Four former U.S. surgeons general took to the pages of the Orlando Sentinel this week to highlight what they see as the foremost public health crisis facing America: the surging rates of dementia among older Americans.

Drs. Richard Carmona, Jocelyn Elders, Antonio Novello, and David Satcher served three presidents for over 20 years, handling serious public health crises such as bird flu, SARS, and Ebola, but they’re warning that the dementia crisis is one of “unprecedented” scale and will only get worse. 

Dementia, or a loss of cognitive ability, primarily occurs in the elderly and is most often caused by Alzheimer’s, though it can also be caused by other neurodegenerative diseases. 

“For those over the age of 65, the number living with the disease doubles every five years. Five years is also how long we have before half of all baby boomers are over the age of 65 — paving the way for 14 million people living with dementia by 2050,” they wrote. 

This crisis is on track to hit Arizona particularly hard, owing to the state’s large number of seniors; 17.5% of Arizonans are 65 or older, according to data from the U.S. Census Bureau. 

There are currently about 140,000 Arizona residents living with Alzheimer’s dementia, according to a 2019 report from the Alzheimer’s Association. By 2025, there will be 200,000 Arizonans living with the disease, a startling 43% increase over 2020 and a growth rate unmatched by any other state in the nation. 

“The Alzheimer’s growth rate in Arizona is stunning,” Dan Lawler, Alzheimer’s Association Desert Southwest Chapter Executive Director, told Phoenix Business Journal in 2018. “It is time to take notice. It is time to take action. We must change the trajectory of this disease.”

Alzheimer’s is already devastating Arizona; 3,058 residents died of Alzheimer’s in 2017, making it the fifth leading cause of death in the state, according to the Centers for Disease Control and Prevention

The disease is also taking its toll on the 339,000 Arizonans who provide care for those with Alzheimer’s. In 2018, these caretakers provided more than 386 million hours of unpaid care valued at more than $4.8 billion, according to estimates from the Alzheimer’s Association. As a result of the stress and difficulty associated with being a caregiver, these individuals also saw their own healthcare costs rise by $198 million in 2017.

The disease also places a burden on the state — Arizona’s Medicaid program will spend $368 million in 2019 on care for those with Alzheimers; a number that is expected to rise by 40% in the next five years.

The impending dementia boom will only increase the burden on caretakers and further strain the state’s finances and healthcare system, which are unprepared for what’s coming.

Arizona isn’t alone in this; the former surgeons general wrote that the United States lacks an “appropriate infrastructure of care” for dementia, which is what pushes nonprofessionals like friends and family into caregiver roles in the first place. 

As more and more Americans age, this lack of infrastructure could provide “potentially catastrophic,” the doctors wrote.

Dementia isn’t random though, and it’s not the inevitable result of aging, either. Writing in the Sentinel, the doctors cited a study from the Lancet Commission finding that “around 35% of dementia is attributable to a combination of the following nine risk factors: education to a maximum age of 11-12 years, midlife hypertension, midlife obesity, hearing loss, late-life depression, diabetes, physical inactivity, smoking, and social isolation.”

They also referred to other studies that point to healthy diets and increased physical and cognitive activity as protection against cognitive decline. 

“What the latest science is therefore telling us is that brain health should be as much on people’s minds as heart health, breast cancer, and the war on smoking have been for decades,” they wrote.

The doctors called for a mobilization of the legislative, public policy, and health communities to work together to inform and educate the public about dementia. More concretely, they emphasized the need to improve the culture of brain health and declared their support for annual cognitive assessments and brain health check-ups. 

Currently, only one in seven seniors in the U.S. gets regular cognitive assessments for memory or thinking issues, according to the Alzheimer’s Association.

There is no currently no cure for Alzheimer’s disease or any way to stop or slow its progression, but there are several Alzheimer’s-prevention studies active right now as researchers and scientists seek to find a way to slow symptoms of the disease. While they’ve yet to find a drug that does that, “there is room for cautious optimism,” Dr. Pierre Tariot, director of the Banner Alzheimer’s Institute in Phoenix, told in 2018. 

At the state level, Arizona launched an Alzheimer’s Task Force in 2011, bringing together public and private stakeholders to address the growing human and financial cost of Alzheimer’s disease and related disorders.

The task force studied the issue and finalized the Arizona Alzheimer’s State Plan in 2016. The plan offers the following five-step framework for public and private sectors, businesses, organizations, and communities to work together in combatting Alzheimer’s: 

  1. Maximize public awareness and understanding
  2. Develop new and enhance existing supports for people with Alzheimer’s disease and their families
  3. Expand dementia-capable workforce in Arizona
  4. Advance and disseminate research
  5. Create a dementia-capable system in Arizona

At the local level, there are some free programs and services to support those with Alzheimer’s and their families, according to Morgen Hartford, regional director of the Alzheimer’s Association Desert Southwest Chapter in Tucson.

These services include helping families with ongoing case management and support, and a research partnership with Arizona State University that works with people in the early stages of Alzheimer’s and their caretakers to adjust to the changes in their lives and plan for their futures. 

“There is quality of life with dementia, and I encourage people to reach out to us,” Hartford told The Tucson office serves seven counties in Arizona.

Despite these efforts, there’s still a long way to go and not very much time to get there. 

By 2020, one in four Arizona residents will be 60 or older, according to state projections, and the state’s Alzheimer’s mortality rate remains more than 15% higher than the national average.