News From the End of Life: Early Alzheimer’s care could reduce costs
In one of the largest national studies of its kind, University of California-Los Angeles researchers found that both caregiver and patient health care costs dramatically rise as symptoms worsen in patients with Alzheimer’s disease.
The study, published in the February issue of the Journal of the American Geriatrics Society, showed that for a six-month period, costs could rise to more than $30,000 per patient, depending on severity of symptoms.
"As Alzheimer’s disease progresses, the costs to society in terms of direct health care costs and loss of productivity of caregivers are astronomical," said Gary Small, MD, lead investigator for the study, Parlow-Soloman Professor on Aging and professor of psychiatry and biobehavioral sciences at UCLA, and director of the UCLA Center on Aging.
The study found that as symptoms progressed, costs rose. For the six-month study period, costs approximated $20,000 for a typical high-functioning patient, compared with $35,000 for a patient with severe dementia.
For example, caregivers missed 2.6 days of work to care for a patient with mild symptoms, compared with 8.7 days missed to care for a patient with severe symptoms. Hospitalizations increased from 1.8 to 3.4 days, depending on the severity of symptoms.
"The study provides an impetus for earlier treatment to help keep Alzheimer’s disease at a less-severe stage for longer," Small said.
According to Small, most Alzheimer’s disease patients live at home and are not institutionalized. Relatives, such as a spouse, son, or daughter, usually provide care. The burden on caregivers is heavy, and the bulk of the costs of this care — almost 90%, according to the study — come from caregiver costs, including the lost productivity of missed days of work and hours per week spent caring for loved ones.
Researchers sent a survey to 1,700 non-institutionalized patients and their caregivers in households throughout the country. Patients represented all stages of the disease. Disease severity was measured using a scale of symptom frequency, such as prevalence of memory loss and depression. Activity and physical functioning were also gauged, such as the ability to dress, prepare food, and shop.
Costs totaled an average of $29,209 per patient over a six-month period. Direct costs of care averaged $3,129 and included hospital stays, physician visits, and emergency room visits. Caregiver costs averaged $26,080, calculated by missed days of work and hours spent per week caring for patients.
Small said most Alzheimer’s disease patients are not taking available medications that could help slow the progression of the disease. Studies have shown that these medications may be cost-effective; however, more studies on them need to be completed.
A general lack of education about Alzheimer’s disease may be preventing patients from receiving optimum treatment. Patients and caregivers often mistake early symptoms of Alzheimer’s disease for normal aging changes, believing that early signs of dementia may be "just senility." Physicians also need more training in recognizing these early signs, perhaps by incorporating more effective tests for cognitive functioning in routine medical exams. Small said medications are often stopped too early as well.
More help for caregivers may also control costs, Small said. According to the study, caregivers spent an average of 85 hours per week providing care to patients.
"Over $100 billion is spent annually on Alzheimer’s disease, making it the third most costly disease in the United States after heart disease and cancer. At least half of these costs are related to caregiving," said Howard Fillit, MD, executive director of the Institute for the Study of Aging in New York City. "Dr. Small’s study will help increase our understanding of the magnitude and sources of caregiver costs as Alzheimer’s disease progresses."
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