DEMENTIA - A FINANCIAL & SOCIAL SINKHOLE

By Women's Brain Heath Initiative:The world’s population is aging, and doing so rapidly. The number of individuals aged 60 years old and over is expected to grow by 56% between 2015 and 2030 – from 901 million to 1.4 billion. By 2050, this figure is projected to reach nearly 2.1 billion. As the population ages, there is a corresponding rise in age-related diseases. Dementia is no exception. Alzheimer’s Disease International (ADI) estimates that 44.35 million people were living with dementia in 2013, and that this number will increase to 75.62 million by 2030, and an alarming 135.46 million by 2050.Caring for individuals with dementia is a growing financial and social burden affecting both governments and families, partly due to the vast numbers of people suffering from the disease, as well as the long duration of illness before death (since much of that time is spent in a state of disability and dependence).In its World Alzheimer Report 2015, ADI estimated that the worldwide cost of dementia was US$818 billion in 2015, and predicted that amount would rise to US$1 trillion by 2018. ADI further anticipates that this figure will double to US$2 trillion by 2030.In its 2013 policy brief entitled “The Global Impact of Dementia 2013-2050,” ADI concluded that dementia is “one of the biggest global public health challenges facing our generation” and stated that it is a “global epidemic” that has been underestimated. More recently, the World Health Organization warned in its 2017 report, Global action plan on the public health response to dementia (2017-2025), that a US$2 trillion price tag to care for individuals with dementia could undermine social and economic development globally, as well as overwhelm health and social services, especially long-term care systems.The Canadian ContextAs is true in all parts of the world, Canada is currently experiencing dramatic increases in the prevalence and cost of dementia. ADI estimates that in 2015, just over 556,000 individuals were living with dementia in Canada, and that this number will increase by a staggering 60% to 886,000 by 2030. However, estimates of the current costs of dementia in Canada have varied, largely because of differences among population-based studies in the definitions of dementia, tests used to measure dementia, and the age and other characteristics of sample members. A review of these estimates by an expert panel comprised of epidemiologists, health economists, and policy analysts concluded that the most accurate way to calculate the total cost of dementia is to include both direct costs (such as medical and social sector costs) and indirect costs (such as the value of unpaid informal care by family members or others). Based on those criteria, the total cost of dementia was estimated to be C$10.4 billion in 2016, and projected to reach C$16.6 billion in 2031.The U.S. ContextThe Alzheimer’s Association in the U.S. reported in a March 2017 fact sheet that Alzheimer’s disease is the most expensive disease in America, costing more than cancer and heart disease. The Alzheimer’s Association estimates that the direct costs of caring for individuals with Alzheimer’s disease and other dementias in the U.S. amounted to US$259 billion in 2017. By 2050, it is anticipated that those costs could rise to US$1.1 trillion.Recent research in the U.S. examined the societal and family lifetime cost of dementia using a mathematical model to simulate disease progression and associated cost of care. The researchers calculated that on average, the total cost to care for an individual with dementia was US$321,780 (in 2015 dollars) over a five-year period. The researchers found that 70% of the total cost burden had to be covered by patients and their families through out-of-pocket payments and the value of informal care. In comparison, caring for a dementia-free senior over the same duration is dramatically less expensive – estimated at US$137,280.“Dementia is one of the most costly diseases, and families incur the majority of the costs,” explained Dr. Eric Jutkowitz of Brown University, lead author of the study. “We anticipated that dementia would be costly and that families would incur a large part of the cost, but we were surprised at the magnitude of the total costs and just how much of that burden is on families.” These findings were published in the Journal of the American Geriatrics Society in August 2017.A different group of U.S. researchers studied the costs of a particular type of dementia known as frontotemporal dementia (FTD), which is characterized by progressive loss of nerve cells in the brain’s frontal or temporal lobes. FTD accounts for up to 50% of dementia cases in individuals under the age of 60, and patients survive an average of eight years after being diagnosed. Dr. James Galvin and his colleagues estimate that the total cost (including direct and indirect costs) of FTD in the U.S. amounts to US$119,654 per patient, each year. That is twice the estimated cost of caring for someone with Alzheimer’s disease. Because the onset of FTD tends to occur at an earlier age than most dementias, FTD patients are often of working age and are forced to leave their jobs during peak earning years. The family members who take on caregiving responsibilities, often the spouse, may also need to adjust their own careers to provide care (for instance, by reducing his or her hours or declining promotion opportunities). Not surprisingly, then, the researchers discovered that the mean household income decreased after an FTD diagnosis – from US$75,000 to US$99,000 one year before diagnosis to US$50,000 to US$59,999 one year after diagnosis, resulting from lost days of work and early departure from the workforce. These findings were published in the November 2017 issue of Neurology. Preparing for the EpidemicPlanning for the costs associated with dementia is critical. Now more than ever, research funding is needed to find a cure and/or develop treatments to prevent or slow the onset of dementia, to educate the public about steps that can be taken to reduce the risk of a dementia diagnosis, to improve the accuracy and timeliness of diagnosis, and to provide short-and long-term health care and social services to support individuals with dementia and their families. While government action is required, individuals can also take proactive measures to reduce their risk of developing dementia by remaining physically, cognitively, and financially healthy (such as making positive lifestyle choices, engaging in cognitively-stimulating activities, and planning ahead financially by saving and/or purchasing an insurance policy).Variations by RegionBetween 2015 and 2050, the number of individuals living with dementia is expected to rise substantially worldwide, but the rate of growth will vary by region. During that time, the following rates of increase are predicted:

• Slightly more than double in North America
• Slightly less than double in Europe
• Triple in Asia
• Quadruple in Latin America and Africa

Source: MIND OVER MATTER V6