Last summer, I was a communications intern at the Alzheimer’s Association St. Louis Chapter. Three articles I wrote about Alzheimer’s caregivers and their involvement with the Association were published in local media, but I wasn’t done writing about Alzheimer’s after my internship. I wanted to dig deeper. The rest of this post is excerpted from a piece I wrote for a journalism class about low-income individuals’ greater risk of developing Alzheimer’s disease. Of course, developing Alzheimer’s is just the beginning.
The Extra Weight of Alzheimer’s on Low-Income Families
Alzheimer’s is a widely known but enigmatic and often misunderstood brain disease. Nasty and relentless, the disease gradually obstructs the functioning of brain cells, then kills them. The prevalence of Alzheimer’s is frightening–an estimated 5.2 million Americans had the disease in 2013, and it is the sixth leading cause of death in America. Scientists are still working to figure out what exactly happens to the brain, and why, and how to treat Alzheimer’s effectively. Studies suggest that socioeconomic status can somehow affect the disease’s development. Unfortunately, those with constrained financial ability to cope with Alzheimer’s disease are also more likely to develop it.
The Alzheimer’s Association 2013 Alzheimer’s Facts and Figures reports that older African Americans “are probably about twice as likely” to have Alzheimer’s as older whites, citing a few demographic studies. Further studies have pointed towards socioeconomic factors as responsible for this increased prevalence, rather than any genetic difference. Kristine Yaffe, M.D., of the University of California, San Francisco, and the San Francisco VA Medical Center, presented the results of such a study at the 2013 Alzheimer’s Association International Conference. In the population studied, African Americans were twice as likely to develop Alzheimer’s as whites during the twelve years of records reviewed. However, when the researchers adjusted for education level, literacy, income, and financial adequacy, the difference in Alzheimer’s risk for whites and African Americans was no longer statistically significant. Such socioeconomic factors appear to be the cause of the disparity.
Many studies have investigated the influence of other socioeconomic factors besides income. One study from Washington University in St. Louis School of Medicine found that individuals with more years of formal education are less likely to exhibit clinical symptoms of Alzheimer’s than those with less education. One theory is that education builds up a “cognitive reserve,” or a pool of brain resources that helps to resist the destructive effects of Alzheimer’s. People can still have the disease’s pathology, the physical changes in their brain cells, but exhibit less cognitive impairment if they have a deeper reserve to draw upon, accumulated over years of education. That’s not to say that a college education vaccinates you against Alzheimer’s, but the brain of someone without the financial option to attend school may be less resilient when damaged by disease.
As if increased risk of Alzheimer’s weren’t enough for those of lower socioeconomic status, families face greater difficulties in caring for a loved one with the disease. It can be hard for anyone to get an Alzheimer’s diagnosis after noticing cognitive or behavioral changes that might or might not be from normal aging. Those without access to stable medical resources don’t see the same doctor regularly, but go to urgent care clinics or hospitals. Doctors who see such patients don’t have firsthand knowledge of a patient’s condition over many years, which would help them recognize the subtle progressive changes indicative of Alzheimer’s. The earlier Alzheimer’s is diagnosed, the more time a family has to plan medical, legal, and financial matters. Without consistent medical exams and trusted doctors to talk to about concerns, families lose valuable time as Alzheimer’s goes undiagnosed.
As the brain goes, so goes the rest of the body, and the mind, and the personality. Memory loss is often an early symptom, and the one most commonly associated with the disease. Alzheimer’s can also cause depression, impaired judgment, decreased ability to solve problems and make plans, spatial disorientation, and changes in mood, behavior, and personality. Eventually, as the brain damage spreads, the disease can also interfere with speaking, swallowing, and walking. In late-stage Alzheimer’s, patients can’t bathe, dress, eat, or go to the bathroom on their own.
Alzheimer’s is a slow killer, and families watch their loved ones die through the years as they gradually need more and more care. Some people with Alzheimer’s need the constant company of a family member or paid caregiver to make sure they are safe. Depending on the service, adult day care can cost $60 to $90 a day, and a nurse’s aide about $18 per hour (in the St. Louis area). If a loved one needs care and the family can’t pay for the service or get it though Medicaid or veteran benefits, a caregiver may have to quit his or her job to provide care. Across America, 15.5 million caregivers provided $220 billion worth of unpaid care in 2013. Those already more vulnerable to the disease can afford it less than others.