Now that the Baby Boomer generation is heading into the retirement age, Alzheimer’s disease has become the next major concern for healthcare professionals - and entitlement programs. With new changes in healthcare reform during a troubled economy, a new generation is increasingly growing concerned about the looming financial burden of caring for millions of patients affected by this disease. How will this affect healthcare providers, Medicaid, and the patients and their families’ finances - not to mention the emotional toll of caring for a loved one suffering from dementia?
Miami Jewish Health System's own Dr. Marc E. Agronin shares his vision of how to combat the disease on medical, social, and economic fronts with the New York Times in the Room For Debate column.
More Training and Research
Marc E. Agronin, a geriatric psychiatrist, is the medical director for mental health and clinical research at the Miami Jewish Health Systems.
Alzheimer’s disease is most commonly depicted as a disorder of memory and other cognitive skills. The inexorable decline in daily functioning eventually renders its victims completely dependent, and exacts an enormous social and economic toll on individual caregivers and caregiving systems alike.
Nursing homes are the new psychiatric hospitals with the majority of residents suffering from disorders, attributable to dementia.
.But there is another side to Alzheimer’s disease that is too often overlooked, and that is the presence of mental health problems that have a multiplicative effect on caregiver burden and economic cost. More than 50 percent of individuals with Alzheimer’s disease face serious problems with depression, apathy, psychosis, delirium or behavioral disturbances that overwhelm even the best attempts at care.
Indeed, nursing homes have become the new psychiatric hospitals with the majority of residents suffering from one or more psychiatric disorder, most of which are attributable to Alzheimer’s disease or other forms of dementia. Ask any caregiver or clinician on the frontlines of care and they will tell you that these mental health issues are some of the most troublesome and time-consuming problems they face. They are a primary reason why caregivers themselves suffer from increased rates of depression, medical problems and even mortality.
Geriatric psychiatrists and other mental health clinicians who have the training to treat these conditions face daunting tasks. In the United States there are less than half the clinicians needed on the frontlines, and certainly not enough in the pipeline from poorly financed training programs.
Medicare reimbursement rates provide an incentive for volume of patients seen instead of quality of care. And the use of psychotropic medications in dementia patients is stymied by concerns about safety, liability and diagnostic confusion that have frightened both clinicians and caregivers and have driven many pharmaceutical companies out of the business of finding effective treatments.
Without a cure on the horizon, Alzheimer’s disease will be with us for some time – so what is to be done? We need more funding for geriatric training programs, psychiatry and medicine alike. We need to devise better payment systems to account for the complexity and time-consuming nature of psychiatric care for Alzheimer-associated behavioral disorders. Finally, we need more funded research into safe and effective medications as well as diagnostic labels for behavioral disturbances that are acceptable to the Food and Drug Administration.
A modest investment in these areas will yield an economic benefit in the long-run, but most important, it will bring certain improvement to the quality of life and dignity for those suffering from this mental scourge.