Dementia Incidence, Burden and Cost of Care: A Filipino Community-Based Study

Abstract

Background: In the midst of competing priorities and limited resources in low-middle-income countries (LMIC), convincing epidemiological evidence is critical for urging governments to develop national dementia plans. The majority of primary epidemiological studies on dementia are from high income countries (HIC). Implications for developing countries are typically extrapolated from these outcomes through modeling, meta-analyses, and systematic reviews. In this study, we directly assessed the incidence of dementia, disability adjusted life years (DALYs), and cost of care among community-dwelling Filipino elderly.Methods: This was a follow-up study of the prospective cohort Marikina Memory Ageing Project (MMAP). Baseline assessment was performed in 2011–2012, and follow-up was done in 2015–2016 (N = 748 at follow-up). Incident dementia was determined. Disease burden was computed using the incidence rates and DALYs. Both indirect and direct (medical and non-medical) costs of dementia care were computed.Results: The crude incidence rate was 16 (CI: 13–20) cases per 1,000 person-years (pyr) with 17 (CI: 12–21) per 1,000 pyr for females and 14 (CI: 9–21) per 1,000 pyr for males. Based on this incidence, we project an estimation of 220,632 new cases in 2030, 295,066 in 2040, and 378,461 in 2050. Disease burden was at 2,876 DALYsper 100,000 persons. The economic burden per patient was around Php 196,000 annually (i.e., ~4,070 USD, or 36.7% of average family annual income in the Philippines). The majority (86.29%) of this care expense was indirect cost attributed to estimated lost potential earning of unpaid family caregivers whereas direct medical cost accounted for only 13.48%.Conclusions: We provide the first Filipino community-based data on the incidence of dementia, DALYs, and cost of care to reflect the epidemiologic and economic impact of disease. The findings of this study serve to guide the development of a national dementia plan.

Physician-Assisted Suicide in Dementia: Paradoxes, Pitfalls and the Need for Prudence

“…Further searches were conducted within these results using the additional search terms "caregiver," "caregiver burden," "stress," "behavioral and psychological symptoms of dementia," "BPSD," "economic," "financial," "autonomy," "dignity," "identity," "personhood" and "ethics." By this method, a total of 103 citations were retained (Pereira, 2011;Schuurmans et al, 2021;Kemmelmeier et al, 2002;Bradley, 2009;Baeke et al, 2011;Chakraborty et al, 2017;Madadin et al, 2020;Nichols, 2013;Emanuel et al, 2000;Krag, 2014;Trachtenberg and Manns, 2017;Bilchik, 1996;Lazar and Davenport, 2018;Karrer et al, 2020;Stakišaitis et al, 2019;Finucane et al, 2007;Finucane, 1999;Sachs et al, 2004;Dominguez et al, 2021;Meier, 1997;Liu et al, 2020;Gao et al, 2019;Gilhooly et al, 2016;Watson et al, 2019;Cheng, 2017;Biggs et al, 2019;Fam et al, 2019;Dening et al, 2013;Owen et al, 2001;Cohen-Mansfield and Brill, 2020;Anderson et al, 2019;O'Dwyer et al, 2016;Bravo et al, 2018;Wicher and Meeker, 2012;Stolz et al, 2015;Seike et al, 2021;Kashimura et al, 2021;Zwingmann et al, 2018;…”

“…For the purpose of the review and analysis presented below, the PubMed, ProQuest and Scopus literature databases were searched using the broad search terms “dementia” AND either “euthanasia,” “assisted suicide,” “physician-assisted suicide” or “medical assistance in dying.” After removal of duplicates, a total of 642 citations were retrieved via this initial search. Further searches were conducted within these results using the additional search terms “caregiver,” “caregiver burden,” “stress,” “behavioral and psychological symptoms of dementia,” “BPSD,” “economic,” “financial,” “autonomy,” “dignity,” “identity,” “personhood” and “ethics.” By this method, a total of 103 citations were retained ( Pereira, 2011 ; Schuurmans et al, 2021 ; Kemmelmeier et al, 2002 ; Bradley, 2009 ; Baeke et al, 2011 ; Chakraborty et al, 2017 ; Madadin et al, 2020 ; Nichols, 2013 ; Emanuel et al, 2000 ; Krag, 2014 ; Trachtenberg and Manns, 2017 ; Bilchik, 1996 ; Lazar and Davenport, 2018 ; Karrer et al, 2020 ; Stakišaitis et al, 2019 ; Finucane et al, 2007 ; Finucane, 1999 ; Sachs et al, 2004 ; Dominguez et al, 2021 ; Meier, 1997 ; Liu et al, 2020 ; Gao et al, 2019 ; Gilhooly et al, 2016 ; Watson et al, 2019 ; Cheng, 2017 ; Biggs et al, 2019 ; Fam et al, 2019 ; Dening et al, 2013 ; Owen et al, 2001 ; Cohen-Mansfield and Brill, 2020 ; Anderson et al, 2019 ; O'Dwyer et al, 2016 ; Bravo et al, 2018 ; Wicher and Meeker, 2012 ; Stolz et al, 2015 ; Seike et al, 2021 ; Kashimura et al, 2021 ; Zwingmann et al, 2018 ; Gitlin et al, 2019 ; von Känel et al, 2019 ; Zwingmann et al, 2019 ; Gerk, 2017 ; Kipke, 2015 ; Deardorff and Grossberg, 2019 ; Tiel et al, 2015 ; Borroni et al, 2008 ; Kim et al, 2021 ; Yunusa et al, 2019 ; Seibert et al, 2021 ...…”

“…Given this, it is plausible that economic considerations may lead to the incentivization of PAS for patients with dementia, regardless of the best interests of the patient or their caregivers ( Finucane, 1999 ; Sachs et al, 2004 ). This danger may be especially acute in low- and middle-income countries, where rapid increases in the elderly population and the absence of a social welfare “safety net” may further contribute to such incentivization ( Dominguez et al, 2021 ). Though economic considerations are important in the efficient running of healthcare systems, the interests of the patient should not be subordinated to them ( Meier, 1997 ).…”

Filipino Multicomponent Intervention to Maintain Cognitive Performance in High-Risk Population (FINOMAIN): Study Protocol for a Cluster Randomized Controlled Trial

“…In a population-based cohort study of Filipino older adults, aged ≥ 60 years, we found a dementia prevalence of 10.6% ( 5 ), much higher than the 7% estimate for Southeast Asia ( 2 ), and 23.2% had mild cognitive impairment (MCI). Almost half (48.1%) of those with baseline MCI status, from the same cohort, developed incident dementia after 3–4 years of follow-up ( 6 ) indicating MCI as a potentially progressive condition that makes older individuals at high risk for developing dementia ( 7 ). Progression from MCI to dementia occurs at a higher rate with an estimated conversion rate of 10–15% per year ( 7 , 8 ).…”

“…Progression from MCI to dementia occurs at a higher rate with an estimated conversion rate of 10–15% per year ( 7 , 8 ). The odds of progressing to dementia is increased by 3.07 times among those with MCI ( 6 ) and further increased by 1.53–2.95 times higher if identified with comorbid conditions such as cardiovascular risks and metabolic syndrome ( 9 ). This condition is prevalent in Filipino older adults, with around 82.0% of men and 70.4% of women having at least one cardiovascular risk factor (hypertension, diabetes, dyslipidemia, and smoking) ( 5 ).…”