“And I say to the press here, if we don’t do something, for example about Alzheimer’s, every single bed in American hospitals today will be occupied by someone with Alzheimer’s within 20 years, every single bed.”
— Biden, remarks while touring a cancer hospital in Columbus, Ohio, March 23
This is one of those classic Biden factoids — an assertion with specific numbers that seems to change in each telling.
In the course of a couple of months, the period when Alzheimer’s patients would overwhelm hospital beds shrank from 20 years to 15 years. (And during an Oct. 13 campaign stop in Florida, then-candidate Biden said “every single solitary bed” would be occupied in 19 years.)
In making this statement, the president is signaling his concern that combating Alzheimer’s is an important issue. He has proposed creating the Advanced Research Projects Agency for Health, a biomedical research lab that aims to produce new treatments for Alzheimer’s, cancer and other diseases.
But even if one made allowances for the year — let’s say the tipping point for when hospital beds will be overwhelmed is 2040 — is there any evidence that Biden’s claim is correct?
Normally when a politician makes a detailed claim like this, we can quickly find a possible source — a report in an academic journal or from a think tank, a congressional hearing or an expert’s speech — from which the factoid was plucked (and possibly twisted). But we could not find anything. We consulted with many experts on Alzheimer’s disease, but they were stumped, too. This seems to be a Biden original.
Alzheimer’s disease, a type of brain disease, generally is thought to begin about 20 years before symptoms arise — and then once symptoms appear, it gets worse with time. It’s a dispiriting disease, both for the patient and caregivers, and costly to treat.
Alzheimer’s is the most common cause of dementia, accounting for an estimated 60 percent to 80 percent of cases. But the two frequently get mixed together. Dementia reflects a group of symptoms, such as difficulties with memory or problem-solving skills, which are caused by diseases such as Alzheimer’s.
In trying to evaluate the accuracy of Biden’s statement, we frequently encountered a mix of statistics — some related to Alzheimer’s, some related to dementia, or sometimes both. Dementia would cover more diseases, and so using those figures is more generous to Biden, but that was often the easiest data to work with.
One issue that quickly came up: Alzheimer’s patients spend time in hospital beds but that is not where they end up. Hospitalization is often considered harmful and costly for people with dementia, so the less time spent in a hospital, the better. People with Alzheimer’s often end up in long-term nursing-home care and eventually hospice care. The president is focused on hospital beds, but that’s not necessarily an important problem.
A big reason for the increase in Alzheimer’s and similar diseases is that the U.S. population is aging as the baby boom generation moves into retirement. Age is considered the greatest risk factor for dementia, with women accounting for about two-thirds of the cases (in part because they live longer than men).
By 2040, 80 million Americans will be over the age of 65, according to the Urban Institute. The incidence of Alzheimer’s — a measure of risk for developing a disease — and the prevalence in the United States may actually have declined in the past 25 years, according to a variety of studies. But the sheer number of people getting older still means that the number of people with Alzheimer’s will keep increasing.
Meanwhile, the Alzheimer’s Association calculates that there are 538 hospital stays per 1,000 Medicare beneficiaries age 65 and older with Alzheimer’s or other dementias. (This compares with 266 hospital stays per 1,000 Medicare beneficiaries age 65 and older without these conditions.)
With these numbers in hand, we can do a few calculations to see whether Biden’s claim holds up. But caveat emptor. It’s possible to be admitted to a hospital because of a hip fracture, for example, but to also have Alzheimer’s disease as a secondary diagnosis. People with Alzheimer’s or other dementias also have a relatively high rate of a readmission to a hospital within 30 days. So in doing these calculations, we do not intend to diminish the pain and cost of such diseases.
When you plug the figure of 538 hospital stays per 1,000 people into a total of 13 million patients, you end up with 7 million hospital stays a year attributed to dementia.
Given that there are about 36 million hospital stays a year currently — the American Hospital Association says there are no projections for 2040 — it is clear that Biden’s statistic is falling short.
But we can go a bit deeper.
The Alzheimer’s Association further says that there is average stay of 23 days in a hospital or skilled nursing facility per dementia patient. For the sake of simplicity, let’s assume these were all hospital stays. (This is also being rather generous to Biden.) That adds up 161 million days in hospitals.
Divided by 365 days in the year, that means about 440,000 beds would be occupied by a person suffering some form of dementia. Currently there are about 920,000 acute-care hospital beds in the United States, a figure that could conceivably grow by 2040. (Hospital beds have fallen from 1.5 million beds in 1975 because of a trend toward outpatient services.)
A 2015 study of several hospitals in the United Kingdom found that about 25 percent of the hospital beds were occupied by dementia patients. (We did not find comparable figures for the United States.) Our admittedly rough calculations, giving Biden every benefit of the doubt, suggest that by 2040, the percentage might nearly double. But, contrary to Biden’s claim, it still does not add up to 100 percent — “every single, solitary hospital bed.”
Of course, Biden’s comment completely ignores the basics of supply and demand. If more hospital (or nursing home) beds are required, then presumably the market would respond with additional resources.
“We track total beds throughout the years as part of AHA Statistics but we don’t make projections,” said Marie Johnson, AHA vice president for media relations. “Hospitals and health systems are constantly planning for the future to ensure they meet the needs of patients and communities.”
We had sought an explanation from the White House for Biden’s claim, but did not receive an answer.
The Pinocchio Test
Biden wants to show that he considers combating Alzheimer’s and other diseases to be an important priority. That’s a laudable aspiration. But he shouldn’t gild the lily with figures that seem plucked from thin air — which might also explain why they change depending on the day. Contrary to his claim, our calculations show that in 2040 there would still be plenty of hospital beds even with the anticipated increase in patients with Alzheimer’s disease.
The president earns Four Pinocchios.
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