Alzheimer’s Disease Awareness Month: Nearly 6M Americans have it, burden projected to grow to 13.9M by 2060
Millions of Americans have Alzheimer’s disease or other dementias. As the size of the US population aged 65 and older continues to increase, the number of Americans with Alzheimer’s or other dementias will grow, predict health experts. An estimated 5.8 million people in the US aged 65 years and older are living with Alzheimer’s in 2020. Eighty percent are 75 years or older.
According to the Alzheimer’s Association, out of the total US population, one in 10 people (10%) aged 65 years and older has Alzheimer’s. The percentage of people with the disease increases with age: 3% of people age 65-74, 17% of people age 75-84, and 32% of people age 85 and older have it. People younger than 65 can also develop Alzheimer’s, but it is much less common and prevalence is uncertain.
The estimated number of people aged 65 and older with Alzheimer’s comes from a study that used the latest data from the 2010 US Census and the Chicago Health and Aging Project (CHAP), a population-based study of chronic health conditions of older people. The estimates are likely an undercount. “Because Alzheimer’s dementia is often underdiagnosed — and if it is diagnosed, people are often unaware of their diagnosis — a large portion of Americans with Alzheimer’s may not know they have it,” write authors.
A recent survey by the Alzheimer’s Association, for example, found that on average, primary care physicians inform their patients 92% of the time when cognitive impairment is detected, and 64% of the physicians reported they always inform patients. Of the 36% of surveyed physicians who do not always inform their patients, 73% say it is because it is premature to do so before a full diagnostic workup, and 41% say brief cognitive assessments have high rates of false positives or false negatives.
The experience of worsening or more frequent confusion or memory loss (often referred to as subjective cognitive decline) is one of the earliest warning signs of Alzheimer’s disease and maybe a way to identify people who are at high risk of developing it. The Behavioral Risk Factor Surveillance System survey, which includes questions on subjective cognitive decline, found that 11% of Americans aged 45 and older reported subjective cognitive decline, but 54% of those who reported it had not consulted a healthcare professional. Not all of those who experience subjective cognitive decline goes on to develop dementia.
“Subjective cognitive decline refers to a self-perceived worsening of memory and other thinking abilities by an individual, separate from cognitive testing, clinical diagnosis, or anyone else noticing. Individuals concerned about declines in memory and other cognitive abilities should consult a healthcare professional,” recommend experts.
More women than men are affected by it: nearly two-thirds of Americans with Alzheimer’s are women. Of the 5.8 million, 3.6 million are women and 2.2 million are men. Based on other estimates, among people aged 71 and older, 16% of women have Alzheimer’s or other dementias compared with 11% of men.
Incidence and future projections
Incidence provides a measure of risk for developing a disease. According to one analysis, approximately 491,000 people aged 65 or older will develop Alzheimer’s in the US in 2020. Other studies have arrived at much higher incidence estimates. For example, as per CHAP estimates, approximately 910,000 people aged 65 or older developed Alzheimer’s in the US in 2011, a number that would be expected to be even higher in 2020 if CHAP estimates were available for that year.
“By 2025, the number of people age 65 and older with Alzheimer’s dementia is projected to reach 7.1 million — almost a 22% increase from the 5.8 million age 65 and older affected in 2020,” reveals analysis.
According to the US Centers for Disease Control and Prevention (CDC), the burden of Alzheimer’s disease and related dementias in 2014 was 5 million people, which is 1.6% of the US population in 2014, or 319 million people. This burden is projected to grow to 13.9 million, nearly 3.3% of the population in 2060 – that is, 417 million people.
The Alzheimer’s Association report indicates that between 2020 and 2025, every state across the country is expected to experience an increase of at least 6.7% in the number of people with Alzheimer’s. These projected increases in the number of people with Alzheimer’s are due solely to projected increases in the population age 65 and older in these states. Because risk factors for dementia such as midlife obesity and diabetes can vary dramatically by region and state, the regional patterns of future burden may be different than reported here. Based on these projections, the West and Southeast are expected to experience the largest percentage increases in people with Alzheimer’s dementia between 2020 and 2025.
Alzheimer’s is the sixth-leading cause of death in the US and the fifth-leading cause of death among those age 65 and older. An estimated 1 in 3 seniors dies with Alzheimer’s or another dementia. It is also the leading cause of disability and poor health. Before a person with Alzheimer’s dies, he or she lives through years of morbidity as the disease progresses.
While deaths from other major causes have decreased significantly or remained the same, official records indicate that deaths from Alzheimer’s disease have increased significantly. Between 2000 and 2018, the number of deaths from Alzheimer’s as recorded on death certificates has more than doubled, increasing 146%, while the number of deaths from the number one cause of death (heart disease) decreased by 7.8%.
For the US as a whole, the death rate for Alzheimer’s in 2018 — the most recent year for which state-by-state data are available — was 37.3 deaths per 100,000 people.
Among other findings, the analysis shows that between 2000 and 2018, the death rate from Alzheimer’s increased 32% for people age 65 to 74, but increased 53% for people age 75 to 84 and 84% for people age 85 and older. Among people aged 70, 61% of those with Alzheimer’s are expected to die before the age of 80 compared with 30% of people without Alzheimer’s — a rate twice as high.
“The increase in the number of death certificates listing Alzheimer’s as the underlying cause of death probably reflects both a real increase in the actual number of deaths from Alzheimer’s due in large part to the disease becoming a more common cause of death as the population ages, as well as increased reporting of Alzheimer’s deaths on death certificates over time by physicians, coroners and others who assign causes of death,” explains the report.
People aged 65 and older survive an average of 4 to 8 years after a diagnosis of Alzheimer’s dementia, yet some live as long as 20 years with Alzheimer’s. This reflects the slow, uncertain progression of the disease, says the Alzheimer’s Association. “A person who lives from age 70 to age 80 with Alzheimer’s dementia will spend an average of 40% of this time in the severe stage. Much of this time will be spent in a nursing home. At age 80, approximately 75% of people with Alzheimer’s dementia live in a nursing home compared with only 4% of the general population age 80,” it emphasizes.
Cost to the nation
The costs of healthcare and long-term care for individuals living with Alzheimer’s or other dementias are substantial, and dementia is one of the costliest conditions to society. In 2020, Alzheimer’s and other dementias are projected to cost the US $305 billion, including $206 billion in Medicare and Medicaid payments. Out-of-pocket spending is expected to be $66 billion, or 22% of total payments.
Studies suggest that people living with Alzheimer’s or other dementias have twice as many hospital stays per year as other older people. Older people living with Alzheimer’s or other dementias have more skilled nursing facility stays and home health care visits per year than other older people. People living with Alzheimer's or other dementias also make up a large proportion of all elderly people who receive adult day services and nursing home care.
“Unless a treatment to slow, stop or prevent the disease is developed, in 2050, Alzheimer’s is projected to cost more than $1.1 trillion (in 2020 dollars). This dramatic rise includes more than four-fold increases both in government spending under Medicare and Medicaid and in out-of-pocket spending,” warn researchers.