美國醫療現狀：20年間，老年痴呆症死亡人數上升了55%！

阿爾茨海默病（AD）是一種起病隱匿的進行性發展的神經系統退行性疾病。臨床上以記憶障礙、失語、失用、失認、視空間技能損害、執行功能障礙以及人格和行為改變等全面性痴獃表現為特徵，病因迄今未明。65歲以前發病者，稱早老性痴獃；65歲以後發病者稱老年性痴獃。

以下文章來自medscape：

Deaths from Alzheimer's disease rose by 55% between 1999 and 2014, according to a new report published in the Centers for Disease Control and Prevention's (CDC's) Morbidity and Mortality Weekly Report.

根據疾病控制與預防中心(CDC)發病率和死亡率周報發表的一份新報告，從1999年到2014年，阿爾茨海默病的死亡人數上升了55%。

The number of patients with Alzheimer's disease dying at home has also increased during this same period, from 14% to 25%.

在同一時期內，老年痴呆症患者的數量也在增加，從14%增加到25%。

"We would expect an increase in Alzheimer's disease with a larger population of older adults because we know that age is the greatest risk factor for Alzheimer's disease, but with these rates increasing in such magnitude, we thought there might be something else going on," the report's lead author, Christopher Taylor, PhD, from the CDC, Atlanta, Georgia, told Medscape Medical News.

「我們希望增加老年痴呆症的老年人人口大因為我們知道年齡是最大的阿爾茨海默病的危險因素,但與這些利率增加在這些大小,我們認為可能有別的,」該報告的主要作者,克里斯托弗·泰勒博士,來自CDC,亞特蘭大,喬治亞州,告訴Medscape醫學新聞。

More people are being diagnosed with Alzheimer's now because awareness of its early symptoms grows.

現在越來越多的人被診斷出患有老年痴呆症，因為他們對早期癥狀的認識增強了。

"If a person receives a diagnosis from their physician, and then they ultimately die from Alzheimer's disease, it is more likely that the physician would assign Alzheimer's disease as the cause of death on the death certificate," Dr Taylor said.

「如果一個人從他們的醫生那裡得到診斷，然後他們最終死於阿爾茨海默氏症，那麼醫生很可能會將阿爾茨海默氏症作為死亡證明，」泰勒博士說。

Increases in the mortality rate for Alzheimer's disease could also be a result of decreases in mortality rates for competing causes of death, including cardiovascular disease and stroke, "so life expectancy has increased as a result of fewer people dying earlier from cardiovascular events. People don't usually get symptoms of Alzheimer's disease until they're in their mid-sixties, so if someone dies of a heart attack earlier they wouldn't live long enough to develop the symptoms," he said.

阿爾茨海默病死亡率的增加也可能是導致死亡的死亡率降低的結果，包括心血管疾病和中風。「因此，由於心血管疾病的死亡人數減少，人們的預期壽命也增加了。人們通常在六十多歲的時候才會出現阿爾茨海默氏症的癥狀，所以如果有人死於心臟病發作，他們就不會活得太久，無法發展出癥狀。」他說。

The other significant finding from the report — that more Alzheimer's disease patients are dying at home rather than in hospital — points to an added burden for caregivers.

這份報告的另一個重要發現是，更多的老年痴呆症患者在家裡而不是在醫院裡死去，這給護理者帶來了額外的負擔。

"We don't know the reasons for this, but we know that people who are in the late stages of the disease are pretty much entirely dependent on caregiving for all their basic needs. A lot of times, the caregivers are family members and friends. We know that this care is intensive, and it is very possible that caregivers would need some assistance. With this increasing number of caregivers we want to make sure that they have what they need to keep themselves healthy, as well as care for their loved ones with Alzheimer's disease," Dr Taylor said.

「我們不知道原因，但我們知道，處於疾病晚期的人幾乎完全依賴於照料他們的基本需求。」很多時候，照顧者都是家庭成員和朋友。我們知道這種護理是集約化的，而且很有可能護理人員需要一些幫助。隨著越來越多的護理人員，我們想要確保他們有他們需要的東西來保持他們的健康，同時也要照顧他們愛的人患老年痴呆症。」泰勒博士說。

He would like to see more education for caregivers so they would know what to expect throughout the different stages of Alzheimer's disease, and respite care for caregivers.

他希望能看到更多的護理人員的教育，這樣他們就能知道在老年痴呆症的不同階段，以及對護理者的休息護理。

"It's important for caregivers to know where they can go to request respite care and all of the resources that might be available for them to help them care for their relative or friend. The person with Alzheimer's disease could also have other chronic conditions — they could be diabetic, they could have high cholesterol that has to be managed by the caregiver — so you have to make sure that caregivers are educated on ways to manage such conditions as well as keep themselves healthy."

「對於護理人員來說，知道他們可以去哪裡尋求喘息的機會，以及所有可能為他們提供的資源，幫助他們照顧他們的親戚或朋友，這是很重要的。」阿爾茨海默氏症的人也可能有其他慢性病——他們可能是糖尿病,他們可能有高膽固醇,是護理管理的,所以你必須確保護理人員教育等方法來管理狀況以及保持自己的健康。」

Dr Taylor and his team analyzed death certificate data for 1999–2014 using the CDC WONDER online portal for persons whose underlying cause of death was listed as Alzheimer's disease.

泰勒博士和他的團隊分析了1999-2014年的死亡證明數據，使用疾病防控中心在線門戶網站為那些潛在的死亡原因被列為阿爾茨海默病的人。

The analysis showed that 93,541 Alzheimer's deaths occurred in 2014 at an age-adjusted (to the 2000 Census standard population) rate of 25.4 deaths per 100,000 people, a 54.5% increase compared with the 1999 rate of 16.5 deaths per 100,000.

分析顯示，在2014年，有93,541名阿爾茨海默病的死亡發生在年齡調整(2000年人口普查標準人口)中，每10萬人中有25.4人死亡，比1999年每10萬人中有16.5人死亡的人數增加了54.5%。

Rates were higher than in 1999 among all age groups and were higher among women than in men and in non-Hispanic whites compared with other racial/ethnic populations.

在所有年齡組中，1999年的發病率高於男性和非西班牙裔白人，與其他種族/民族相比，女性的比例更高。

Most deaths occurred in a nursing home or long-term care facility in 1999 (67.5%) and in 2014 (54.1%). The percentage of patients who died in a medical facility declined from 14.7% in 1999 to 6.6% in 2014.

大多數死亡發生在1999年的養老院或長期護理機構(67.5%)和2014年(54.1%)。在醫療機構中死亡的患者比例從1999年的14.7%下降到2014年的6.6%。

Deaths at home increased, from 13.9% in 1999 to 24.9% in 2014. An additional 6.1% of patients with Alzheimer's disease died in a hospice facility in 2014.

國內的死亡人數從1999年的13.9%上升到2014年的24.9%。2014年，另有6.1%的老年痴呆症患者死於一所臨終關懷醫院。

"Alarming" Numbers

「令人擔憂」的數字

"The numbers are not surprising but they are alarming," Keith N. Fargo, PhD, director of Scientific Programs and Outreach, Alzheimer's Association, Chicago, Illinois, told Medscape Medical News.

「這些數字並不令人驚訝，但它們令人擔憂，」基思。n。法戈博士，伊利諾斯州芝加哥，阿爾茨海默病協會的科學項目和外展主任，告訴Medscape醫學新聞。

"We have actually been following this trend for the last decade and a half, as has the CDC, and there has been a steady increase over that time, to the 55% we see now. I actually think, and the authors of this report might agree with me, that this may even be a little bit of an undercount," Dr Fargo said.

「我們在過去的10年半里一直在跟蹤這一趨勢，就像疾病防控中心一樣，在這段時間裡，我們看到的這一比例一直在穩步上升，現在我們看到的是55%。」我實際上認為，這份報告的作者可能會同意我的觀點，認為這可能只是一個小數目，」法戈博士說。

The age-unadjusted numbers would give a more accurate account of Alzheimer's mortality, Dr Fargo said.

法戈博士說，年齡未調整的數據將更準確地描述阿爾茨海默病的死亡率。

"The unadjusted numbers reveal the impact of the fact that we are an aging population. The unadjusted number is an 83% increase in death rate, because people are living so much longer, and you have this bolus of people, these waves of people coming through the baby boomers, who are getting older and dying from Alzheimer's disease. It's a huge problem and really is unsustainable," he said.

「未經調整的數字揭示了我們是一個老齡化人口的事實。」這個未經調整的數字是死亡率的83%，因為人們活得更久，你有這群人，這些人在嬰兒潮時期出生的人，他們越來越老，死於阿爾茨海默氏症。這是一個巨大的問題，真的是不可持續的。」他說。

Dr Fargo agreed that improved treatments for cardiovascular disease and cancer is one explanation for this increase.

法戈博士同意改善心血管疾病和癌症的治療方法是這一增長的原因之一。

"There are probably multiple different explanations that account for some of the increase, but the fact that you are now less likely to die from heart disease or cancer than you were before is a big part of it. People are now living long enough that they are getting other diseases, and one of those is Alzheimer's disease," he said.

「可能有多種不同的解釋解釋了其中的一些原因，但事實上，你死於心臟病或癌症的可能性比你之前更少，這是很大一部分原因。」人們現在的壽命足夠長，以至於他們得了其他疾病，其中之一就是阿爾茨海默病。」他說。

Physicians are also getting better at recognizing and diagnosing Alzheimer's disease and recording it as a cause of death on death certificates, Dr Fargo agreed.

醫生們也越來越擅長識別和診斷阿爾茨海默氏病，並將其記錄為死亡證明的死因。

However, the fact that more patients with Alzheimer's are dying at home than in the past is a surprise, he said.

然而，他說，越來越多的阿爾茨海默病患者在家中死亡，這一事實讓人感到意外。

"That's news to us. At the Alzheimer's Association, we have not seen the data point to support that. Certainly we do talk to literally hundreds of thousands of people every year on our 24/7 help line, so we hear a lot of crisis calls from people who are dealing with major issues with their loved ones, but this is the first time we've seen a data point that is showing that more people are dying at home," he said.

「這對我們的新聞。在阿爾茨海默病協會，我們還沒有看到數據支持這一點。當然我們跟每年成千上萬的人在幫助熱線24/7,所以我們聽到很多危機處理重大問題的人的電話和他們所愛的人,但這是我們第一次看到一個數據點顯示,更多的人死在家裡,」他說。

Caring for patients in the late stage of Alzheimer's is extremely labor intensive.

在老年痴呆症晚期，照顧病人是極其勞動密集的。

"By the time people get to the period when they are going to die, they are really in the late stages of disease, and they are bed bound and they can't communicate any longer and they can't feed themselves and they can't toilet themselves. People have to turn them over so they don't get bed sores. It's a really intensive level of care, and for most people in that situation, they really need nursing home care," Dr Fargo said.

「當人們到了他們將要死去的時候，他們真的處於疾病的晚期，他們被綁在床上，他們不能再交流了，他們不能養活自己，也不能自己去廁所。」人們必須把他們翻過來，這樣才不會有褥瘡。這是一個非常密集的護理水平，對於大多數人來說，他們真的需要護理家庭護理。」法戈博士說。

"But nursing homes are not cheap," he added. "The general public doesn't know that Medicare does not pay for nursing homes. A lot of people think that Medicare is going to kick in and pay for their nursing home care when they need it, but it doesn't. Maybe if they spend down their assets they might be able to get Medicaid help for nursing home care, but the fact is, nursing home care is a huge expense that most people are not insured for, even through Medicare."

「但養老院並不便宜，」他補充說。「普通大眾不知道醫療保險不為養老院買單。」很多人認為醫療保險會在他們需要的時候介入並支付他們的護理費用，但事實並非如此。也許，如果他們花掉了他們的資產，他們可能會得到醫療補助，幫助他們照顧家庭護理，但事實是，養老保險是一項巨大的支出，大多數人都沒有得到保險，即使是通過醫療保險。」

Increased deaths at home may be due to the fact that nursing home care is so expensive.

在家增加的死亡人數可能是由於療養院護理費用昂貴的事實。

"That is speculation on my part, but it may be part of what we are seeing here. The Association's reaction is that this really cries out for more study to figure out what's going on so that we know how to fix it," Dr Fargo said.

「這是我的猜測，但這可能是我們在這裡看到的一部分。」協會的反應是，這確實需要更多的研究來弄清楚到底發生了什麼，這樣我們才能知道如何去解決它。」法戈博士說。

Dr Taylor and Dr Fargo have disclosed no relevant financial relationships.

泰勒博士和法戈博士沒有透露任何相關的財務關係。