FLORHAM PARK, NJ – The Greater New Jersey chapter of the Alzheimer’s Association (AAGNJ) has announced that findings from the organization’s recently released “Alzheimer’s Disease Facts and Figures” report 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 the impact on caregivers nationally and in New Jersey, 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.
Following the release of the 2019 report, Cheryl Ricci-Francione, executive director of the AAGNJ chapter, expressed why it is crucial for anyone going in for a Medicare Annual Wellness Visit—especially those who have concerns about their thinking or memory—to initiate a conversation with his or her doctor about a cognitive assessment.
“In New Jersey, there are 180,000 people living with the disease supported by 448,000 caregivers providing more than 511-million hours of unpaid care,” said Francione. “Early detection of cognitive impairment offers numerous medical, social, emotional and planning benefits for both affected individuals and their families.”
According to AAGNJ, the 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 one in three seniors are aware that 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, according to the 2019 report.
The report found that only one in seven 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).
This year’s “Facts and Figures” report also reveals what AAGNJ described as “a troubling disconnect between seniors and primary care physicians” regarding who these individuals believe is responsible for initiating these assessments and reticence from seniors in discussing their concerns.
The survey found that although nearly 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 four in 10 (40 percent) have ever discussed these concerns with a health care provider, and fewer than one in seven 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.
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).
“It’s normal to feel nervous about undergoing a cognitive assessment, but there are steps you can take to have a productive conversation with your doctor and to understand what to expect from an assessment,” said Francione. “Visit alz.org to access a checklist to prepare for your visit and issues to discuss with your doctor, as well as to review the reasons to get checked and additional resources the Alzheimer’s Association provides.”
Click HERE to read a Q&A session with Joanne Pike, DR. P.H., chief program officer, Alzheimer's Association, that was featured in the "Health Talk" section of The Star Ledger following the release of this year’s report.
See below for some statistics from the 2019 “Alzheimer’s Disease Facts and Figures” report, including the accompanying special report, or click here to read the full text of the report along with the accompanying article, “Alzheimer’s Detection in the Primary Care Setting: Connecting Patients with Physicians.”
2019 Fact and Figures Report 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 for 2019:
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, 180,000 are New Jersey 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 New Jersey, the estimated number of individuals with Alzheimer’s will be 210,000.
- 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 New Jersey, 2,829 died from Alzheimer’s in 2017, the most recent figure available.
- 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 New Jersey, the report estimated total Medicaid costs for Americans with dementia age 65 and older is nearly $2.1 billion for 2019. In the next six years, that figure is expected increase 23.7 percent to $2.6 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).
- More than 16 million Americans provide unpaid care for people with Alzheimer’s or other dementias.
- In New Jersey, there are 448,000 caregivers. In 2018, these caregivers provided 511,000,000 total hours of unpaid care, valued at $6,455,000,000.
- Caregivers in New Jersey have $359,000,000 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.
About 2019 Alzheimer’s Disease Facts and Figures:
This annual report is a comprehensive compilation of national statistics and information on Alzheimer’s disease and related dementias. It conveys the impact of Alzheimer’s on individuals, families, government and the nation’s health care system. Since its 2007 inaugural release, the report has become the preeminent source covering the broad spectrum of Alzheimer’s issues.
The “Facts and Figures” report is an official publication of the Alzheimer’s Association. Visit alz.org or call the 24/7 Helpline at 800-272-3900 to learn more.