Chapter 1
Our Current Dilemma
To begin, let’s review the basics of the history of Alzheimer’s disease and how our collective perspective about it has changed over time.
A Brief History
The term “Alzheimer’s disease” was coined in 1910 by Emil Kraepelin to acknowledge the work of German psychiatrist and neuropathologist, Alois Alzheimer, who in the early 1900’s identified, diagnosed and described the disease after working with and doing a post-mortem autopsy of a patient by the name of Auguste Deter. He found it to be a progressive, degenerative disease of the brain—a form of dementia whose major symptoms are short- and long-term memory loss, confusion, mood swings, aggression, and loss of bodily functions. “Alzheimer’s” was, for decades, thought to manifest in people between the ages of 45 and 65. Following a conference in 1977, the term senile dementia of the Alzheimer type (SDAT) was adopted to also describe those over 65 afflicted with such symptoms. By the 1990’s the public was becoming more aware that something called Alzheimer’s and/or dementia was on the rise. During that decade, over 2 million cases were reported in the US, and over 5 million worldwide.
Current and Future Projections
Presently, Alzheimer’s remains an incurable disease that has increased its reach exponentially, in terms of those it has affected. However, unlike the last few decades, when knowledge of Alzheimer’s was more limited to clinical circles, today, it is a household term and commonly referred to in public discussion. This shouldn’t be surprising, since in the US alone there are currently 5.4 million reported cases of Alzheimer’s and more than 36 million people worldwide living with this condition. It is the 6th leading cause of death in the US, and even proportionately higher in those aged 65 and over, as one in three seniors die of dementia or related complications. It has been earmarked as a priority for research by ongoing presidential administrations, where funding is currently at 606 million dollars. And according to both a study done by the Alzheimer’s Association and an article on philanthropy news source Bloomberg, it is recommended that research be increased twofold to $1.2 billion immediately to help counteract the spread of Alzheimer’s over the next 10 years.
As for future projections, ADI’s World Alzheimer’s Report 2013 predicts that by 2050, Alzheimer’s will effect up to 16 million seniors in the US and 115 million worldwide, reflecting a significant global health concern.
Economic Costs
Certainly, the result of such a large increase in the number of Alzheimer’s cases reaches far beyond the emotional toll it places on family, friends and caregivers (a topic I will explore more extensively in Chapter 3). The economic costs of such a dramatic rise in those afflicted by Alzheimer’s needs to be addressed, as well.
Economists like to speak in terms of direct and indirect costs. For the purpose of our discussion, these can be defined as: what it costs a patient or family (direct), and what it costs the rest of society as the disease runs its course (indirect). An objective look at the current numbers involved provide insight as to why those in government, business and industry, the healthcare field and elsewhere are looking at the situation with more than a little concern. On an individual level, according to the American Alzheimer’s Association’s website, as of 2013, the estimated direct cost per patient is $34,500 a year with $7,259 currently coming directly out of the family’s pocket (the remainder being shouldered by both governmental agencies—Medicaid, Medicare, etc.—and other social support service providers). On a national level, it’s predicted that, in 2014, direct costs for Alzheimer’s care in the US will be $214 billion, with indirect costs adding up to nearly $1 trillion dollars (
http://www.usagainstalzheimers.org/crisis).
Additionally, caregivers donate or expend 17 billion hours supporting Alzheimer’s-afflicted individuals, the time of which is valued at more than $216 billion annually.
Looking forward, these already massive economic costs are expected to rise substantially. According to The World Alzheimer Report 2010: The Global Economic Impact of Dementia, by 2030 the direct cost of Alzheimer’s worldwide will grow by 85%, i.e., from the present $604 billion annual cost to over $1 trillion a year. Globally, this cost is estimated by some to be over $20 trillion by mid-century.
You may now be wondering how all of these facts and figures about Alzheimer’s apply to the current healthcare system. Regardless of your political allegiances or opinions, you are likely aware of the concern that, over the next 10–20 years, the cost of healthcare, social security and other governmental and non-governmental costs will likely take up increasing amounts of our annual national budget, with some quite reasonably distressed that the current healthcare system may collapse. One factor contributing to this fear is that the 80–100 million Baby Boomers (those born between 1946–1965) are aging and will be reaching a stage where they will be in need of services over the next few decades. Certainly, not all of these healthcare system concerns are related to Alzheimer’s and dementia. Still, with an aging population on the rise, an increasing percentage of these national budgets can significantly (and relatively quickly) consume resources.
I believe, however, there is some good news in the face of this pressing, widespread and highly challenging health issue. The urgency and growing concern about our ability to cover ever-increasing healthcare costs inadvertently creates an opportunity to look at alternative approaches. This is especially notable if such approaches are preventative in nature, cost-effective, or cost-neutral relative to existing avenues, and evidence-based in their approach.
The Current Senior Care System
Alzheimer’s, Diabetes, and Heart Disease Quick Facts for US Population
Alzheimer’s:
• Projected 115.4 million worldwide by 2050
• Sixth leading cause of death
• 1 in 3 seniors die with Dementia or related complications
• 5.4 million currently diagnosed
Diabetes
• 28.5 million children and adults.
• Another 7 million undiagnosed, or more than 10% of the population
• On the rise in the younger population and expected to increase.
• 1 in 3 adults in the US could have diabetes by 2050
• 79 million (20 or over are estimated to have Pre-diabetes.
• In ages 65 or older, 26.9% of the population are diagnosed
• Seventh leading cause of death
Heart Disease
• 26.5 million non-institutionalized adults or 6% of the population
• Number one cause of death
There are a few more facts and figures to discuss in order to round out the picture of how our present healthcare system is caring for those afflicted by Alzheimer’s. First, we’ll briefly review how professionals in the medical field are treating patients living with Alzheimer’s disease and dementia. Then, we will touch on the approaches and practices being used in many nursing homes and other assisted living institutions that offer long-term care for Alzheimer’s patients, as well as the support and challenges that at-home caregivers and families are facing. “Quality of life” is a term often heard in the senior care industry, and we will look at that, as well.
Current Approaches
Given there is a great deal of research being conducted on Alzheimer’s, which I will review in the following chapter, let’s take a quick overview of our existing approaches to treating the disease, including current medical and institutional practices. As was mentioned earlier, there is no known cure for Alzheimer’s. The best approach, at the moment, is to, at the very least, delay the onset of the disease. This has resulted in the use of such medications as Aricept and the Exelon patch. The results of the administration of such drugs has had mixed results, but offers a resource to those in need of assistance. As Alzheimer’s progresses and brain tissue degenerates, both of these drugs seem to be less effective.
Not surprisingly, researchers have come to realize over the years that since the effects of the disease in the advanced stages is so devastating, it makes sense to both study, and if possible, treat the disease at an earlier stage. This has resulted in a growing awareness of the importance of identifying early symptoms and has brought into usage such terms as mild cognitive impairment (MCI), in an attempt to describe and also treat potential onset of Alzheimer’s at an earlier stage. Unfortunately, options for early intervention and treatment—with the exception of the medical interventions mentioned above—are still basically nonexistent. That is, in part, the reason why the BodyEnergy Longevity Prescription emerged as a response: we are taking a different view of the...