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Understanding the Costs of Alzheimer’s

By Dr Marion Morkel, 11 November 2019

World Alzheimer’s Day was on 21 September 2019 and the worrying increase in the prevalence of this disease, is undoubtedly a focus worldwide. Alzheimer’s South Africa statistics show that by 2030, there’ll be an estimated 75.6 million people with dementia (Alzheimer’s is the most common subgroup of dementia) worldwide – that’ll rise to 135.5 million by 2050.

The World Alzheimer’s Report 2018 suggests it could even get to 152 million. The report puts the cost of the disease at about a trillion US dollars per annum – which should double by 2030. It also suggests that globally, informal care (people caring for parents, partners etc.) amounts to 82 billion hours (equating to 6 hours per day) – with 71% of these supplied by women.

Alzheimer’s in South Africa

The cost of dementia – and, specifically Alzheimer’s – to a family is immense. Alzheimer’s in Action states that 750 000 South Africans have Alzheimer’s – a subgroup of dementia. It adds that Alzheimer’s threatens to bankrupt families, due to escalations in the cost of care and medication. Dr Marion Morkel, Chief Medical Officer for Sanlam, says people tend to underestimate the costs associated with cognitive diseases, “Eventually, a family may need to employ a full-time carer, which can cost about R7 500 to R9 000 per month. If a person needs to go to an assisted nursing care facility for his or her own safety and quality of life, that starts at about R20 500 per month.”

Dr Morkel says that around the world, medical professionals are concerned by the increase in dementia – the World Health Organisation suggests there are nearly 10 million new cases a year – which they attribute primarily to diet, a sedentary lifestyle and the fact that we’re living longer. There’s also an increase in associated diseases of lifestyle. It’s a huge challenge for the medical fraternity, and it’s a significant problem in South Africa, where we have a shortage of adequate care facilities.

Diseases related to Alzheimer’s

Dr Morkel explains that dementia encompasses many diseases that involve a person losing his or her cognitive functioning, specifically awareness and the thinking processes you’d expect an adult to be able to do. The causes of dementia are numerous and can include earlier ageing of the brain due to vascular diseases and diabetes. Added head injuries can also bring about dementia later. Dr Morkel says it’s important to remember the process can be slowed down, “There’s no magic tablet, but we’ve seen that eating well-balanced meals, staying socially engaged, and being physically and intellectually active does slow down progression.”

Alzheimer’s disease is a common subgroup of dementia. Crucially, it involves loss of memory, difficulty in finding the right words and performing routine tasks, and personality and mood changes, which can be very upsetting for the families of Alzheimer’s patients.

Medication for Alzheimer’s

While diet, lack of physical exercise and lifestyle-associated diseases are linked to Alzheimer’s, there’s also evidence of a genetic link of up to 30%, depending on the kind of Alzheimer’s. Studies suggest the genetic link is stronger if a family member experienced dementia at an early age. Right now, we know what slows progression down. Medications like Aricept can make a difference in early-stage dementia. For severe Alzheimer’s, it becomes more about controlling symptoms like personality changes through mood stabilisers.

Dr Morkel says these medications can add up. But it’s the costs of care that really escalates, and that’s where dread disease cover can play a big role, “In 2019, Sanlam paid out about R8 million in cognitive disease-linked claims. We’ve seen Alzheimer’s claims slowly climb year-on-year. Alzheimer’s also influences disability claims; for example, someone who has a heart attack may also experience cognitive impairment, and as, a result, may struggle to continue to work down-the-line.”

Dread Disease Cover

Dr Morkel says dread disease cover provides a payout which can be used to contribute toward the expensive cost of care at home or a frail-care facility. “A family needs to make provision for the long term. You could be covering the cost of a carer or facility for 15 years or more, so it’s very important to seek assistance from a financial adviser.”

It’s important to note that South African law demands that if a policyholder can no longer make executive decisions, then a curator bonis must be appointed before a claim can be processed. A curator bonis is a legal representative a court appoints to manage the finances or estate of another person who can no longer do so himself/herself. This can take months to a year to put in place and can also cost thousands. “Sanlam assists families through this process through guidance from our legal team.”

Care Options for People with Alzheimer’s

Another challenge mentioned by Dr Morkel is that there are not enough assisted nursing care facilities in the country, so families may find themselves on a waiting list. Just Retirement did a report last year that found that the cost of home care can be double (around R37 000 per month) than that of a middle-market retirement village with frail care. So, it’s important to be prepared for this.

Dr Morkel concludes, “It’s so important to remember we can slow the onset and progression of dementia. We’ve seen from studies of siblings with the same risk profile that those who exercise often, eat well, engage in ‘intellectual work-outs’, and socialise do delay the disease. Exercise and having a ‘happy disposition’ make a difference.”

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