Alzheimer’s Associations (AA)
March 4, 2019
Findings from the Alzheimer's Association 2019 Alzheimer's Disease Facts and Figures report released today show that, despite a strong belief among seniors and primary care physicians that brief cognitive assessments are important, only half of seniors are being assessed for thinking and memory issues, and much fewer receive routine assessments. In addition to providing an in-depth look at the latest national statistics on Alzheimer's prevalence, incidence, mortality, costs of care, and impact on caregivers, the new Facts and Figures report examines awareness, attitudes, and utilization of brief cognitive assessments among seniors age 65 and older and primary care physicians.
A brief cognitive assessment is a short evaluation for cognitive impairment performed by a health care provider that can take several forms — including asking a patient about cognitive concerns, directly observing a patient's interactions, seeking input from family and friends or using short verbal or written tests that can be administered easily in the clinical setting. An evaluation of cognitive function is a required component of the Medicare Annual Wellness Visit, but findings from the report show that only 1 in 3 seniors are aware these visits should include this assessment.
The report also found, however, that among both seniors and primary care physicians there is widespread understanding of the benefits of early detection of cognitive decline and the importance of brief cognitive assessments. In fact, 82 percent of seniors believe it is important to have their thinking and memory checked, and nearly all primary care physicians (94 percent) consider it important to assess all patients age 65 and older for cognitive impairment.
"While it's encouraging to see that the vast majority of seniors and physicians understand the value of brief cognitive assessments, we're still seeing a significant gap in those that actually pursue, perform or discuss these assessments during routine exams," said Joanne Pike, Dr.P.H., chief program officer for the Alzheimer's Association. "Early detection of cognitive decline offers numerous medical, social, emotional, financial and planning benefits, but these can only be achieved by having a conversation with doctors about any thinking or memory concerns and through routine cognitive assessments."
The report found that just 1 in 7 seniors (16 percent) say they receive regular cognitive assessments for memory or thinking issues during routine health checkups, compared with blood pressure (91 percent), cholesterol (83 percent), vaccinations (80 percent), hearing or vision (73 percent), diabetes (66 percent) and cancer (61 percent).
The Facts and Figures report also reveals a troubling disconnect between seniors and primary care physicians regarding who they believe is responsible for initiating these assessments and reticence from seniors in discussing their concerns.
The survey found that while half of all seniors (51 percent) are aware of changes in their cognitive abilities — including changes in their ability to think, understand or remember — only 4 in 10 (40 percent) have ever discussed these concerns with a health care provider, and fewer than 1 in 7 seniors (15 percent) report having ever brought up cognitive concerns on their own.
Instead, most seniors (93 percent) say they trust their doctor to recommend testing for thinking or memory problems if needed. Yet fewer than half of primary care physicians (47 percent) say it is their standard protocol to assess all patients age 65 and older for cognitive impairment. Only 1 in 4 seniors (26 percent) report having a physician ever ask them if they have any concerns about their cognitive function without seniors bringing it up first.
“The findings indicate there are missed opportunities for seniors to discuss cognitive concerns and problems in the exam room,” said Pike. “We hope the report will encourage seniors and physicians both to be more proactive in discussing cognitive health during the Medicare Annual Wellness Visit and other routine exams.”
Nearly all physicians said the decision to assess patients for cognitive impairment is driven, in part, by reports of symptoms or requests from patients, family members and caregivers. Physicians who choose not to assess cognition cite lack of symptoms or complaints from a patient (68 percent), lack of time during a patient visit (58 percent) and patient resistance (57 percent) as primary factors.
In addition, most physicians say they welcome more information about assessments, including which tools to use (96 percent), guidance on next steps when cognitive problems are indicated (94 percent) and steps for implementing assessments efficiently into practice (91 percent).
"The Alzheimer's Association is working to help educate physicians on best practices for conducting brief cognitive assessments and to ensure that all seniors understand what to expect from an assessment, as well as how to navigate an Alzheimer's diagnosis and care planning when needed," said Pike. "As the number of individuals living with Alzheimer's continues to increase, we need to detect the disease early and give individuals the best opportunity to plan for the future."
By the Numbers
94 percent of primary care physicians consider it important to assess all patients age 65 and older for cognitive impairment.
- 82 percent of seniors believe it is important to have their thinking and memory checked.
- 50 percent – average number of senior patients that primary care physicians say they assess.
- 16 percent of seniors report receiving regular assessments for memory or thinking issues.
Seniors reporting regular assessment for:
- Blood pressure – 91 percent
- Cholesterol – 83 percent
- Vaccinations – 80 percent
- Hearing/Vision – 73 percent
- Diabetes – 66 percent
- Cancer – 61 percent
- Cognitive Assessment – 16 percent
Top reasons some physicians choose not to provide a cognitive assessment:
- Lack of symptoms or complaints from a patient – 68 percent
- Lack of time during a patient visit – 58 percent
- Patient resistance to testing – 57 percent
Information and resources primary care physicians would welcome to facilitate cognitive assessments:
- Assessment tools to use – 96 percent
- Guidance on next steps when cognitive problems are indicated – 94 percent
- Steps for implementing assessments efficiently into practice – 91 percent
Updated Alzheimer's Statistics
The Alzheimer's Association Facts and Figures report also provides a look at the latest national statistics and information on Alzheimer's prevalence, incidence, mortality and morbidity, costs of care and caregiving.
Prevalence, Incidence and Mortality
- An estimated 5.8 million Americans of all ages are living with Alzheimer's dementia in 2019, including 200,000 under the age of 65.
- By 2025 — just six years from now — the number of people age 65 and older with Alzheimer's dementia is estimated to reach 7.1 million — an increase of 27 percent from the 5.6 million age 65 and older affected in 2019.
- Barring the development of medical breakthroughs, the number of people age 65 and older with Alzheimer's dementia may nearly triple from 5.6 million to 13.8 million by 2050.
- Two-thirds of Americans over age 65 with Alzheimer's dementia (3.5 million) are women.
- Alzheimer's is the sixth-leading cause of death in the U.S., and it is the fifth-leading cause of death for those age 65 and older.
- As the population of the U.S. ages, Alzheimer's is becoming a more common cause of death.
Cost of Care
- Total national cost of caring for those with Alzheimer's and other dementias is estimated at $290 billion (not including unpaid caregiving) in 2019, of which $195 billion is the cost to Medicare and Medicaid; out-of-pocket costs represent $63 billion of the total payments, while other costs total $32 billion.
- Total payments for health care, long-term care and hospice care for people with Alzheimer's and other dementias are projected to increase to more than $1.1 trillion in 2050 (in 2019 dollars).
- In 2018, the lifetime cost of care was greater for those with dementia than those without ($350,174 versus $192,575, respectively).
- Nearly half of all caregivers (48 percent) who provide help to older adults do so for someone with Alzheimer's or another dementia.
- Approximately two-thirds of caregivers are women, and one-third of dementia caregivers are daughters.
- Forty-one percent of caregivers have a household income of $50,000 or less.
- It is estimated that the U.S. has approximately half the number of certified geriatricians than it currently needs, and only 9 percent of nurse practitioners report having special expertise in gerontological care.