Alzheimer’s: The Need for Nutritional & Social Change

Background

Alzheimer’s disease is a fatal neurodegenerative progressive brain disease that mostly affects those of older ages.^{1, 2} It is usually depicted by the increasing decline of the brain’s cognitive performance¹ which causes the person afflicted to be incapable of taking care of themselves as they rely on the guardianship of others to execute even the most uncomplicated of both physical and mental tasks.²

The earliest symptoms of the disease include slight loss of memory and faint social changes, but the disease progresses into more severe symptoms, such as being unable to communicate and understand language and controlling his or her own bowels.² It is this grave state that usually confines these individuals to residence in a nursing home, as they need help with all facets of personal care.^{1, 2} Currently, the cause of Alzheimer’s disease is unknown, but many studies have indicated that both age and a family history of the disease are the strongest epidemiological risk factors.² Other risk factors include education, the maternal age at birth, hypothyroidism, head trauma, and the presence of the Apo-lipoprotein E4 genotype.^{2, 3}

One of the main concerns in regards to this specific disease is that to date, there is no known cure² and diagnostic testing for the disease is very expensive.⁴ The only way to positively confirm the presence of Alzheimer’s disease is through autopsy, so in order for a close diagnosis to be made, physicians put the patient through a long series of expensive physical, psychological, and neurological tests.^{2, 4}

Several studies suggest that the use of anti-inflammatory drugs, anti-oxidants, estrogen replacement in women, vitamin E, and the management of cardiovascular risk factors (i.e., hypertension) can help manage and possibly slow the progression of the disease, but no known cure has been found to date.^1,3,5 The Food and Drug Administration has also approved only 4 drugs for the treatment of Alzheimer’s disease (tacrine, galantamine, donepezil, rivastigmine)¹ and even these drugs only show marginal improvement in those with deep progression of the disease.^1,3

Cost of Care

It is because of these factors that Alzheimer’s disease put strain not only on the health care system but also on their family and friends.^3,5 Individuals with Alzheimer’s disease use health services more often and are prone to a higher rate of falls and accidents than other individuals of the same age without the disease.¹ As the US population ages, the costs of long-term care for these patients are increasing as well,⁶ and incidence of the disease is expected to increase.^{1,2,3,4,5,6,7}

In 2004, there were 4.5 million people in the United Stated with Alzheimer’s disease aged 65 to 74 years, 2.4 million ages 75 to 84 years, and 1.8 million aged 85 and older.⁵ By 2050, this number is expected to quadruple,^1,3,7 with an estimated 1 in 45 Americans expected to live with the disease.³ Currently, Alzheimer’s disease affects six to ten percent of the American elderly population⁷ and new cases are expected to triple from 360,000 (1997) to 1.14 million (2047).⁷

It is these blinding numbers that have raised the importance of not only preventing the disease, but also finding manners in which the health care system can lower the cost of care for these individuals as it effects not only formal health services but informal health services (usually provided by friends and family).^6,7 Regardless of the type of care, research has estimated the total Alzheimer’s disease associated costs to be about $47,000 per year.³ Formal care differs from community placement to institutional placement, but since 1995, costs have increased for Alzheimer’s disease treatment in both categories of facilities.⁷ Formal care includes hospital and nursing home stays, cost of doctors, cost of social services, and prescription medications.^4,6,7 Informal care is categorized as care unable to be reimbursed by traditional medical markets as it is given by friends and family outside of a medical institution.⁶

The greatest rise in Alzheimer’s disease care cost is by far in cases where individuals with the disease must be institutionalized.¹ Although this method assists with the severely impaired, it poses the greatest monetary load the American health system. Since 1994, the costs to Medicaid for Alzheimer’s disease institutionalization has increased 2.25 times¹, and since a large amount of this financial burden is carried by federal (specifically Medicare) and state governments, the public suffers as informal and formal out-of-pocket expenses rise.⁶ The estimated cost of care for Alzheimer’s disease in 1991 alone was estimated to be between $28 billion to $31 billion dollars,⁷ and those living with the disease for longer period of time need more medical care than those individuals that are freshly diagnosed.³

Regardless of the impact on the federal and state medical societies, the greatest weight lies on the shoulder of informal care: friends and family.^2,8 Half of care costs and even up to two-thirds of care costs are paid by personal caregivers, and almost all of these costs are not reimbursed⁵ despite state and federal governments assuming costs through Medicaid and Medicare.⁶ The average family member spends an approximated sixteen hours per week assisting the afflicted family member, with the number of hours and the burden of responsibility increasing as the disease worsens.⁸ For those with the most severe progression of Alzheimer’s disease, caregivers may spend up to thirty-five hours a week caring of the individual.⁷ The costs of care through friends and family is almost three times the amount of formal medical care for individuals with Alzheimer’s disease.⁶

Strategies and Recommendations

The financial and emotional costs of Alzheimer’s disease could be lessened if more attention was placed on the prevention and the slowing of the progression of the disease. If more interventions were implemented, a recent study has shown the formal medical services could save up to a whopping $24,348 per patient in care.^6,7 Delaying the onset of Alzheimer’s disease by even 1 year could reduce new diagnosed cases in 10 years by 210,000 and in 50 years by 770,000.³ By even impeding the commencement of the disease by six months, both formal and informal services could see an annual savings of $4.7 billion dollars after 10 years of preventative measures and up to $18 billion dollars after 50 years of preventative measures.^1,3 This mere six month impedance could also see 100,000 less new cases after 10 years and up to 380,000 new cases after 50 years.³ Furthermore, if institutions would treat those afflicted in assisted living centers instead of the more confined nursing home centers, costs could be cut up to $9,132 per patient.⁷

This cost can be proportioned with the cost of care for acquired immunodeficiency syndrome in order to show the gravity of Alzheimer’s disease effects on public health costs. Acquired immunodeficiency syndrome(AIDS) costs in 1991 where no more than $4 billion dollars⁸ versus the mammoth $28 to $31 billion dollars in costs for Alzheimer’s disease.⁷ This shows that the costs of even a more widely researched and more publicized disease such as AIDS do not hold a candle to the medical costs of the more unnoticed Alzheimer’s disease. It is obvious that more research for preventative measures, and even a cure, are needed as America’s population over the age of sixty-five is expected to more than double to approximately 70 million by the year 2030.⁹ With this fact, it is expected that the United States medical system can expect a wave on new Alzheimer’s disease patients over the next twenty to thirty years.

Current public health policy should focus on a number of important interventions when dealing with the rising aging population, the rise in newly diagnosed Alzheimer’s disease cases, and the rising costs in health care costs. NIH grants for discovering more on Alzheimer’s disease and it’s epidemiology should be increased significantly in order to discover better treatment methods (both medicinal and non-medicinal) and to discover early warning markers for the disease.^1,10

All future clinical trials involving an older population should include mental indicators and Alzheimer’s disease symptom indications as part of their assessment in order to provide a worldwide effort to improve the information collected and the efforts for a cure. Through earlier detection of Alzheimer’s disease, better patient care can be administered, and preventative measures can be dispensed earlier in the disease in order to further hinder its progression.

As vitamin E and the controlling of cardiovascular risk factors are thought to help slow the advancement of Alzheimer’s disease,^1,3,5 a Registered Dietician should be recommended immediately by the diagnosing physician in order to counsel both the individual recently diagnosed with the disease and the friends and family charged with the care of the individual. This is extremely important in the older population, as older individuals suffering from malnutrition have poor physical performance, are at a higher risk of falls, and suffer more often from depression and cognitive impairment than those of the same age group who are nutritionally well-maintained.¹¹ Additionally, the typical American diet of high-fat red-meats, saturated fat, refined starches, and sweet desserts has been found to contribute to the promotion and advancement of Alzheimer’s disease.¹² This is due to the increased amyloid-B protein production¹² which increases oxidative stress in both the body and the brain.^12,13 Through the physician mandated assistance of a Registered Dietician to all patients diagnosed with Alzheimer’s disease, adherence to the Mediterranean diet (abundant in plant foods, dairy, olive oil as the principle fat, fish and poultry, and low in saturated fat),¹⁴ the Japanese diet (based on fish, whole grain rice, and soy products),¹⁵ and the Healthy Diet (higher consumption of fish, fruits, and vegetables)¹³ may slow the progression of Alzheimer’s.¹³ Furthermore, if this service was mandated to all individuals over the age of 65, regardless of Alzheimer’s diagnosis, adherence to these diets may even prevent Alzheimer’s in a large part of the population.¹³

From a public health position, it is important to emphasize the fact that more than three-fourths of the costs for Alzheimer’s disease formal care is for home care. If public policy for home care was developed to improve the ability for an individual diagnosed with Alzheimer’s disease to remain in the community under medically provided supervision, it would remove much of the burden from the family and friends.¹⁶ Also, although a dependent care tax credit exists in order to assist caregivers in subtracting a portion of the expenses from their federal income tax, most families in the lower-income brackets are not reimbursed, and even more families are deprived of this opportunity due to eligibility limitations.¹⁷

Conclusion

The rising aging population⁹ and increasing health care costs should raise concerns of the possible influx of newly diagnosed Alzheimer’s disease cases. Through better prevention strategies, both nutritional and social, and through better public policy opportunities for improved institutional, community, and at home-care, the threatening problem of an overwhelming amount of new Alzheimer’s disease patients from here until 2050 can be significantly reduced.

References

1. Boustani M, et al., The Public Health Impact of Alzheimer’s Disease, 2000-2050: Potential implication of treatment advances. Rev. Public Health. 2002; 23: 213-31
2. Ernst R, Hay J, The Economic Costs of Alzheimer’s Disease. Am J Public Health. 1987: 77; 1169-1175
3. Brookmeyer R. et al., Projections of Alzheimer’s Disease in the United States and the Public Health Impact of Delaying Disease Onset. Am J Public Health. 1998; 88 (9): 1337-1342
4. Ernst R, Hay J, The US Economic and Social Costs of Alzheimer’s Disease Revisited. Am J Public Health. 1994; 84: 1261-1264
5. Bienas J, et al., Alzheimer Disease in the US Population. Arch Neurol. 2003; 60: 1119-112
6. Fox PJ, et al., The economic burden of Alzheimer’s disease care. Health Affairs, 1993; 12(2): 164-176
7. Cheng CK, et al., Alzheimer’s disease care: costs and potential savings. Health Affairs. 1998; 17(6): 206-216
8. Weiler G, The Public Health Impact of Alzheimer’s Disease. AJPH. 1987; 77(9): 1157-1158
9. Baughman R, Smith K, Caring for America’s aging population: a profile of the direct-care workforce. Sociology Scholarship. 2007; Paper 14: 1-8
10. Arnold S, et al., Advancing Alzheimer’s disease diagnosis, treatment, and care: recommendations from the Ware Invitational Summit. Alzheimer’s and Dementia. 2012; 8: 445-452
11. Manaf ZA, et al., Correlation between nutritional status and comprehensive physical performance measures among older adults with undernourishment in residential institutions. Clin Interv Aging. 2014; 9:1415-23
12. Hu N, et al., Nutrition and the Risk of Alzheimer’s disease. Biomed Res-Tokyo. 2013; Article ID 524820: 1-12
13. Harris PL, et al., Amyloid-beta deposition in Alzheimer’s transgenic mice is associated with oxidative stress. J Neurochem. 1998 May; 70(5): 2212-5
14. Drescher G, et al., Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr. 1995; 61(6): 1402s-1406s
15. Kesteloot, et al., Prevention of Coronary Heart Disease by Diet and Lifestyle. Circulation. 2002; 105: 893-898
16. Doty, et al., Family Care of the Elderly: The Role of Public Policy. The Milbunk Quarterly. 1986; 164 (1): 34-75.
17. Older Women’s League., “Failing America’s Caregivers: A Status Report on Women Who Care,” Mother’s Day Report (1989)

Angelique Johnson

Angelique Johnson is a Registered Nutrition and Dietetics Technician from Miami, FL. Through her own journey in weight loss, she discovered her love for health and nutrition, and through her venture realized she wanted to help others suffering from obesity and other medical illnesses achieve a healthier lifestyle.
She graduated with honors from Florida International University with a Bachelor of Science in Nutrition and Dietetics, and is currently pursuing her Masters of Science in Nutrition and Dietetics. She was the winner of the Dean's Academic Excellence Award for her graduating class and the 2014 recipient of the Florida Academy of Nutrition and Dietetics Clara St. Augustine Scholarship.

Angelique has been featured as a nutrition consult on CBS4 Miami News and is a published contributor on MindBodyGreen. She is passionate about debunking diet rumors and showing her clients how to have a healthy, balanced relationship with food. No starving. No dieting. Just real science-based advice on living and loving a healthier life. She currently works as a nutrition counselor and educator in Miami, FL. You can visit Angelique's website at www.nutritionbyangelique.net