Tuesday, September 09, 2008

Alzheimer's caseload is multiplying rapidly worldwide, with major societal implications

An AP story from June 11, 2007, permanently published at MSNBC, states that 1 in 85 people worldwide will have Alzheimer’s disease by 2050, for a total of 104 million cases. 26 million have the disease now.

In the North America, there are 3.1 million cases, somewhat less than 1% of people, but the caseload in the US should reach 8.8 million in 2050. The link for the report is here.

One major reason for the large increase in cases is that other medical treatment (including drugs that prolong life in the case of cancer and heart disease) is prolonging life, and memory and cognition loss is occurring somewhat naturally with age in some populations, possibly because of genetics. It may be possible to design new medications to halt the memory loss much more effectively than now.

The Centers for Disease Control in Atlanta has a webpage for Alzheimer’s here.

The large number of cases suggest a huge future caregiving problem. It’s hardly clear that the long term care insurance industry would be able to take care of most of this, given issues like premiums and actuarial, the multiple criteria required to file a long term care claim, the number of facilities and beds available, and the number of employees.

Neither presidential candidate has paid much attention to eldercare in comparison to the general population health care insurance issues, because there is an impression that Medicare takes care of this. However, Medicare generally does not cover custodial care.

The recently tightened rules preventing Medicaid “givebacks” are well known, but less clear to people is that in many states adult children could be pursued for impoverished parents’ eldercare expenses even when there has been no inheritance, according to filial responsibility laws. States may start becoming more aggressive deploying these. Pennsylvania recently moved elder filial responsibility from the “welfare code” to “family code.” It’s particularly unclear how responsibilities could be enforced across state lines, or divided up among adult children. Childless adults may find that they have “mandatory family responsibility” regardless of the reproductive choices that they made (or didn’t make). One could actually be much better off in such a world if one does have children (as it was a century ago, well before social programs, when children were a necessary economic asset). This problem could have a profound affect on how we perceive “family values” and associated “moral values,” and the modern concept of “personal sovereignty.”

China, with its one-child-per-family policy, makes an interesting comparison, because of its Confucian value system ("filial piety") and general lack of government safety net since embracing “People’s capitalism.” In China, as Ted Koppel noted in his recent Discovery Channel series, young LGBT adults say that they are still expected to marry, form families, and have one child, and must “go back into the closet”. It’s interesting to make these connections

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