Association Report: Disconnect Between Seniors and Physicians When It Comes to Cognitive Assessment

 

Findings from the Alzheimer’s Association 2019 Alzheimer’s Disease Facts and Figures report released today 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 impact on caregivers nationally and in Michigan, 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.

A 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 1 in 3 seniors are aware 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.

“There are 190,000 people living with Alzheimer’s disease in Michigan, and more than 517,000 people providing unpaid care for someone with the disease,” says Jennifer Howard, Executive Director of the Alzheimer’s Association, Michigan Great Lakes Chapter. “For these families, routine cognitive assessments provide an opportunity for thinking or memory issues to be detected and addressed early, and offers individuals the opportunity to plan for the future, participate in clinical trials, and take advantage of lifestyle changes that may help preserve their existing cognitive function for as long as possible.”

The report found that just 1 in 7 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).

The Facts and Figures report also reveals a troubling disconnect between seniors and primary care physicians regarding who they believe is responsible for initiating these assessments and reticence from seniors in discussing their concerns.

The survey found that while 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 4 in 10 (40 percent) have ever discussed these concerns with a health care provider, and fewer than 1 in 7 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.

“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,” says Howard. “If you are going in for your Medicare Annual Wellness Visit or have concerns about your thinking or memory, initiate the conversation with your doctor about getting checked.”

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).

“The Alzheimer’s Association encourages seniors and physicians to be more proactive in discussing cognitive health during the Annual Wellness Visit and other routine exams,” says Howard. “We offer a number of tools on alz.org to help with this, including the Alzheimer’s Association Cognitive Assessment Toolkit, which provides guidance to physicians on conducting these assessments. We also offer a checklist to help seniors prepare for their visit and questions to ask their doctor. Anyone who’s interested in getting more specific guidance is also welcome to call and set up a free appointment to meet with one of our social workers on staff to discuss their concerns and put together a care plan.”

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

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, 190,000 are Michigan 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 Michigan, the estimated number of individuals with Alzheimer’s will be 220,000.
  • 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 Michigan, 4,428 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 Michigan, the report estimated total Medicaid costs for Americans with dementia age 65 and older is $1.422 billion for 2019. In the next six years, that figure is expected to increase 20.9% to $1.719 billion.
  • In Michigan, among Medicare beneficiaries with Alzheimer’s or other dementias, 23.4 percent of hospital stays are followed by a readmission within 30 days. Michigan has the second-highest hospital readmission rate in the nation.
  • 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).

Caregiving

  • More than 16 million Americans provide unpaid care for people with Alzheimer’s or other dementias.
  • In Michigan, there are 517,000 caregivers. In 2018, these caregivers provided 589 million total hours of unpaid care, valued at $7.4 billion.
  • Caregivers in Michigan have $376 million 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.

 Full text of the 2019 Alzheimer’s Disease Facts and Figures report, including the accompanying special report, “Alzheimer’s Detection in the Primary Care Setting: Connecting Patients with Physicians,” can be viewed here. For multi-media support of this year’s report click here.

 About 2019 Alzheimer’s Disease Facts and Figures

The Alzheimer’s Association 2019 Alzheimer’s Disease Facts and Figures report is a comprehensive compilation of national statistics and information on Alzheimer’s disease and related dementias. The report 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.

About the Alzheimer’s Association

The Alzheimer’s Association is the leading voluntary health organization in Alzheimer’s care, support and research. Our mission is to eliminate Alzheimer’s disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer’s®. Visit alz.org or call 800.272.3900.

 

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