Alzheimer's Disease in Elderly Adults: Diagnosis and Ethics

Introduction to Alzheimer's Disease in Elderly Adults

Alzheimer's disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and eventually the ability to carry out even the simplest tasks. In most people with Alzheimer's, symptoms first appear after the age of 60. It is the most common cause of dementia among older people (Alzheimer's Association, 2012).

Age is the greatest risk factor for Alzheimer's disease. It is estimated that one in every fourteen people over the age of 65 and one in every six people over the age of 80 has Alzheimer's disease. Another study shows that one in nine people aged 65 and older — approximately 11% — have Alzheimer's disease. The same study shows that approximately one-third, or 32%, of people aged 85 and older have the disease.

Diagnosis of Alzheimer's in Elderly Adults

Of those diagnosed with Alzheimer's disease, it is estimated that only 4% are under 65 years of age, 13% are between 65 and 74, 44% are between 75 and 84, and 38% are 85 or older (Alzheimer's Association, 2012). These figures clearly indicate that the risk of an Alzheimer's diagnosis increases substantially with age. This does not mean the disease is restricted to older people, but the data is a strong indication that Alzheimer's disease is far more prevalent among elderly adults.

Numerous studies have been conducted on Alzheimer's disease, most focusing on differences in diagnosis rates with respect to age, gender, and race. One such study presents the proportion of Americans aged 55 and older with cognitive impairment, broken down by race and ethnicity:

Proportion of Americans Aged 55 and Older with Cognitive Impairment, by Race/Ethnicity (Atsali, 2014)

Research Studies on Age, Gender, and Race

Age Bracket: 55–64 | 65–74 | 75–84 | Over 85
Whites: 3% | 5% | 9% | 25%
African Americans: 7% | 9% | 22% | 56%
Hispanics: 5% | 11% | 44% | —

This research indicates that in the United States, African Americans are almost twice as likely, and Hispanics are approximately one and a half times more likely, than older white people to develop Alzheimer's disease. According to researchers, the disparity in prevalence between racial groups may be due to various factors, including cultural backgrounds and higher rates of vascular disease among African Americans. Vascular risk factors such as diabetes and high blood pressure increase the risk of Alzheimer's disease, and the differences in rates between racial and ethnic groups may therefore stem from non-genetic factors. These factors can be reduced through dietary changes, medication, exercise, and education.

Another set of studies examines lifetime risks of Alzheimer's with a focus on age and sex. The following two tables show the percentage prevalence of men and women at different ages (Atsali, 2014):

Study One:
Age: 65 | 75 | 85
Men: 10% | 12% | 14%
Women: 19% | 23% | 24%

Study Two:
Age: 65 | 75 | 85
Men: 9.1% | 10.2% | 12.1%
Women: 17.2% | 18.5% | 20.3%

Case Study Overview: Catherine

Although the two studies report slightly different figures, both show the same trend: women are more likely to develop Alzheimer's disease than men. This difference is partly explained by the fact that women live longer than men on average, and by the role that hormonal changes play in cognitive aging.

The case study provided concerns an elderly woman named Catherine, who is brought to counseling by her daughter, who is concerned about her condition. Based on the research reviewed, Alzheimer's disease is more prevalent among elderly adults and among women than among younger adults and men. This context is directly relevant to Catherine's situation, since her age and sex place her in a higher-risk demographic. It would be appropriate to explain these risk factors to Catherine and her family as part of the counseling process.