Number of Americans with Alzheimer’s and related dementias will nearly double to 13 million in 20 years, says study
Alzheimer’s is the most expensive disease in the US and costs more than cancer and heart disease.
The number of Americans living with Alzheimer’s disease or other dementias is expected to nearly double — from 7.2 million to 13 million by 2040 — with the number of women being disproportionately impacted and projected to rise to 8.5 million.
With increased lifespans over the past century, the number of people living with dementia is expected to rise significantly, says the research team from Milken Institute, which released the latest projections at the 2019 Milken Institute Future of Health Summit in Washington, DC.
“Without a cure or disease modifying treatment, the growing population of people living with Alzheimer’s disease will strain families, caregivers and the overall health care system,” Rajiv Ahuja, an associate director in the Milken Institute Center for the Future of Aging, told MEA Worldwide (MEAWW).
Increased longevity, say experts, is perhaps one of the greatest success stories of our modern public health system. “People around the globe are living longer than ever before, thanks to major medical and public health advances and greater access to health care. Sixty-five-year-olds living in developed countries today can expect to live another 19 years on average, that’s age 83 for men and 86 for women,” says the research team.
According to Nora Super, lead author of the report and senior director of the Milken Institute Center for the Future of Aging, “Along with this success comes one of our greatest challenges to healthy longevity. As we age, the risk of neurodegenerative disease increases dramatically. Our risk of developing dementia doubles every five years after we turn 65; by age 85, nearly one in three of us will have the disease.”
Neurodegenerative diseases are characterized by a progressive deterioration of brain function, with a significant decrease in quality of life subsequently. Alzheimer’s disease is by far the most common type of neurodegenerative disease, affecting millions of people worldwide. According to the National Institutes of Health (NIH), dementia is the “loss of thinking, remembering, and reasoning… that interferes with a person’s daily life and activities.” Age is still the greatest risk factor for dementia.
“Our research determined 7.2 million Americans today live with Alzheimer’s disease or other dementias. Alzheimer’s disease is the most common cause of dementia and accounts for 60-80% of all cases, which means nearly 5.8 million people are currently living with Alzheimer’s disease in the US. Of those living with Alzheimer’s, 81% are age 75 and older,” says the study.
It further says, “This research projects that over the next 20 years, the total number of those living with Alzheimer’s disease or other dementias in the US is expected to approximately double from 7.2 million to nearly 13 million, with 8.5 million women and 4.5 million men.”
Women disproportionately impacted
Gender, says the team, is one of the most established determinants for developing dementia. By 2020, roughly 4.7 million women in the US are projected to have dementia, which represents nearly two-thirds of all people living with dementia, says the analysis. Women are disproportionately impacted, not only by the disease itself, but because they bear the majority of the responsibility for providing caregiving services.
The majority of dementia caregivers are women (58%) and are around age 54 on average, which is about six years older than non-dementia caregivers. The researchers say that women, on average, are more likely to handle the most challenging caregiving tasks — bathing, toileting, and dressing, with 36% of female caregivers taking on these responsibilities compared to 24% of men.
The research also shows that women caregivers spend more time providing care than men (21.9 against 17.4 hours per week). For people at the later stages of dementia, caregivers often report missing work or having to quit their jobs, and female caregivers are 40% more likely than male caregivers to quit their jobs.
According to Jill Lesser, a founding board member of UsAgainstAlzheimer's, among the ‘breakthrough’ findings, the new data have "unveiled key discoveries about the differences between men's and women's brains, and how they age. Moreover, women typically take on greater caregiver responsibilities than men. Women caregivers are more likely to be impacted financially and leave their jobs or miss work to care for a family member. And research demonstrates that spousal caregivers may be at a higher risk of cognitive impairment or dementia than non-caregivers."
Cost of Dementia
Alzheimer’s is the most expensive disease in the US and costs more than cancer and heart disease. According to the Alzheimer’s Association, direct costs accounted for $290 billion spent in 2019 across Medicare, Medicaid, private insurance, and out-of-pocket costs for individuals living with dementia.
An estimated 83% of caregiving in the US comes from family members, friends, or other unpaid caregivers. In 2018, over 16 million Americans served as caregivers to people with dementia, providing an estimated 18.5 billion hours of unpaid care.
According to the latest projections, the economic impact of dementia will reach nearly $380 billion by 2040. This, says the research team, is a cumulative $520 billion over a nearly three-decade period. Experts say over 70% of these costs would be attributed to the treatment of women, even though women are less likely to be treated for the disease than men are.
Further, over the next 20 years, say researchers, the economic burden of dementia will exceed $2 trillion, with women shouldering more than 80% of the cumulative costs.
“Because most people living with dementia and caregivers are women, the economic loss associated with women alone will total $2.1 trillion, representing over 80% of the cumulative costs from 2012 to 2040,” says the report.
Super says with no cure at sight, efforts must be made to double down on efforts for reducing the cost and risk of dementia. “Emerging evidence shows that despite family history and personal genetics, lifestyle changes such as diet, exercise, and better sleep can improve health at all ages,” she added.
According to the Milken Institute, there are roughly 9.6 million dementia caregivers compared with 7.2 million people living with dementia. The physical and emotional impact on these caregivers resulted in more than $11 billion in health costs alone in 2018.
The current projections state that over the next 20 years, the total number of unpaid caregivers for people living with dementia will increase from 9.6 million to 19.5 million, two-thirds of whom will be women.
“Dementia caregivers are also more likely to be impacted at work. We project that nearly 60% or 11.6 million of these caregivers will be employed in 2040. The number of caregivers that will have to leave their jobs due to the strain of caregiving will more than double as well from 145,000 to almost 295,000. Sixty per cent of these caregivers who leave their jobs will be women. Women experience a more significant financial strain, given that they spend a higher percentage of their average annual income on caregiving expenses,” says the team.
With Alzheimer’s, says Ahuja, it is not just those with the disease who suffer — it is also their caregivers and families. “Caregiving for people with Alzheimer’s disease will also cost all our healthcare system payers, including Medicare, Medicaid. Certain groups, including women and minorities will be disproportionately impacted as both patients and caregivers. In the US, we need to develop a national Medicare dementia prevention and detection strategy to spread awareness of risk reduction strategies, increase regular cognitive assessments, and improve early detection rates. This strategy will incentivize early and accurate diagnosis of dementia, and incentivize providers to coordinate care among various providers,” Ahuja told MEAWW.
“Policymakers will also incentivize effective dementia care interventions, including effective care coordination, safety evaluation and strategies, management of coexisting conditions, connection to community resources, including home and community-based services, caregiver support, education and training of the workforce, advance care planning, and interventions that are flexible and tailored to changing needs,” he told MEAWW.