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 statistics on Alzheimer’s prevalence, incidence, mortality, costs of care, and impact on caregivers nationally and in Georgia, 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.

“There is a fast growing human and financial impact of Alzheimer’s in Georgia”, added Linda Davidson, Executive Director, Alzheimer’s Association, Georgia Chapter. “Early detection of Alzheimer’s or related dementia offers numerous medical, social, emotional and planning benefits for both affected individuals and their families”, added Davidson.

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.

“Our hope is that through the awareness of this report, that the discussion of cognitive assessments among seniors and their physicians will begin to become as important as other annual checks like blood pressure for instance”, added Davidson.

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).

“Here in Georgia, we have education classes and materials that we provide to those living with Alzheimer’s and their caregivers on how to talk to their physicians about their memory concerns and other cognitive issues”, added Davidson. “We also have materials for caregivers on how to talk to their loved ones if they suspect any issues and how to talk to them about seeing a physician about their concerns”.

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 and local 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.

Of the estimated 5.8 million Americans living with Alzheimer’s dementia in 2019, 150,000 are Georgia residents.

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. Here in Georgia, the estimated number of individuals with Alzheimer’s will be 190,000.

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. In Georgia, 4,298 died with Alzheimer’s in 2017.

Georgia had a 248% increase in deaths since 2000, which is significantly higher than national average.

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.

In Georgia, the report estimated total Medicaid costs for Americans with dementia age 65 and older is $1.18 billion for 2019. In the next six years, that figure is expected to increase 33.5 percent.

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).

Caregiving

More than 16 million Americans provide unpaid care for people with Alzheimer’s or other Georgia, there are 533,000 caregivers. In 2018, these caregivers provided 607 million total hours of unpaid care, valued at $7.6 billion.

Caregivers in Georgia have $317 million higher health care costs.

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.