1. ALZHEIMER’S DISEASE:
MANAGEMENT CHALLENGES
& TREATMENT MEASURES
RICCI M. HAYES
JUNE 7, 2015
HCM310 – Introduction to the U.S. Healthcare System
Colorado State University – Global Campus
Dr. Dawn Tesner

2. Alzheimer’s Disease (AD): The Numbers
AD afflicts 5.2 million people and is
expected to reach as much as 16
million by 2050 (Medscape, 2015a).
Americans spend roughly
$100,000,000 per year on AD
care, a figure expected to rise
exponentially (de la Torre, 2010).
Source: http://reference.medscape.com/features/slideshow/alzheimers/
80-90% of nursing home patients
with dementia have
neuropsychiatric symptoms, a
precursor to staff turnover, stress,
and burnout (Van de Ven, Draskovic, Van
Herpen, Koopmans, Donders, Zuidema,
Adang, Vernooij-Dassen , 2014).

3. Incidence of AD vs other chronic disease
Aging-related Alzheimer’s Disease
increasingly evident until ~ 90
years old
Other co-morbidities such as
diabetes and arthritis, start to
decline ~ 70-80 years old.
(Akushevich, Kravchenko, Ukraintseva,
Arbeev, &Yashin, 2012).
Source: Akushevich, et al, 2012, p. 325

4. AD in Skilled Nursing Facilities (SNFs)
 Many AD afflicted are in SNFs. This is covered
by Medicare, right?
 Not exactly…
 Days 1-20, paid in full
 Days 21-100, Medicare Part A pays primary,
patient pays co-pay
 Day 101…no Medicare reimbursement
(Center for Medicare & Medicaid Services, 2014)

5. Affordable Care Act (ACA) and AD
 ACA includes mandate: improve transparency
about ownership of SNFs (Sultz & Young, 2014).
 ACA through CMS provides patient
information about “grades” of SNFs relative to:
 Health Inspection
 Staffing
 Quality Measures (Medicare, 2015)

6. AD Treatment & Cost Containment
 Are there treatment options that reduce cost of
long-term care?
 Van de Ven, et al, (2014) previously studied
dementia-care mapping (DCM) and showed
effective in dementia care, but sought to
examine further…
Is the one-to-one treatment cost efficient
for SNFs?

7. AD Treatment & Cost Containment (cont.)
“We find that DCM is a cost-neutral intervention
for nursing home residents with dementia that
has an advantage over usual care when it
comes to the costs of outpatient hospital
appointments. Since DCM has shown positive
effects on resident outcome measures such as
depression, agitation and quality of life,
considerations other than costs may
determine whether or not a nursing home will
adopt this method,” (Van de Ven, et al, 2014, p.8, para.2)

8. Prevention=Cost Savings Champion
There is no cure for Alzheimer’s.
Early prevention of known risk
factors, may delay, or even
eliminate the causation of AD.
Author states that “carotid artery
ultrasound and echocardiography
together with ankle-brachial index…
[are] cost-effective, non-invasive,
and reasonably accurate” in
detecting risks for AD (de la Torre,
2010, p.868, para.5).
Source: de la Torre. (2010). p.865

9. Prevention=Cost Savings Champion
In Medscape’s etiology section on AD, it says:
Midlife hypertension is an established risk factor for
late-life dementia, of which AD is the most common
type. A brain autopsy study evaluating the link
between hypertension and AD found that patients
using beta-blockers to control blood pressure had
fewer Alzheimer's-type brain lesions on autopsy
compared to patients taking no drug therapy or those
taking other medications (2015b).

10. Alzheimer’s Disease Management
AD is a debilitating, progressive disease.
AD care costs Americans millions of dollars.
AD has no cure.
Only by addressing the lifestyle, preventable
risks of AD, can we hope to curb the
increasing rate of disease and its associated
financial burden to American healthcare.

11. References
 Akushevich, I., Kravchenko, J., Ukraintseva, S., Arbeev, K., Yashin, A. (2012, February). Age patterns of
incidence of geriatric disease in the U.S. elderly population: Medicare-based analysis. Journal of the
American Geriatrics Society, 60(2), 323-327. doi: 10.1111/j.1532-5415.2011.03786.x
 Center for Medicare and Medicaid Services. (2014, August). Skilled nursing facility (SNF) billing reference.
Retrieved from http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-
MLN/MLNProducts/downloads/SNFSpellIllnesschrt.pdf
 de la Torre, J. (2010, July 1). Alzheimer’s disease is incurable but preventable. Journal of Alzheimer’s Disease,
20(3), 861-870. doi: 10.3233/JAD-2010-091579
 Medicare. (2015). Nursing home compare. Retrieved from
http://www.medicare.gov/NursingHomeCompare/compare.html#cmprTab=0&cmprID=555161%2C05615
3%2C555639&cmprDist=0.7%2C1.0%2C3.6&loc=94558&lat=38.3170536&lng=-122.3019206
 Medscape. (2015a). Alzheimer’s disease: Slideshow. Retrieved from
http://reference.medscape.com/features/slideshow/alzheimers/
 Medscape. (2015b). Alzheimer disease: Etiology. Retrieved from
http://emedicine.medscape.com/article/1134817- overview#aw2aab6b2b5
 Sultz, H. & Young, K. (2014). Health care USA: Understanding its organization and delivery (8th edition).
Burlington, MA: Jones & Bartlett Learning, LLC.
 Van de Ven, G., Draskovic, I., Van Herpen, E., Koopmans, R., Donders, R., Zuidema, S., Adang, E., Vernooij-
Dassen, M. (2014, January). The economics of dementia-care mapping in nursing homes: A cluster-
randomised controlled trial. Plos One, 9(1), 1-8. doi: 10.1371/journal.pone.0086662