Economic Burden

The economic and social costs of AD are tremendous. According to 1998 vital statistics data from the Centers for Disease Control, Alzheimer's disease is the 9^th leading cause of death for persons 65 years and older. Because of the protracted course and disability associated with AD, patients may reside in a continuum of care settings. It is not unusual to observe that a patient may reside first at home, then in an assisted living facility, and finally in an skilled nursing facility in the last 2-3 years of life. The cost of caring for individuals with AD rises steadily throughout the course of the disorder, reflecting the increasing use of institutionalized care as functional and psychiatric disability increases. Leon and colleagues estimated in a 1998 study that the annual cost of caring for an AD patient is $18,408 in mild AD, $30,096 in moderate AD, and $36,132 in severe AD.⁷

The total annual National cost of caring for AD patients is estimated at $104 billion dollars - the second most costly illness after cardiovascular disease.

Comparative Annual Economic Impact of Diseases in the United States

Source: Alzheimer's Disease Education and Referral Center, National Cancer Institute
American Diabetes Association, Arthritis Association, National Center for Health Statistics.

A one month delay in nursing home placement would result in $1,863 in savings according to Leon and colleagues ⁷ . If these savings were annualized, $1.12 billion dollars could potentially be saved. It is important to realize that dollars saved for third party payers may result in additional burden on family caregivers if individuals remain at home for longer periods. Family caregivers assume much of the financial burden associated with AD care. A 1994 study reported that families spent $5,800 per year on nonreimbursable expenses such as supplies, paid labor, medications and services. Factoring in the cost of unpaid labor provided by caregivers resulted in total out-of-pocket costs of $18,256 annually.⁸ In addition, family caregivers are at high risk of developing depression and exacerbation of underlying medical comorbidity. Researchers have suggested that the combination of loss, prolonged distress, physical demands of caregiving, and biological vulnerabilities of older caregivers may increase their risk for health problems, leading to increased mortality. In one recent example, elderly caregivers who experienced significant stress while providing direct care to a disabled spouse were observed to have mortality risks that were 63% higher than noncaregiving controls.⁴

Despite significant out-of-pocket costs and stress, many families prefer to maintain the AD patient in the home environment. Interventions that provide education and support, including respite care can delay the time to institutionalization. Patients who respond to cholinesterase inhibitors by retaining functional independence longer than anticipated by the natural course of AD may require less direct care and supervision, thus lessening caregiver burden. Previous studies utilizing tacrine and donepezil in patients with mild-moderate AD have reported delays in nursing home placement at study endpoint.¹⁰

AD is an important healthcare challenge that must be more aggressively addressed. Despite the significant economic and caregiver burden associated with AD, the illness has received relatively little national attention as compared to cancer, cardiac disease, and AIDS. Population estimates show that individuals 85 and older comprise the fastest growing segment of the US population. Since this group appears to be at highest risk of developing AD, it is imperative that a multi-factorial public health approach is mounted, emphasizing education, early diagnosis, appropriate treatment and caregiver support.