Alzheimers Dement. 2012;8(2):131-68. doi: 10.1016/j.jalz.2012.02.001.
This report provides information to increase understanding of the public health impact of Alzheimer's disease (AD). Topics addressed include incidence, prevalence, mortality rates, health expenditures and costs of care, and effect on caregivers and society. The report also explores issues that arise when people with AD and other dementias live alone. The characteristics, risks, and unmet needs of this population are described. An estimated 5.4 million Americans have AD, including approximately 200,000 age <65 years who comprise the younger-onset AD population. Over the coming decades, the aging of the baby boom generation is projected to result in an additional 10 million people with AD. Today, someone in America develops AD every 68 seconds. By 2050, there is expected to be one new case of AD every 33 seconds, or nearly a million new cases per year, and AD prevalence is projected to be 11 million to 16 million. Dramatic increases in the number of "oldest-old" (those age ≥85 years) across all racial and ethnic groups are expected to contribute to the increased prevalence of AD. AD is the sixth leading cause of death in the United States and the fifth leading cause of death in Americans age ≥65 years. Although the proportions of deaths due to other major causes of death have decreased in the last several years, the proportion due to AD has risen significantly. Between 2000 and 2008, the proportion of deaths due to heart disease, stroke, and prostate cancer decreased by 13%, 20%, and 8%, respectively, whereas the proportion due to AD increased by 66%. In 2011, more than 15 million family members and other unpaid caregivers provided an estimated 17.4 billion hours of care to people with AD and other dementias, a contribution valued at more than $210 billion. Medicare payments for services to beneficiaries age ≥65 years with AD and other dementias are three times as great as payments for beneficiaries without these conditions, and Medicaid payments are 19 times as great. In 2012, payments for health care, long-term care, and hospice services for people age ≥65 years with AD and other dementias are expected to be $200 billion (not including the contributions of unpaid caregivers). An estimated 800,000 people with AD (one in seven) live alone, and up to half of them do not have an identifiable caregiver. People with dementia who live alone are exposed to risks that exceed the risks encountered by people with dementia who live with others, including inadequate self-care, malnutrition, untreated medical conditions, falls, wandering from home unattended, and accidental deaths.
本报告提供了有关阿尔茨海默病(AD)对公众健康影响的信息。报告涵盖了发病率、患病率、死亡率、卫生支出和护理费用,以及对护理人员和社会的影响。报告还探讨了 AD 患者和其他痴呆症患者独居时出现的问题。报告描述了这一人群的特征、风险和未满足的需求。据估计,有 540 万美国人患有 AD,其中包括约 20 万名年龄<65 岁的人,他们构成了发病年龄较轻的 AD 人群。在未来几十年,婴儿潮一代的老龄化预计将导致另外 1000 万人患有 AD。如今,美国每 68 秒就有一人患上 AD。到 2050 年,预计每 33 秒就会出现一例新的 AD 病例,即每年近 100 万例新病例,AD 的患病率预计将达到 1100 万至 1600 万例。所有种族和族裔群体中“最年长的老年人”(年龄≥85 岁的人)数量的急剧增加预计将导致 AD 患病率的上升。AD 是美国第六大死因,也是美国 65 岁及以上人群的第五大死因。尽管近年来其他主要死因的死亡比例有所下降,但 AD 的死亡比例却显著上升。在 2000 年至 2008 年期间,心脏病、中风和前列腺癌的死亡比例分别下降了 13%、20%和 8%,而 AD 的死亡比例则上升了 66%。2011 年,超过 1500 万家庭成员和其他无薪护理人员为 AD 患者和其他痴呆症患者提供了约 174 亿小时的护理,其价值超过 2100 亿美元。医疗保险为 65 岁及以上患有 AD 和其他痴呆症的受益人的服务支付额是为没有这些疾病的受益人的支付额的三倍,医疗补助支付额则是 19 倍。2012 年,为 65 岁及以上患有 AD 和其他痴呆症的人提供的医疗保健、长期护理和临终关怀服务的支出预计将达到 2000 亿美元(不包括无薪护理人员的贡献)。据估计,有 80 万名 AD 患者(每七人中有一人)独居,其中多达一半人没有可识别的护理人员。独居的痴呆症患者面临的风险超过了与他人一起生活的痴呆症患者面临的风险,包括自我护理不足、营养不良、未治疗的医疗状况、跌倒、无人看管离家出走和意外死亡。