“After billions of dollars in research and hundreds of failed drugs, the race to come up with a treatment for Alzheimer’s keeps hitting wall after wall after wall.” This quote from a recent article, The Outlook For Alzheimer’s Research Keeps Getting Bleaker, by Sam Baker of Axios hit me hard this week.
Alzheimer’s and dementia affects a large portion of the population—and prevalence is expected to grow. Already, in 2019 about 10% of Americans age 65 and older (5.8 million people) are living with Alzheimer’s dementia (see 10% Of Americans Aged 65 & Older Have Alzheimer’s Disease), and among people aged 75 and older, 14.3% have reported at least one symptom of subjective cognitive decline (SCD), an early indicator of Alzheimer’s disease (see 14% Of Those Aged 75+ Have Early Symptom Of Alzheimer’s). The median survival time for people with dementia is six years, and 6.2 years for those with dementia due to Alzheimer’s disease (see Median Survival Time For People With Dementia Is Six Years). Of the 261,914 dementia deaths in the U.S. in 2017, 46.4% of these deaths were due to Alzheimer disease (see 46.4% Of U.S. Dementia Deaths From Alzheimer’s Disease). Prevalence estimates show that this is a growing problem—the Centers for Disease Control and Prevention (CDC) expects Alzheimer’s disease to double by 2060 and affect 3.3% of the population (13.9 million people) (see U.S. Alzheimer’s Disease Prevalence To Double By 2060).
This all got me wondering at the current state of treatment, which hasn’t progressed much in recent years. Currently, treatment is focused on managing behavioral symptoms, maintaining mental function, and generally slowing down symptoms of the disease. There are several medications approved by the federal Food and Drug Administration (FDA) for to help reduce symptoms and slow down the progression of the disease, and consumers with Alzheimer’s are also sometimes prescribed other medications to address specific symptoms of the disease, such as sleeplessness, depression, agitation, anxiety, and aggression (see National Institute on Aging: How Is Alzheimer’s Disease Treated? and What’s To Know About Alzheimer’s Disease?). But despite a lot of time and money exploring new drugs to combat the disease, the pharmaceutical pipeline for new medications hasn’t looked good for years (see A Long Line of Alzheimer’s Failures: Roche Drops Two Drug Trials, Why Do Trials For Alzheimer’s Disease Drugs Keep Failing? A Discontinued Drug Perspective For 2010–2015, and Alzheimer’s Drug Fails in Another Crushing Disappointment).
This is troublesome considering that the average cost of care for the current Alzheimer’s population is nearing $290 billion in 2019, a 4.69% increase from the 2018 average cost of care projection of $277 billion. The cost of care for people living with dementia represents approximately 7.59% of the estimated $3.492 trillion national health expenditure. The $290 billion covers health care, long-term care, hospice care, and prescription medications (see Alzheimer’s Costs Expected To Increase By $20 Billion, To $277 Billion In 2018). In the final five years of a consumer’s life, the costs dementia total about $287,000—compared to $175,000 for a consumer with heart disease and $173,000 for a consumer with cancer (see Costs Of Alzheimer’s To Medicare And Medicaid). Combined Medicare and Medicaid spending on consumers with Alzheimer’s are expected to reach $770 billion by 2050.
So, what is working? First, there has been a greater focus on prevention as we gain a greater understanding of the health factors that can affect dementia. I thought the advice given by dementia expert John DenBoer was interesting—that aerobic and mental exercise are the only effective treatments (see 8 Questions For The Dementia Doctor Whose Netflix Documentary Premieres Thursday). Recent studies have shown a link between controlling blood sugar and dementia—consumers with untreated type 2 diabetes are 1.62 times more likely to develop dementia than older adults with normal blood glucose levels (see Older Adults With Untreated Type 2 Diabetes 60% More Likely To Develop Dementia Than Those Without Diabetes), and controlling blood pressure and dementia (see New Studies On Dementia Released; Focus On Blood Pressure & Blood-Brain Barrier). There are also opportunities to promote increased consumer engagement and education to promote healthier lifestyles as part of a long-term approach to overall healthcare (see Lifestyle Changes Are Effective For Preventing Dementia).
Second, though advances in pharmaceutical interventions haven’t been as promising, there has been some other technology advancements. Transcranial magnetic stimulation (TMS)—the application of MRI strength magnetic field pulses to the left pre-frontal cortex—has shown some promise in recent years (for a quick dive into this tech, check out Where Does TMS Fit In The New Landscape? and TMS 10 Years Later). In late 2016, Neuronix Ltd. announced it had filed for clearance from the U.S. Food and Drug Administration (FDA) to market its neuroAD Therapy System, a transcranial stimulation therapy system that includes cognitive training as a treatment for mild to moderate Alzheimer’s disease (see Neuronix Seeks FDA Clearance For Alzheimer’s Therapy That Uses Transcranial Stimulation, Cognitive Training).
What are the opportunities for provider organization in this market? For executives of provider organizations looking for ways to bring value to this landscape, finding less expensive treatment options that help to shift away from institutional and residential levels of support will be key. First, there is an opportunity for more community-based programs, like adult day centers, activity programs that support cognitive functions, support groups, and other therapeutic interventions to address the symptoms of dementia. These types of support programs, along with tech-enabled support tools, are essential to enabling consumers with dementia to remain in the community.
Next, there is a need for more care coordination programs to support consumers with comorbid conditions and complex support needs. Integrated care management programs that address a consumer’s medical, mental health, and social support needs can lower the cost of care. One example of this approach that was recently shown to be successful is the University of California Los Angeles Health System Alzheimer and Dementia Care program, which reduced nursing home admissions by 40%. Each participant in the program and their caregiver met with a nurse practitioner specializing in dementia care for a 90-minute, in-person structured needs assessment. The nurse practitioner then provided a personalized dementia care plan for needed medical, mental health, and social treatments. The nurse practitioner coordinated with the consumer’s primary care physician, and the plan included referrals to community supports and 24/7 access to clinical professionals (see Los Angeles Dementia Care Program Reduces Nursing Home Admits By 40%).
Until there is a new pharmaceutical intervention or other treatment methodology on the horizon, it will be up to long-term care organizations and specialty provider organizations to serve consumers with dementia in both facilities and in the community. The need will only grow, along with the costs.
For more on the long-term services and supports market, check out our recent analyses:
- The Shifting Long-Term Services Market: A Strategic Guide To Support Services For Complex Population
- The Medicaid MLTSS Market Shift
- In Managed Long-Term Care, Whole Person Takes One Step Further
- The Formula For Success In Long-Term Services & Supports
- LTSS Drives Whole Person Care Strategies
- LTSS Investment-& Restructuring- Speeds Up
For more, join us at The 2019 I/DD Executive Summit in New Orleans on Monday June 3. The Summit is designed to give executive teams the strategic tools they need to build sustainable organizations in a value-based world. This year, the Summit is focused on helping organizations build a business model focused on improving performance outcomes, preserving consumer self-direction, and exploring new partnerships across the care continuum.