Last month, The Journal of the American Medical Association (JAMA) published a major report on the State of U.S. Health 1990-2010 as part of the Global Burden of Disease project funded by the National Institutes of Health, the National Institute of Environmental Health Sciences, and the Bill and Melinda Gates Foundation.
There’s a ton of information on changes in life expectancy and healthy life expectancy at birth over this 20-year span and all the usual international comparisons. Probably most people have heard the good news/bad news parts of the report: Both life expectancy and healthy life expectancy have increased in the U.S. (+3.0 and +2.3 years, respectively), but we continue to lose ground in comparison to other Organisation for Economic Co-operation and Development (OECD) nations, falling to 27th and 26th from 20th and 14th out of the 34 countries in the group.
But what interested me most is the change in the impact of Alzheimer’s disease in the U.S. Between 1990 and 2010, the rate of death due to Alzheimer’s increased by 524 percent, the most of any of 30 diseases and injuries contributing to reduced life. Even the rate of years of life lost (YLL), which takes into account the shorter life expectancy of people affected by a disease of aging, shows an increase of 391 percent.
Alzheimer’s disease, which wasn’t even ranked in the top 30 for death or YLL in 1990 (it was #32), has shot to the #9 position in 2010.
The change is also significant when one looks at years lived with disability, a statistic that reflects the frequency of an issue, the severity of its impairment, and how long people usually live with it. Here, despite the fact that Alzheimer’s is a terminal illness that strikes people late in life, it has risen to the #12 cause of years lived with disability from #17, beating out ischemic heart disease, stroke, and chronic kidney disease.
As an aside, the disabling conditions that lead Alzheimer’s are the common mental health conditions of depression and anxiety, pain issues (backs, necks, arthritis, and other), breathing disorders (COPD and asthma), drug use disorders, and falls.
I would suspect that part of the increase in Alzheimer’s as a cause of death is due to changes in how cause of death is coded. And perhaps, given that Alzheimer’s is a terminal disease for which there are no life-prolonging treatments, it is unavoidable to see death rates attributable to it rise, demonstrating that other more controllable threats are being treated appropriately.
Nonetheless, at #9 for death and #12 for years living with a disability, Alzheimer’s is clearly a very big deal and not one I had expected to see on this list, given that these data end in 2010—before members of the baby boom generation began turning 65 and well before the major expansion of the oldest old we will see over the next 30 years.
The John A. Hartford Foundation has done a lot over the years to address this issue. About half of the 193 Beeson Scholars we have supported over the past 20 years have been basic scientists focusing their research on neurological disease. Nonetheless, the news is still bleak with regards to any pharmacological cure for Alzheimer’s even at the beginning of the long drug development pipeline.
So while the National Institute on Aging and others continue to focus their attention on possible cures, I am proud that we are supporting grantees working to improve the care of people with Alzheimer’s and reducing the burden faced by their families today and into the foreseeable future.
PHI (formerly known as the Paraprofessional Healthcare Institute) works to improve the care of older adults and the disabled by improving the training, supervision, and job-quality of the front-line caregivers in homes and institutions. These are the paid workers who provide the most care to people with dementia and are essential to maintain quality of life.
And just last week, the Hartford Foundation’s board of trustees approved a wide-ranging grant aimed at mobilizing “alumni” of all different past Hartford projects, to bring their talents and energy to bear on improving the care provided to older Americans. While we think that one of the strengths of this Change AGEnts program will be that it calls upon participants to find their own best contribution, it will be led by Laura Gitlin, PhD, one of the nation’s premier scientists and leaders in the development of behavioral interventions in dementia.
Moreover, a select group of AGEnts will jump into their work by convening a workgroup of the nation’s best and brightest geriatric experts to focus on ways to support family caregivers of older adults with dementia.