The Hidden Public Health Crisis: Alzheimer’s Disease and an Aging Population

The Hidden Public Health Crises - header image with title and MRI scans

Alzheimer’s disease is “the most under-recognized public health crisis of the 21st century,” according to the Alzheimer’s Association. Only 45 percent of people with Alzheimer’s have been told about their diagnosis by a healthcare provider, while more than 90 percent of people with the four most common types of cancer have been told about their diagnosis. And of the top 10 causes of death in the United States, Alzheimer’s is the only one that cannot be prevented, cured or slowed.

What is a public health crisis? The World Health Organization (WHO) uses the term “crisis” for a “situation that is perceived as difficult.” A crisis may at times elude public knowledge, contain different levels and layers of intensity and have the potential to reach levels beyond what is predicted. For example, specific events such as the 2014 Ebola virus epidemic and the 2001 anthrax attacks have been characterized as public health crises. Issues like addiction and obesity often have the same distinction.

Alzheimer’s fits the definition of a public health crisis. People who have the disease are impacted, along with their loved ones and the entire healthcare system. In the coming years, the number of Alzheimer’s diagnoses and deaths is expected to increase. And the financial toll of the disease to families and the economy is expected to rise, worsening an already difficult situation.

The State of Alzheimer’s Disease

Statistics

According to the report “2015 Alzheimer’s Disease Facts and Figures” from the Alzheimer’s Association, an estimated 5.3 million Americans have Alzheimer’s. One in nine people age 65 and older have the disease, as well as one in three people age 85 and older. Nearly two-thirds of Americans with Alzheimer’s are women.

Due to advances in medicine and the aging of the baby-boom generation, the population of older Americans is expected to increase dramatically. As a result, the Alzheimer’s Association projects a similar increase in the prevalence of the disease.

  • By 2025, an estimated 7.1 million Americans age 65 and older may have Alzheimer’s, a 40 percent increase from 2015.
  • By 2050, a projected 13.8 million Americans age 65 and older may have Alzheimer’s — without a medical breakthrough to prevent or cure the disease — nearly tripling the figure from 2015. Some estimates place the number closer to 16 million, based on high projections of population growth from the U.S. Census Bureau.

Alzheimer’s is the sixth-leading cause of death in the United States and the fifth-leading cause of death for people age 65 and older. Regardless, the Alzheimer’s Association notes that figures from the Centers for Disease Control and Prevention (CDC) may actually be low. Statistics on Alzheimer’s deaths from the CDC only occur when the disease is listed as the underlying cause of death on the death certificate. Many times other causes of death are listed, such as pneumonia, instead of Alzheimer’s when the disease often causes the complication. Commonly, seniors die from Alzheimer’s or a contributing factor caused by the disease.

As a result, the Alzheimer’s Association distinguishes between deaths from Alzheimer’s and deaths with Alzheimer’s. Using data from the Chicago Health and Aging Project (CHAP), a total of 700,000 people age 65 and over are expected to die in 2015 with Alzheimer’s. One in three seniors dies with Alzheimer’s or another form of dementia.

Bar graph illustrating the percentage changes in certain causes of death between 2000 and 2013.

Consequences

Alzheimer’s is a progressive brain disease with gradually worsening symptoms. It typically begins with memory loss and moves toward late-stage symptoms where individuals are unable to carry on a conversation or respond to their environment. After symptoms become noticeable, those with Alzheimer’s live an average of eight years, though survival can range from four to 20 years.

Friends and family of people with Alzheimer’s also suffer. The Alzheimer’s Association reports that loved ones provided 17.9 billion hours of unpaid care valued at $217.7 billion in 2014. Caregivers rate emotional stress as high or very high, and 40 percent experience depression. Alzheimer’s and dementia caregivers had an additional $9.7 billion in healthcare costs due to the physical and emotional toll of providing care.

Alzheimer’s and other dementias will directly cost America an estimated $226 billion in 2015. For people age 65 and over with Alzheimer’s and other types of dementias, the per-person cost is three times higher for Medicare and 19 times higher for Medicaid than those without dementias. Without some type of solution, these costs will total more than $1.1 trillion in 2050, in 2015 dollars.

What Is Being Done?

The CDC’s BRFSS Survey

The Behavioral Risk Factor Surveillance System survey collects data at the state and local level to target and build health promotion activities. Because the data tracks the impact of cognitive decline and Alzheimer’s disease, it can be a strong tool for informing the community about these trends and how to respond. The survey can also help policymakers with decisions involving Alzheimer’s.

Initiatives Promoting Cognitive Health

Enhanced cognitive activity — along with good physical health, exercise, nutrition and social engagement — can potentially reduce the risk of cognitive decline and possibly prevent Alzheimer’s disease.

The following initiatives represent some of the ways federal agencies are addressing the crisis of Alzheimer’s disease.

Healthy Brain Initiative

The CDC and the Alzheimer’s Association organize the Healthy Brain Initiative, which seeks to better understand cognitive impairment. The initiative targets interventions to improve cognitive health and the implementation of positive actions into public health practice.

According to the public road map report for 2013-2018, the initiative focuses on ensuring that people with dementias are aware of their diagnosis, as well as reducing preventable hospitalizations among patients with dementias. Other action items are divided into four domains: monitor and evaluate public health data; educate and empower the nation about causes of disease, injury and disability; develop policy and mobilize partnerships on cognitive health; and assure a competent public health workforce.

Healthy People 2020

The Healthy People program establishes national health-related goals set by the U.S. Department of Health and Human Services. The most recent 10-year agenda for public health topics and objectives listed dementias, including Alzheimer’s disease, as a new topic area for the program.

The primary goal in Healthy People 2020 is reducing morbidity and costs related to dementia, as well as maintaining or enhancing the quality of life for those with dementia. Other areas where progress is important include early diagnosis, interventions to delay and prevent onset of disease, better ways of management when other chronic conditions are present, and understanding lifestyle factors that influence risk.

The Role of Education

Education is critical for the public health crisis of Alzheimer’s disease. Greater public understanding of the disease should lead to more support for people with Alzheimer’s and their caregivers. Enhanced public education can also create additional momentum for research on Alzheimer’s. Public health professionals who are trained to help with Alzheimer’s can make a difference, from investigating the disease to providing resources in their community.

At Rivier University, both the online B.S. Public Health and the online Master of Public Health offer a convenient and flexible way for students to earn their degree and advance their careers. This educational path can lead to rewarding, high-paying jobs. For instance, the U.S. Bureau of Labor Statistics reports that epidemiologists earn a median salary of $65,270. Along with other public health professionals such as educators and biostatisticians, they are heavily involved in increasing awareness and helping communities.