Alzheimer’s disease and related dementias (ADRD) have taken on an increasingly important role in American medicine. Given the large population of older individuals afflicted by the degenerative condition, healthcare providers and policymakers have dedicated greater attention and resources to addressing it. Despite the recognition that Alzheimer’s disease is a leading cause of death among older adults, it has been historically underdiagnosed. A recent contribution to JAMA Heath Forum sought to measure the burden of ADRD on deceased Americans, as well as their healthcare utilization patterns. This rising trend coincides with GlobalData epidemiologists’ estimation of greater ADRD prevalence in the US.
To estimate recent epidemiological patterns of ADRD, the authors analyzed the Medicare billing data of approximately 3,515,000 decedents between 2004 and 2017, representing a 20% national sample of beneficiaries. The study design complemented diagnosis and mortality patterns with patient demographics and claims for related services (e.g., home health and hospice care). In considering these indicators together, the authors attempted to provide a better understanding of ADRD’s disease burden on the US.
The results showed a 34.7% increase in ADRD diagnoses in the last two years of life between 2004 and 2017. The starkest increase occurred between 2011 and 2013, which the authors mainly attribute to the Centers for Medicare and Medicaid Services (CMS) expansion of diagnostic codes. Another trend of note was the changing landscape of care. At the outset of the study period, 12.3% of ADRD-diagnosed patients passed away in intensive care units before dropping to 5.4% in 2017. Conversely, records showed a 25% increase in hospice care utilization and a 13% increase in community setting residencies. These patterns suggest not only an increase in ADRD’s impact on the American healthcare system, but also a concomitant expansion in medical services to better accommodate patients and caregivers.
The large increase in ADRD prevalence can be accounted for by a variety of factors. Perhaps the most important is the expansion of ADRD diagnostic codes implemented through the National Plan to Address Alzheimer’s Disease legislation enacted in 2011. The authors also posit that patients and caregivers have a greater awareness of Alzheimer’s disease, leading to more proactive care-seeking patterns. Social and political forces may have inflated the ADRD patient pool, but the rising prevalence is likely part of a broader epidemiological trend as well. As increased survival leads to longer lives, age-related neurodegenerative diseases take on larger roles in the lives of older Americans.
GlobalData epidemiologists have projected similar trends in the diagnosed prevalent cases of Alzheimer’s disease and dementia alike. Forecasting patterns show a rise from approximately 2,068,000 Alzheimer’s disease cases to over 2,804,000 between 2018 and 2028. Likewise, dementia cases are estimated to increase from almost 3,287,000 to 4,394,000 in the same time span (as shown in Figure 1). While this growth will most likely remain stable, increased awareness of ADRD and wider diagnostic criteria could lead to slightly higher estimates than currently projected.