by Kara Kuntz, MD, Saint Alphonsus Medical Group
Over 6 million Americans are living with dementia. The cost of caring for these individuals is estimated by the Alzheimer’s Association to be 355 billion dollars in 2021. As a local geriatrician, I care for families who experience tremendous frustration over delayed diagnoses, poor efficacy of current drug therapies, lack of insurance coverage for in-home caregiving, and subsequent exhaustion of family members who assume this full-time responsibility with no training or compensation. The emotional and financial cost of this disease demands our attention.
This year, I discovered what I now consider the most important book I have read in my career: The Problem of Alzheimer’s - How Science, Culture, and Politics Turned a Rare Disease into a Crisis and What We Can Do About It, by Alzheimer’s expert, Jason Karlawish. His book outlines several ways to address this global crisis, thus providing hope to a seemingly bleak situation. Dr. Karlawish states that while many clinical trials are underway to develop treatments for dementias, research has demonstrated that these are complex diseases, unlikely to ever be cured or effectively treated with a single medication. A more comprehensive approach is needed to address this heterogeneous disease.
Oftentimes, diagnosed patients withdraw from their communities as they struggle with stigma. To combat this, dementia-friendly communities could be developed by creating safe spaces for individuals and families to engage in meaningful, social interactions. Churches and senior centers could offer activities and educational programs. Emerging technology may also help preserve autonomy in the future via self-driving cars and family-led remote monitoring of questionable financial transactions.
Multidisciplinary memory centers, such as Saint Alphonsus Geriatrics Consult Clinic where I work, are effective at providing a more comprehensive approach, but they are sparse throughout the country, let alone the state. Our patients meet with a pharmacist, social worker, geriatric nurse practitioner, and geriatrician. We provide care in Ada and Canyon counties, and elsewhere via telehealth as able, but statewide expansion in geriatric care is essential. We are fortunate to have a geriatrics fellowship at the Family Medicine Residency of Idaho, though more training to all healthcare workers is needed to improve early diagnosis, reduce delirium triggers, minimize harmful medications, and connect families with resources.
Unless an individual has Medicaid, most insurance carriers do not offer coverage for in-home caregiving. Many individuals must leave jobs to care for their loved one. Allowing a dementia patient to remain in familiar surroundings for as long as possible often improves outcomes and reduces cost. Therefore, our society must address how to financially compensate caregivers and offer respite to prevent burnout. More adult day centers for those with advanced disease with well-trained caregivers will be needed.
We must also engage in public conversations about lifestyle choices, brain health and offer more caregiver training and education. The Alzheimer’s Association Idaho Chapter, the Area Agency on Aging, the Idaho Caregivers Alliance, and Legacy Corp are among those doing this already. I am pleased to see that our legislature has taken note of this crisis and taken a step in the right direction this year by creating a dementia coordinator position, which will bring together related resources for the entire state.
Given the Treasure Valley’s burgeoning retired population, this community will be increasingly impacted by dementia over the years to come. This month, Dr. Karlawish will be speaking to the Ada County Medical Society and his keynote address will be publicly available on October 16th at 6:30 PM. To find out more, or to get a discounted copy of his book, visit adamedicalsociety.org.
Dr. Kara Kuntz is an Idaho-trained geriatrician and works for Saint Alphonsus Geriatrics Consult Clinic.