BY SUSAN M. MATHEWS, PhD, RN, MSBE
A July 2017 report published by the Population Research Bureau provides both good and bad news about our aging society and the prevalence of Alzheimer’s and vascular dementias.
It is undeniable that the absolute number of Americans with dementia is increasing, however, the proportion of those with dementia has decreased over the past 25 years. As of 2018, almost 6 million Americans suffer from some form of dementia, with a projected 13 million by 2050.
According to studies supported by the National Institute on Aging, aggressive treatment of cardiovascular issues, obesity, and diabetes contributes to better brain health. Interestingly, they now suggest that the availability of higher levels of education, aka, brain stimulation, also makes a difference.
Researchers recently looked at pre-and post-World War II Americans. They measured the percentage of Americans 65 and over with dementia in 2000 versus 2012. The U.S. Health and Retirement Survey found a 24 percent drop in new cases which translated into a “million fewer Americans with dementia in 2012 than if the 2000 rates had continued.”
The findings showed about 56 percent of baby boomers (1946-1964) attended some college while only 25 percent of the pre-World War II Americans were able to do so. Further research also highlighted the value of occupations that require daily complex interpersonal interactions as being a positive factor in delaying the onset of cognitive impairment or dementia.
The physiology behind this improvement in mental capacity may be the creation of stronger connections among brain cells, called a cognitive reserve, that can be called upon when memory begins to decline. Or education may just enhance the ability to better adapt and hide the decline.
Of significance is the finding that the quality of the educational experience is responsible for a dramatic difference in outcomes, not just education alone.
“Lower-quality education early in life and poor literacy skills late in life explain nearly one-third of the disparity in late-life cognition between one population of U.S.-born African Americans and non-Hispanic whites ages 65 and older living in New York state (Sisco et al. 2014). The researchers speculate that “poorer early-life educational quality may limit one’s occupational choices, which may result in greater risk for poverty and chronic stress (a factor harmful to cognition), while also limiting opportunities for occupation-related cognitive enrichment (a factor enhancing cognition).”
So, the good news is that dementias are declining as a proportion of the general population over 65. Nevertheless, even though the trend is downward, the aggregate population over 65 grows by over 10,000/day.
The bad news is that dementia care is expensive for taxpayers. Forty-two percent of State’s Medicaid budgets are consumed by nursing home care. Although this amount is not entirely related to dementia-care, it nonetheless illustrates the crisis at hand.
In 2008, then-Secretary of Health and Human Services, Michael Leavitt, said “Medicaid costs [are] projected to grow so fast that within 10 years they [will] “crowd out virtually every other category of spending.” State spending on higher education, infrastructure and safety, he predicted, would all get squeezed.
The estimated cost for both paid and unpaid dementia caregiving in 2010 was between $159 billion and $215 billion. If we assume the positive trend will continue, by 2040, costs are projected to increase by just 60 percent, even with an older population, rather than the earlier trajectory of a 100 percent increase. That’s still a big number.
Medicaid has methodically invaded every other cell on budget spreadsheets and has heavily impacted available funds for education. But wait!
Research supports the value of quality education in delaying or deterring dementias, thereby reducing downstream costs.
How can a balance be struck between providing early in life quality education with later in life quality care? Just another elephant in the room which comes down to money…again.