Alzheimer's: Let's Search for Better Care Models as Well as a Cure

Jul 9, 2013, 2:00 PM, Posted by

An elderly disabled man walks with a stick on a path in a garden.

The New Yorker recently ran an excellent article by Jerome Groopman MD, Before Night Falls, about efforts to find a drug that can delay or even stop the onset of Alzheimer’s. What struck me most about this thorough piece of reporting, however, is that it covers much the same ground as a feature I wrote for Businessweek—in 2007. Despite the huge amount of money and other resources devoted to Alzheimer’s research, the quest for an effective treatment has moved forward by mere fractions in the past six years.

Almost every drug I wrote about in 2007 has since failed, which means it will be at least a decade, and probably far longer, before an effective treatment wins regulatory approval. Meanwhile, the Alzheimer’s Association recently reported that one in three seniors will die with Alzheimer’s or another form of dementia in the U.S. this year, and 5.2 million people are currently living with Alzheimer’s. By 2025, the number of people living with the disease will likely reach 7.1 million. So while we’re waiting for a cure, the medical community should also be developing better methods for caring for the millions of patients who are suffering right now.

There are few greater burdens for patients, caregivers, and the economy. The New England Journal of Medicine reported in April that the total cost of treating dementia in 2010 was $109 billion, more than was spent on heart disease or cancer. By 2020, dementia patients will account for 10 percent of the elderly, and 17 percent of Medicare spending. On top of that, the Alzheimer’s Association estimates that some 15 million family caregivers are providing more than 17 billion hours of unpaid care for people suffering from Alzheimer’s, and they racked up $9.1 billion in additional health care costs of their own in 2012.

Right now, too many dementia patients are lying in nursing homes subjected to anti-psychotic drugs and physical restraints. There has been some research into better approaches, but not enough. Still, there is evidence that coordinated care and smaller institutions can deliver both better and more affordable results. For example, a Veterans Affairs study funded by the RWJF found that, by taking a holistic approach to care and integrating primary and acute health services for people with Alzheimer’s, outcomes are improved at no extra cost.

Particularly innovative is the Green House Project, also funded by RWJF, a residential care facility that resembles a private home more than an institution. Each Green House accommodates six to 12 residents, all of whom have a private bedroom and bathroom, and the freedom to set their own daily routine. There is a kitchen table, a living room and a team of highly trained caregivers, with a low staff-to-resident ratio that results in four times more staff contact than traditional nursing homes.

In a recent Wall Street Journal article, Green House Project director David Farrell said the small homes allow residents the small homes have lower administrative costs than a nursing home, and, because the  nursing staff develop a closer relationship with residents, “the [nurses] can pick up on subtle changes in the elderly,” which leads to preemptive care rather than medical emergencies. Consequently, these small homes have better clinical outcomes that traditional nursing homes at the same cost.

So, sure, I’m all for doubling down on efforts to find a drug for this horrible disease. But in the meantime, let’s try to come up with better, more cost-effective approaches to care, before night falls for too many more of us.