Alzheimers Dement. 2020 Mar 10. doi: 10.1002/alz.12068.
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the future challenges of meeting care demands for the growing number of people living with Alzheimer's dementia in the United States with a particular emphasis on primary care. By mid-century, the number of Americans age 65 and older with Alzheimer's dementia may grow to 13.8 million. This represents a steep increase from the estimated 5.8 million Americans age 65 and older who have Alzheimer's dementia today. Official death certificates recorded 122,019 deaths from AD in 2018, the latest year for which data are available, making Alzheimer's the sixth leading cause of death in the United States and the fifth leading cause of death among Americans age 65 and older. Between 2000 and 2018, deaths resulting from stroke, HIV and heart disease decreased, whereas reported deaths from Alzheimer's increased 146.2%. In 2019, more than 16 million family members and other unpaid caregivers provided an estimated 18.6 billion hours of care to people with Alzheimer's or other dementias. This care is valued at nearly $244 billion, but its costs extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2020 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $305 billion. As the population of Americans living with Alzheimer's dementia increases, the burden of caring for that population also increases. These challenges are exacerbated by a shortage of dementia care specialists, which places an increasing burden on primary care physicians (PCPs) to provide care for people living with dementia. Many PCPs feel underprepared and inadequately trained to handle dementia care responsibilities effectively. This report includes recommendations for maximizing quality care in the face of the shortage of specialists and training challenges in primary care.
本文描述了阿尔茨海默病（AD）对公共卫生的影响，包括发病率和患病率、死亡率和发病率、护理的使用和成本，以及对护理人员和社会的总体影响。这份特别报告讨论了满足美国越来越多阿尔茨海默病痴呆症患者护理需求的未来挑战，特别强调了初级护理。到本世纪中叶，65岁及以上患有阿尔茨海默病痴呆症的美国人数量可能增至1380万。这与目前估计的580万65岁及以上患有阿尔茨海默病痴呆症的美国人相比大幅增加。官方死亡证明记录显示，2018年有122019人死于AD，这是可获取数据的最新年份，这使得阿尔茨海默病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2018年期间，中风、艾滋病毒和心脏病导致的死亡人数减少，而报告的阿尔茨海默病死亡人数增加了146.2%。2019年，超过1600万家庭成员和其他无薪护理人员为患有阿尔茨海默病或其他痴呆症的人提供了约186亿小时的护理。这种护理的价值近2440亿美元，但其成本还包括家庭护理人员情绪困扰风险增加以及负面的身心健康后果。医疗保险为65岁及以上患有AD或其他痴呆症的受益人提供的人均服务支付费用是没有这些病症受益人的三倍多，医疗补助支付费用则超过23倍。2020年，为65岁及以上患有痴呆症的人提供医疗保健、长期护理和临终关怀服务的总支付费用估计为3050亿美元。随着患有阿尔茨海默病痴呆症的美国人口增加，照顾这一人群的负担也在增加。痴呆症护理专家短缺加剧了这些挑战，这给初级护理医生（PCP）为痴呆症患者提供护理带来了越来越大的负担。许多初级护理医生觉得自己没有充分准备好，也没有得到足够的培训来有效承担痴呆症护理责任。本报告包括在专家短缺和初级护理培训挑战的情况下，实现高质量护理的建议。
