Dementia More Costly Than Cancer, Will Become More Common

Dementia More Costly Than Cancer, Will Become More Common

Posted on Friday, April 5th, 2013 at 9:05 am by Life Matters Media

Image: Pixabay, Gerd Altmann via Creative Commons

Gerd Altmann via Creative Commons

Researchers determined dementia leads to total annual societal costs of more than $40,000 per case in the U.S.

The most comprehensive study on the costs of dementia shows the disease is more expensive than heart disease and cancer, costing society and families around $200 billion a year.

The costs of dementia-related care and the number of people suffering from the disease will more than double by 2040, according to research supported by the RAND Corporation, financed by the government and published in The New England Journal of Medicine.

Key findings

Researchers determined dementia leads to total annual societal costs of $41,000 to $56,000 per case in the U.S., totaling up to $215 billion in 2010. More troubling were calculations that estimate the aging population will lead to an increase of almost 80 percent in total costs by 2040.

Most dementia-related costs stem from long-term institutional and home-based care, not medical care. Nursing home, formal and informal care account for up to 80 percent of the costs. These estimates place dementia among the most costly diseases.  In 2010, almost 15 percent of Americans 70 and older suffered dementia.

By 2040, nine million people will have the disease. “I don’t know of any other disease predicting such a huge increase,” Dr. Richard J. Hodes, director of the National Institute on Aging, told The New York Times. “As we have the baby boomer group maturing, there are going to be more older people with fewer children to be informal caregivers for them, which is going to intensify the problem even more.”

Still, the findings are more conservative than previous calculations from the Alzheimer’s Association, which estimated that in 2010 the monetary costs alone were $170 billion, as compared to $110 billion.

Figuring costs of dementia

It is notoriously difficult to glean accurate data about the costs of dementia over time, which makes the new findings especially important to the medical community and financial institutions.

Dementia is a chronic disease associated with aging and is characterized by progressive cognitive decline, mostly affecting seniors already suffering from other ailments. This makes its financial implications difficult to separate.

Secondly, most of those suffering from dementia are looked after by caregivers, many unpaid, making it difficult to estimate monetary costs for caregivers’ time.

The researchers began with some 11,000 people from a long-running government health survey called the Health and Retirement Study, which began in 1992. They surveyed more than 800 of the people aged 51 years or older. To get a strong representation of dementia, those respondents underwent a three-hour in-home clinical assessment. Those results were then reflected upon the larger group.

Researchers then analyzed Medicare records and patients’ out-of-pocket expenses. Foregone wages from family caregivers who gave up work to care were tabulated, as were estimates of what the care may have cost if bought from formal providers. Spending on all other ailments, such as diabetes and high blood pressure was subtracted.

Dr. Kenneth Langa, a University of Michigan researcher who helped with the research, told ABC News, “This is an important difference” from other studies that did not determine how much health care cost was attributable to just dementia.

President Barack Obama signed the National Alzheimer’s Project Act into law in January 2011; it aims to track costs of dementia and improve the health outcomes of those living with the disease.

Occupational Stress: Doctors Suffer When Unable To Save Lives

Posted on Thursday, November 29th, 2012 at 1:03 pm by Life Matters Media

Physicians who treat the terminally ill may suffer from emotional stress when unable to save patients’ lives. Burnout and compassion fatigue are two serious forms of occupational stress physicians may suffer, according to research by Michael Kearney, M.D.

Kearney, a palliative care physician at Santa Barbara Cottage Hospital in California, describes burnout as “the end stage of stresses between the individual and the work environment.” Compassion fatigue is “secondary post-traumatic stress disorder, or vicarious traumatization — trauma suffered when someone close to you is suffering.”

Health care journalist Jane Brody addresses the stress and anxiety oncologists struggle with in a new article for The New York Times. Brody writes, “A doctor with compassion fatigue may avoid thoughts and feelings associated with a patient’s misery, become irritable and easily angered, and face physical and emotional distress when reminded of work with the dying.” Compassion fatigue may lead to burnout.

Up to 60 percent of practicing physicians report symptoms of burnout.

According to Brody: “Patients and families may not realize it, but doctors who care for people with incurable illness, and especially the terminally ill, often suffer with their patients. Unable to cope with their own feelings of frustration, failure and helplessness, doctors may react with anger, abruptness and avoidance.”

Physician suicide linked to occupational stress

According to Crystal Phend, senior staff writer for MedPage Today, “Suicide among physicians appears to follow a different profile than in the general population, with a greater role played by job stress and mental health problems.”

Phend cites a study by Katherine J. Gold, M.D., of the University of Michigan in Ann Arbor, who found that problems with work were three times more likely to have contributed to a physician’s suicide than a nonphysician’s. Mental illness was also 34 percent more common before a suicide among physicians.

Up to 60 percent of practicing physicians report symptoms of burnout

“The results of this study paint a picture of the typical physician suicide victim that is substantially different from that of the nonphysician suicide victim in several important ways,” Gold wrote for General Hospital Psychiatry. “Inadequate treatment and increased problems related to job stress may be potentially modifiable risk factors to reduce suicidal death among physicians.”

Although physicians have more access to health care, they may be reluctant to seek help. “I think stigma about mental health is a huge part of the story. There is a belief that physicians should be able to avoid depression or just ‘get over it’ by themselves,” Gold wrote.

More than 200 of the 31,636 suicide victims reported in the National Violent Death Reporting System from 2003 to 2008 were physicians.

Meditation may help physicians

A 2008 study published by the Journal of Palliative Medicine, in which researchers studied 18 oncologists, found that physicians who viewed their work with patients as both biomedical and psychosocial found end of life more satisfying than those with a more biomedical perspective.

“Physicians, who viewed their physician role as encompassing both biomedical and psychosocial aspects of care, reported a clear method of communication about end of life care, and an ability to positively influence patient and family coping with and acceptance of the dying process,” the researchers concluded.

“In contrast, participants who described primarily a biomedical role reported a more distant relationship with the patient, a sense of failure at not being able to alter the course of the disease, and an absence of collegial support.”

Kearney recommends “mindfulness meditation,” a Buddhist-influenced practice for physicians suffering from stress. “The doctor is able to recognize he’s being stressed, and it prevents him from invoking the survival defense mechanisms of fight (‘Let’s do another course of chemotherapy’), flight (‘There’s nothing more I can do for you — I’ll go get the chaplain’) and freeze (the doctor goes blank and does nothing).” He claims that even 8-10 minutes a day of “mindfulness meditation” can help.