Alzheimer’s cases grow; study finds many primary care doctors not ready

Rick Krause and his wife, Sandy, react as they watch a bird in the backyard of their home in Lilburn on Tuesday, March 10, 2020. Sandy and Rick began to notice problems with her memory several years ago. She was eventually diagnosed with Alzheimer’s disease, and he is her caregiver. HYOSUB SHIN / HYOSUB.SHIN@AJC.COM
Caption
Rick Krause and his wife, Sandy, react as they watch a bird in the backyard of their home in Lilburn on Tuesday, March 10, 2020. Sandy and Rick began to notice problems with her memory several years ago. She was eventually diagnosed with Alzheimer’s disease, and he is her caregiver. HYOSUB SHIN / HYOSUB.SHIN@AJC.COM

Sandy and Rick Krause immediately knew something was off when, on a trip to the Everglades a few years back, Sandy, an avid birder, couldn’t remember the name of the osprey.

“She knows that bird very, very well,” said Rick, her husband of nearly 50 years. “That’s what tipped us off.”

And it wasn’t just birds; sometimes, she struggled to remember people’s names.

Her primary care physician dismissed it at the time.

“He quipped about how he forgets things, too,” said Rick Krause.

At that time, no one considered it might be the beginnings of Alzheimer’s disease.

The Lilburn couple’s experience illustrates what advocates say is a critical gap in services for people with Alzheimer’s and other dementias.

Related: Living with Alzheimer's and the fight to combat it

Eighty-seven percent of primary care physicians expect to see an increase in people suffering from dementia during the next five years, but half of those surveyed say the medical profession is ill-equipped to meet the demand, according to the new “2020 Alzheimer’s Disease Facts and Figures” report, released Wednesday by the Alzheimer’s Association.

“We’re at a moment in time that this disease needs to get everybody’s attention,” said Linda Davidson, executive director of the Alzheimer’s Association, Georgia Chapter. “The impact is large. There’s no one who will not be touched by this disease, and we’re not prepared to meet the demands or the needs of those who are affected. We need to elevate the conversation and raise awareness among all physicians about the signs.”

Based on the annual “Alzheimer’s Disease Facts and Figures” report, there are 150,000 Georgians, aged 65 and older, living with Alzheimer’s. That number is expected to increase by 26.7% to 190,000 in 2025. Nationally, the number exceeds 5 million living with the disease. That’s expected to nearly triple by 2050.

Related: New program at Emory on early memory decline gets $23.7 boost

The annual report gives an in-depth look at the state and national picture of Alzheimer’s prevalence, mortality, costs and impact on caregivers.

A related report, “On the Front Lines: Primary Care Physicians and Alzheimer’s Care in America,” examines the experiences, attitudes and training related to dementia care among primary care physicians, recent medical school graduates and recent residency program graduates now in primary care practice.

Many say they are not confident in their care for patients with Alzheimer’s and other dementias.

• Nearly 39% say they are “never” or only “sometimes comfortable” making a diagnosis of Alzheimer’s or other dementias.

• Nearly 27% report they are “never” or only “sometimes comfortable” answering patient questions about Alzheimer’s or other dementias.

• 22% of all primary care physicians had no residency training in dementia diagnosis and care.

• Of the 78% who underwent training, 65% reported that the amount was “very little.”

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“Most primary care providers are very busy people,” said Dr. Monica Parker, director of minority engagement core for the Goizueta Alzheimer’s Disease Research Center. On average, they may see 20 to 30 patients in a day and spend 10 to 15 minutes with each patient. “Doctors are in a time crunch. You don’t have a long time to spend with a patient to completely address all issues.”

It’s a matter of getting additional training.

She said there are opportunities for online training and partnerships to expand the knowledge base. Often times, dementia patients may be seen in an emergency room setting and may not be able to verbalize what’s wrong.

“The first doctor that a family is going to run to is not a neurologist or a cardiologist, but the primary care physician,” who depending on where they practice may not have expertise in geriatric medicine, Parker said.

Caption
Sandy Krause holds a hand of her husband, Rick Krause, in the backyard of their home in Lilburn on Tuesday, March 10, 2020. Rick is caregiver for Sandy, who has Alzheimer’s disease. HYOSUB SHIN / HYOSUB.SHIN@AJC.COM

Sandy Krause holds a hand of her husband, Rick Krause, in the backyard of their home in Lilburn on Tuesday, March 10, 2020. Rick is caregiver for Sandy, who has Alzheimer’s disease. HYOSUB SHIN / HYOSUB.SHIN@AJC.COM
Caption
Sandy Krause holds a hand of her husband, Rick Krause, in the backyard of their home in Lilburn on Tuesday, March 10, 2020. Rick is caregiver for Sandy, who has Alzheimer’s disease. HYOSUB SHIN / HYOSUB.SHIN@AJC.COM

For too long, signs of Alzheimer’s and dementia have been dismissed as part of aging.

“So when you go in and say I lost my keys and couldn’t find them and then found them in the freezer, that’s different than just forgetting things,” said Davidson.

If physicians on the front lines recognize the signs early, people can make preparations for the future and get the support they will need.

Caption
Sandy Krause holds a hand of her husband, Rick Krause, in the backyard of their home in Lilburn on Tuesday, March 10, 2020. Rick is caregiver for Sandy, who has Alzheimer’s disease. HYOSUB SHIN / HYOSUB.SHIN@AJC.COM

Sandy Krause holds a hand of her husband, Rick Krause, in the backyard of their home in Lilburn on Tuesday, March 10, 2020. Rick is caregiver for Sandy, who has Alzheimer’s disease. HYOSUB SHIN / HYOSUB.SHIN@AJC.COM
Caption
Sandy Krause holds a hand of her husband, Rick Krause, in the backyard of their home in Lilburn on Tuesday, March 10, 2020. Rick is caregiver for Sandy, who has Alzheimer’s disease. HYOSUB SHIN / HYOSUB.SHIN@AJC.COM

Consider the Krauses.

The next time Sandy Krause went to the doctor, he recommended that she see a neurologist, who determined she didn’t have Alzheimer’s, “and of course she did, but he didn’t recognize it,” said Rick Krause.

After more doctor’s visits and tests, Sandy Krause, who is now 77, was eventually diagnosed with Alzheimer’s in 2016.

“The diagnosis came at a snail’s pace,” because they had to see so many doctors, including neuropsychologists, said Rick Krause. “We didn’t know to hurry. We were really on our own. We were clueless.”

Krause doesn’t fault his wife’s primary care physician for not catching the first signs.

“They didn’t have the tools to recognize it at the time,” he said, and he does credit him with sending her to specialists.

Dr. Ted Johnson, Program Lead, Emory Healthcare Primary Care and Division Chief for General Medicine and Geriatrics, estimates there are 96 geriatricians in Georgia, far below what is needed to handle the needs of Alzheimer’s patients in 2050.

Georgia is among 14 states that need to increase that number at lease five-fold to meet projections. It’s estimated that 492 are needed, according to the new report.

Why aren’t there more?

Johnson said there are myriad reasons including that some doctors don’t want to work with elderly patients, and if you’re a geriatrician, most of your income comes from Medicare, the federal health insurance program for people who are 65 or older, rather than private insurance, and it may mean an additional year of training.

“There are definitely problems with the geriatrics pipeline,” he said. “Providers definitely need to get more comfortable working with patients with Alzheimer’s disease.”

‘2020 Alzheimer’s Disease Fact and Figures’

Here are some highlights of the latest report on Alzheimer’s disease in Georgia and nationwide:

  • There are 150,000 Georgians, aged 65 and older, living with Alzheimer's. That number is expected to increase by 26.7% to 190,000 in 2025.
  • The number of deaths among Georgia residents was 4,513 in 2018. That's up 265.4% since 2000.
  • The new report estimates there are currently more than 5 million Americans, 65 and older, living with Alzheimer's, a number that is expected to nearly triple by 2050.
  • Number of Georgia residents serving as unpaid family caregivers: 540,000
  • Total hours of unpaid care provided: 615,000,000
  • Total value of unpaid care: $8 billion

Source: Alzheimer’s Association