Alzheimers Dement. 2023 Apr;19(4):1598-1695. doi: 10.1002/alz.13016. Epub 2023 Mar 14.
This article describes the public health impact of Alzheimer's disease, including prevalence and incidence, mortality and morbidity, use and costs of care, and the overall impact on family caregivers, the dementia workforce and society. The Special Report examines the patient journey from awareness of cognitive changes to potential treatment with drugs that change the underlying biology of Alzheimer's. An estimated 6.7 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, and Alzheimer's disease was officially listed as the sixth-leading cause of death in the United States. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated by the COVID-19 pandemic in 2020 and 2021. More than 11 million family members and other unpaid caregivers provided an estimated 18 billion hours of care to people with Alzheimer's or other dementias in 2022. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $339.5 billion in 2022. Its costs, however, extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes - costs that have been aggravated by COVID-19. Members of the paid health care workforce are involved in diagnosing, treating and caring for people with dementia. In recent years, however, a shortage of such workers has developed in the United States. This shortage - brought about, in part, by COVID-19 - has occurred at a time when more members of the dementia care workforce are needed. Therefore, programs will be needed to attract workers and better train health care teams. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2023 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $345 billion. The Special Report examines whether there will be sufficient numbers of physician specialists to provide Alzheimer's care and treatment now that two drugs are available that change the underlying biology of Alzheimer's disease.
本文描述了阿尔茨海默病的公共卫生影响,包括患病率和发病率、死亡率和发病率、护理的使用和成本,以及对家庭照顾者、痴呆症劳动力和社会的整体影响。特别报告审视了从认知变化意识到潜在药物治疗的患者旅程,这些药物可以改变阿尔茨海默病的潜在生物学。目前,美国有 670 万 65 岁及以上的人患有阿尔茨海默病痴呆症。如果没有预防、减缓或治愈 AD 的医学突破,到 2060 年,这一数字可能会增长到 1380 万。2019 年,官方死亡证明记录了 121499 例 AD 死亡,阿尔茨海默病正式被列为美国第六大死因。2020 年和 2021 年,当 COVID-19 进入十大死因之列时,阿尔茨海默病是第七大死因。阿尔茨海默病仍然是美国 65 岁及以上人群的第五大死因。2000 年至 2019 年,中风、心脏病和艾滋病毒的死亡人数减少,而 AD 的报告死亡人数增加了 145%以上。这种 AD 死亡轨迹可能因 2020 年和 2021 年的 COVID-19 大流行而加剧。2022 年,超过 1100 万名家庭成员和其他无薪照顾者为患有阿尔茨海默病或其他痴呆症的人提供了估计 180 亿小时的护理。与十年前相比,这些数字反映了照顾者人数的减少,以及每个剩余照顾者提供的护理量的增加。2022 年无薪痴呆症护理的价值为 3395 亿美元。然而,其成本还包括家庭照顾者情绪困扰和负面心理和身体健康结果的风险增加,这些成本因 COVID-19 而加剧。从事痴呆症诊断、治疗和护理的专业医疗保健工作者也参与其中。然而,近年来,美国出现了此类工人短缺的情况。这种短缺部分是由 COVID-19 造成的,而此时需要更多的痴呆症护理人员。因此,需要制定吸引工人和更好地培训医疗保健团队的计划。医疗保险为 65 岁及以上患有 AD 或其他痴呆症的受益人的服务支付的人均费用几乎是为没有这些疾病的受益人的费用的三倍,而医疗补助计划的支付费用则超过 22 倍。估计 2023 年,65 岁及以上患有痴呆症的人的医疗保健、长期护理和临终关怀服务的总支出为 3450 亿美元。特别报告审视了是否有足够数量的医生专家来提供阿尔茨海默病护理和治疗,因为现在有两种可以改变阿尔茨海默病潜在生物学的药物。