburg Study of older people described in Skoog et al indicate a 43.5% prevalence rate of Alzheimer’s disease in people over 85 years of age. This should alert all of us to be aware of the latest prevention and treatment modalities for this chronic debilitating disease for which there is no present cure.

The National Institute on Aging's Alzheimer's Disease Education and Referral Center is pleased to announce the release of the newly updated publication "Home Safety for People with Alzheimer's Disease." This 40-page booklet offers helpful tips and guidelines, room by room and behavior by behavior, for families and others taking care of people with AD at home.

Copies of the booklet are available FREE from the ADEAR Center, by calling 1-800-438-4380, or by e-mail to adear@alzheimers.org. You can preview or download the publication online at http://www.alzheimers.org/pubs/homesafety.htm. This publication will soon also be available in Spanish.

The American Journal of Geriatric Psychiatry (2000; 15:50-53) contained a study done in England by Mavis Evans and her group on the role of the drug Donepezil (Aricept) in sustaining cognitive improvement in Alzheimer disease patients. Individuals with mild to moderate Alzheimer’s disease were the target population. Mavis et al found that, in the entire population they studied, 51% showed cognitive improvement, while 65% of those who complied with the study protocol for three months improved cognitively. When the latter group was followed for twelve months, they maintained their cognitive improvement. (See our other articles on Alzheimer’s Disease referred to below)

Caregivers of these patients, when asked about behavioral improvement, independent of cognitive improvement, reported less difficulty in managing patients. This may have been the result of counseling the caregivers received which was an important component of the treatment received by patients in this study.

This study is complemented by the study of Schultz & Beach of the Dept. of Psychiatry and University Center for Social & Urban Research at University of Pittsburgh on "Caregiving as a Risk Factor for Mortality" which demonstrated that caregiving is a risk factor for mortality. This study showed that chronic prolonged distress can influence cardiovascular, immune and endocrine function and these alterations are sufficient to enhance a variety of health treats, particularly among elderly adults. Schultz and Beach recommend that physicians evaluate older married couples as a unit, both in terms of their health status and their caregiving demands

These studies, among many, highlight the need not only for medical treatment but also for counseling of both patients and caregivers at every stage of any devastating disease. In our society, marriage is central to most relationships. Studies time and again have shown that morbidity and mortality are lower for married than unmarried individuals across a variety of health threats and chronic medical conditions. Social support appears to be a critical factor in staving off illness or enhancing speed of recovery. (See Kiecolt-Glaser JK, Dura JR, Speicher CE, Trask OJ, Glaser R. Spousal caregivers of dementia victims, longitudinal changes in immunity and health. Psychosomatic Medicine 1991; 53:345-362.)

Another challenge facing individuals as they age is housing. The need for residential alternatives to the traditional apartment or home is evident and will get even more critical as the population over 65 years of age expands. By the year 2030, the population of individuals over 65 years is expected to pass the 20% mark.

Harvard’s Joint Center for Housing Studies has examined this problem and found that only about 10% of older people live in age-restricted communities, and another 10% either move in with someone or have someone move in with them. The NY Times (Feb. 18, 2000) quotes the executive director of the Joint Center, Eric Belsky, as saying "Fewer seniors will have large families from which to draw support, and continuing income and wealth disparities among seniors will restrict the housing choices of many seniors." This impending issue will face the majority of Americans and must have the attention of all our political leaders, locally and nationally, to avoid crisis intervention band-aid tactics that make it easier for scheming entrepreneurs to take advantage of needy elderly individuals. Long-term care facilities seem always to be beset with care problems and financial manipulations. Prototype senior housing programs have been developed by the Housing and Urban Development Agency which will have to be expanded in the near future to meet the needs of a growing population.

Coverage of the costs of assisted-living housing centers can prove a major problem. Long-term care insurance is available. About 100 companies sell this type of insurance and it is difficult to navigate the intricacies of buying such insurance. Robert Atchley, chair of the gerontology department at Naropa University, feels this insurance is a gamble, since only about 10 percent of people in their 60’s will ever need long-term care. He basis this estimate on data from the National Center for Health Statistics. He further estimates that less then half the people in their 80’s will need long-term care placement. The United Seniors Health Cooperative, a nonprofit organization sells a paperback, "Long-Term-Care Planning: A Dollar and Sense Guide", for $18.50, which could prove helpful. They can be contacted at (800) 637-2604.

FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "HOW TO SELECT A NURSING HOME"

By Harold Rubin, MS, ABD, CRC, Guest Lecturer
updated February 3, 2021.

http://www.therubins.com

email harold.rubin255@gmail.com or allanrubin4@gmail.com

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