Dementia impacts women more, and new approaches are needed

Americans are living longer thanks to medical and public health advances and greater access to health care. If you’re a 65-year-old man in the U.S., you can expect to live another 20 years.  American women can expect to live even longer — to age 86.5.

While this is good news for most of us, increased longevity also creates new challenges. After we turn 65, our risk of developing dementia doubles every five years. By age 85, nearly one in three of us will have the disease.  The impact on women is even greater.

New Milken Institute research estimates that by 2020, roughly 4.7 million women in the U.S. will have dementia, accounting for nearly two-thirds of everyone living with the disease. Women often experience a double whammy. Not only are they more likely to get the disease, they are also more likely to take on most caregiving responsibilities for spouses, parents, in-laws and friends.

Women caregivers are more likely to be impacted financially as they leave jobs or miss work to care for family members. Our analysis predicts that the economic costs of treatment, care and lost productivity due to women suffering from Alzheimer’s and dementia will total $2.1 trillion by 2040, representing over 80 percent of the cumulative costs.

Communities of color face an even greater threat. Older African Americans have the highest risk of dementia, followed by American Indians/Alaska Natives and Latinos. This increased risk, coupled with income differences and cultural attitudes toward family caregiving, results in communities of color shouldering more direct care for people living with dementia than white populations.

I’ve experienced firsthand the devastating impacts of Alzheimer’s disease on families. My dad and his three siblings were diagnosed within a 10-year time frame. As in most families, the emotional and economic strains fell primarily on the women.

My Aunt Trudy, a Julliard-trained concert pianist, began showing signs of dementia in her early 70s.  She had chosen her career over a family — as many women of her generation had to do. Trudy had no kids, husband, or much savings, so my family patched together a mix of paid and volunteer caregivers to provide her meals, rides, and companionship.

After it became too much of a strain on our finances, young families, and work lives, we had to place her in a nursing home paid for by Medicaid — a harrowing decision made by countless Americans every day. Aunt Trudy maintained her indomitable spirit until the end.  When she could no longer speak, she could still play the piano by heart, to the delight of many who sang tunes beside her.

Unfortunately, 10 years since Aunt Trudy died, Alzheimer’s is the only disease among the top-10 causes of death in the U.S. with no known cure. Recent Phase III drug trial failures this year represented a setback in research.

But thanks to increased National Institutes of Health funding to study Alzheimer’s disease, researchers today understand better dementia’s pathology. Perhaps most hopeful for those of us at high risk for dementia, emerging evidence shows that despite family history and personal genetics, lifestyle changes such as a diet, exercise, and better sleep can improve brain health.

Increased participation by women in clinical trials has helped us understand why more women than men have dementia. Researchers believed dementia is primarily connected to longer life expectancy. But new studies have linked it to biological differences, such as hormonal imbalances, that change brain chemistry.

With no cure in sight, we must double our efforts to reduce the risk and cost of dementia. At the Milken Institute, we work to solve significant global problems.  That is why we are making recommendations to improve brain health, reduce gender and racial disparities, and ultimately change the trajectory of this devastating disease.

Most importantly, we must spread awareness of how individuals, communities, and health professionals can improve cognitive function and brain health for all ages. If we can delay the onset of dementia by only five years, we can cut the incidence in half.

With more women working full-time and family size decreasing, we must increase efforts to create a dementia-capable workforce to effectively identify people with dementia, tailor services to meet their needs and those of their caregivers, and ensure those living with dementia get the right care at the right time. The high costs of care for Medicare beneficiaries with dementia are linked to avoidable hospitalizations, poor coordination across care teams, and ineffective care transitions.

We offer many more ideas in the new report, Reducing the Cost and Risk of Dementia:  Recommendations to Improve Brain Health and Reduce Disparities. We are in a race against time. We want to ensure that all of us will be singing songs by heart and enjoying our family and friends as we age. To provide a better future for millions of Americans impacted by dementia, we must act now.

Nora Super is senior director of the Milken Institute Center for the Future of Aging. She previously was executive director of the White House Conference on Aging.