Alzheimers Dement. 2016 Apr;12(4):459-509. doi: 10.1016/j.jalz.2016.03.001.
This report describes the public health impact of Alzheimer's disease, including incidence and prevalence, mortality rates, costs of care, and the overall impact on caregivers and society. It also examines in detail the financial impact of Alzheimer's on families, including annual costs to families and the difficult decisions families must often make to pay those costs. An estimated 5.4 million Americans have Alzheimer's disease. By mid-century, the number of people living with Alzheimer's disease in the United States is projected to grow to 13.8 million, fueled in large part by the aging baby boom generation. Today, someone in the country develops Alzheimer's disease every 66 seconds. By 2050, one new case of Alzheimer's is expected to develop every 33 seconds, resulting in nearly 1 million new cases per year. In 2013, official death certificates recorded 84,767 deaths from Alzheimer's disease, making it the sixth leading cause of death in the United States and the fifth leading cause of death in Americans age ≥ 65 years. Between 2000 and 2013, deaths resulting from stroke, heart disease, and prostate cancer decreased 23%, 14%, and 11%, respectively, whereas deaths from Alzheimer's disease increased 71%. The actual number of deaths to which Alzheimer's disease contributes is likely much larger than the number of deaths from Alzheimer's disease recorded on death certificates. In 2016, an estimated 700,000 Americans age ≥ 65 years will die with Alzheimer's disease, and many of them will die because of the complications caused by Alzheimer's disease. In 2015, more than 15 million family members and other unpaid caregivers provided an estimated 18.1 billion hours of care to people with Alzheimer's and other dementias, a contribution valued at more than $221 billion. Average per-person Medicare payments for services to beneficiaries age ≥ 65 years with Alzheimer's disease and other dementias are more than two and a half times as great as payments for all beneficiaries without these conditions, and Medicaid payments are 19 times as great. Total payments in 2016 for health care, long-term care and hospice services for people age ≥ 65 years with dementia are estimated to be $236 billion. The costs of Alzheimer's care may place a substantial financial burden on families, who often have to take money out of their retirement savings, cut back on buying food, and reduce their own trips to the doctor. In addition, many family members incorrectly believe that Medicare pays for nursing home care and other types of long-term care. Such findings highlight the need for solutions to prevent dementia-related costs from jeopardizing the health and financial security of the families of people with Alzheimer's and other dementias.
本报告描述了阿尔茨海默病对公共卫生的影响，包括发病率和患病率、死亡率、护理成本以及对护理人员和社会的整体影响。它还详细研究了阿尔茨海默病对家庭的经济影响，包括家庭每年的支出以及家庭为支付这些支出而经常做出的艰难决策。据估计，有 540 万美国人患有阿尔茨海默病。到本世纪中叶，美国患有阿尔茨海默病的人数预计将增长到 1380 万，这在很大程度上是由于婴儿潮一代的老龄化。如今，美国每 66 秒就有一人患上阿尔茨海默病。到 2050 年，预计每 33 秒就会出现一例新的阿尔茨海默病病例，每年将新增近 100 万例病例。2013 年，官方死亡证明记录了 84767 例死于阿尔茨海默病的病例，使其成为美国第六大死因，也是 65 岁及以上美国人的第五大死因。2000 年至 2013 年，死于中风、心脏病和前列腺癌的人数分别减少了 23%、14%和 11%，而死于阿尔茨海默病的人数则增加了 71%。阿尔茨海默病导致的实际死亡人数可能远高于死亡证明上记录的死于阿尔茨海默病的人数。2016 年，估计有 70 万 65 岁及以上的美国人将死于阿尔茨海默病，其中许多人将死于阿尔茨海默病引起的并发症。2015 年，超过 1500 万的家庭成员和其他无薪护理人员为患有阿尔茨海默病和其他痴呆症的人提供了约 181 亿小时的护理，这一贡献价值超过 2210 亿美元。医疗保险为年龄≥ 65 岁的阿尔茨海默病和其他痴呆症患者提供的人均医疗服务支付额是所有无这些疾病患者的两倍半以上，而医疗补助支付额则高出 19 倍。2016 年，为≥ 65 岁患有痴呆症的人提供的医疗、长期护理和临终关怀服务的总支出估计为 2360 亿美元。阿尔茨海默病护理的费用可能给家庭带来巨大的经济负担，他们经常不得不从退休储蓄中取出资金，减少购买食物，并减少自己去看医生的次数。此外，许多家庭成员错误地认为医疗保险支付疗养院护理和其他类型的长期护理费用。这些发现突出表明，需要采取解决办法，防止与痴呆症相关的费用危及阿尔茨海默病和其他痴呆症患者家庭的健康和经济安全。
