Blog | Tuesday, June 25, 2013

What underlies the costs of dementia


A story in the New York Times concerned the projected costs of dementia in the United States. Pam Belluck did a top-notch job covering the new findings of a RAND analysis, published in the New England Journal of Medicine. The researchers found that the financial impact of dementia rivals that of cancer and heart disease.

Dementia affects nearly 15% of people over 70 of age in the U.S., these researchers found. They used various statistical tools, adjustments, estimates, etc., to estimate the costs of care for an individual with dementia: it typically ranges between $41,600 and $52,300 per year. The tallies are huge for the population, involving some $109 billion per year for "care purchased in the market" or $215 billion if you include the "estimated monetary value of informal care", i.e. home care by relatives, days off from work and things people do all the time to assist old friends, family members and others in their communities.

The Times headline about dementia-related expenses doubling between now and 2040 and the NEJM article, focus on dollars and cents. And that's fair enough. Unless we're going to leave aging folks to die of thirst in a metaphorical woods, or purposively give them a woefully large dose of painkillers in a clinical setting, or otherwise kill them, we've got to find a way to take care of elderly people who need help.

But, and I hope this doesn't come across as heartless, I don't think it's reasonable to consider dementia in the very elderly along the same lines as illnesses that affect younger people, like lethal viruses, brain cancer or multiple sclerosis, to (randomly) name a few. Some degree of cognitive decline is normal, and aging is normal. It's natural, if you will, like grief, distraction and other aspects of the human experience. I don't really see the costs of dementia, when it doesn't occur prematurely, as "medical." Rather, it's the price we pay for extending human life by feeding tubes, screening for and treating cancers, placing pacemakers, performing dialysis and giving other treatments that so many live beyond a ripe old age.

What's not considered, left unaddressed, untended, is whether a legitimate goal of health care is to prolong life beyond a certain point. Few may be willing to mark that point, but I do think we're missing it. If we can afford the research, technology and consequences of extending life by what some might consider unnatural processes is a really tough question.

This post originally appeared at Medical Lessons, written by Elaine Schattner, MD, FACP, a nonpracticing hematologist and oncologist who teaches at Weill Cornell Medical College, where she is a Clinical Associate Professor of Medicine. She shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology and as a patient who's had breast cancer.