A Public Health Approach to Alzheimer's and Other Dementias
A PUBLIC HEALTH APPROACH TO ALZHEIMERS AND OTHER DEMENTIAS ALZHEIMERS DISEASE WHAT IS THE ROLE OF PUBLIC HEALTH? LEARNING OBJECTIVES List 3 key tools public health can apply to the Alzheimers disease epidemic Describe surveillance/monitoring and how public health can apply it in response to Alzheimers disease Name the 2 BRFSS modules that pertain to cognitive
decline and caregiving Describe primary prevention and how public health can apply it to Alzheimers disease Explain why it is important to promote early detection of Alzheimers disease 2 COMPETENCIES Association for Gerontology in Higher Education (AGHE): 1.2.4 Recognize common late-life syndromes and diseases and their related bio-psycho-social risk and protective factors.
Association of Schools and Programs of Public Health (ASPPH): Domain 2: Describe how the methods of epidemiology and surveillance are used to safeguard the populations health. Domain 3: Endorse lifestyle behaviors that promote individual and population health and well-being. Council on Linkages Between Academia and Public Health Practice: 3A8. Describes the roles of governmental public health, health care, and other partners in improving the health of a community. 8A3. Describes the ways public health, health care, and other organizations can work together or individually to impact the health of a community. 8A4. Contributes to development of a vision for a healthy community
3 COMPETENCIES CONT. National Association of Chronic Disease Directors (NACDD): Domain 7: Identify relevant and appropriate data and information sources for chronic disease. Domain 7: Articulate evidence-based approaches to chronic disease prevention and control. National Commission for Health Education Credentialing, Inc. (NCHEC): 1.7.4 Identify emerging health education needs. 7.1.1 Identify current and emerging issues that may influence health and health education. 4
INTRODUCTION: DEMENTIA & ALZHEIMERS DISEASE Dementia is a decline in mental ability severe enough to interfere with daily life Caused by damage to brain cells, primarily affects older adults Alzheimers disease is the most common type of dementia Progressive loss of memory and brain function, behavior and personality changes No cure and limited treatment options Caregivers provide increasing assistance
Huge impact on individuals, families, caregivers, and the health care system Public health plays important role in addressing Alzheimers disease through surveillance, prevention, detection, and support of dementia capable systems 1 Alzheimers Association. 2015 Alzheimers Disease Facts and Figures. 5 ALZHEIMERS: A PUBLIC HEALTH
CRISIS Historically viewed as medical or aging issue Growing recognition of public health crisis: o Large and growing epidemic o Significant impact o Ways to intervene 6 ALZHEIMERS: EPIDEMIC (U.S.)
Over 5 million adults 1 in 9 adults age 65 1 in 3 adults age 85 By 2050, expected to reach 13.8 million 2 Alzheimers Association. 2016 Alzheimers Disease Facts and Figures. 7 ALZHEIMERS IMPACT: COSTS Significant costs to Medicare, Medicaid, individuals, caregivers
Annual costs of care over $200 billion Most expensive disease in the U.S. 3 Alzheimers Association. 2016 Alzheimers Disease Facts and Figures. 8 ALZHEIMERS: DISPROPORTIONAL IMPACT Women: 2/3 of the population African-Americans: 2 times more likely
Hispanics: 1.5 times more likely 9 4 Alzheimers Association. 2016 Alzheimers Disease ALZHEIMERS: CAREGIVING BURDEN Requires increasing levels of caregiving (paid or unpaid) Over 15 million caregivers
18 billion hours of unpaid care annually Hardships: health, emotional, financial 5 Alzheimers Association. 2016 Alzheimers Disease Facts and Figures. 10 ALZHEIMERS: HEALTH CARE BURDEN Disproportionate use of health care resources o Hospitalized 2-3 times more often o Represents 64% of Medicare beneficiaries
living in nursing homes Workforce shortage Inadequate training Alzheimers Association. (2013) Combating Alzheimers Disease: A Public Health Agenda. Alzheimers Association. 2016 Alzheimers Disease Facts and Figures. 8 U.S. Department of Health and Human Services. National Plan to Address Alzheimers Disease: 2013 Update. 6 7
11 PUBLIC HEALTH: TOOLS & TECHNIQUES 3 key public health intervention tools: o Surveillance/monitoring o Primary prevention o Early detection and diagnosis Alzheimers Association. (2013) Combating Alzheimers Disease: A Public Health Agenda. 9 12
TOOL #1: SURVEILLANCE ALZHEIMERS DISEASE WHAT IS THE ROLE OF PUBLIC HEALTH? 13 SURVEILLANCE & PUBLIC HEALTH Compile data on a population level including: o Prevalence of certain diseases o Health risk factors o Health behaviors o Burden of diseases Little state-level data on Alzheimers and dementia 14
10 Alzheimers Association. (2014) Data Collection and Behavioral Risk Factor Surveillance System (BRFSS). BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) Behavioral Risk Factor Surveillance System (CDC) o Health-related risk behaviors o Chronic health conditions o Use of preventive services State-based data Cognitive Decline, Caregiver
modules 15 Alzheimers Association. (2014) Data Collection and Behavioral Risk Factor Surveillance System (BRFSS). 11 BRFSS: COGNITIVE DECLINE MODULE Comprised of questions about: o Confusion or memory loss o Impact on daily activities o Need for assistance and caregiving o Discussed with health care professional
52 states/territories have used at least once Alzheimers Association. (2014) Data Collection and Behavioral Risk Factor Surveillance System (BRFSS). Centers for Disease Control and Prevention. Behavioral Risk Factor Surveillance System (BRFSS) 2015 Cognitive Decline Module. Accessed June 10, 2015 from website: 16 http://www.cdc.gov/aging/healthybrain/brfss-faq.htm 12 13 BRFSS: CAREGIVER MODULE Comprised of questions about: o Prevalence of caregiving and caregiving activities o Caregiver age, gender, relationship to care recipient o Scope of caregiving
o Caregiver challenges 40 states/territories have used at least once 14 Alzheimers Association. (2014) Data Collection and Behavioral Risk Factor Surveillance System (BRFSS). 17 DISCUSSION QUESTION How could the Cognitive Decline and Caregiver BRFSS data be used by state and local public
health? 18 PUBLIC HEALTH: SURVEILLANCE DATA Develop strategies to reduce risk Design interventions to alleviate burden Inform public policy Guide research Evaluate programs and policies Educate public and health care community Alzheimers Association. (2014) Data Collection and Behavioral Risk Factor Surveillance System (BRFSS). 16 Centers for Disease Control and Prevention. The CDC Healthy Brain Initiative: Progress 2006 2011.
15 19 TOOL #2: PRIMARY PREVENTION & RISK REDUCTION ALZHEIMERS DISEASE WHAT IS THE ROLE OF PUBLIC HEALTH? 20 PRIMARY PREVENTION Designed to prevent a disease or condition from developing in a population Causes of Alzheimers not fully understood
Primary prevention for Alzheimers: o Risk reduction o Promotion of cognitive health Centers for Disease Control and Prevention. The Concept of Prevention. Accessed August 14, 2015 21 from: http://www.cdc.gov/arthritis/temp/pilots-201208/pilot1/online/arthritis-challenge/03-Prevention/concept.ht m 17 DISCUSSION QUESTION
What are risk factors for Alzheimers disease that could be modified/reduced? 22 RISK REDUCTION: HEAD TRAUMA Moderate or severe traumatic brain injury Risk remains for years after original injury Prevention efforts include: o Seat belt use o Use of helmets o Falls prevention
23 Alzheimers Association. (2015) Traumatic Brain Injury. Centers for Disease Control and Prevention. Older Adults Falls: Get the Facts. Accessed June 10, 2015 from website: http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html 18 19 RISK REDUCTION: HEART HEALTH Close link between heart health and brain health Modifying cardiovascular risk: o Quitting smoking o Diet (DASH, Mediterranean) o Physical activity
Alzheimers Association. (2014) Alzheimers and Public Health Spotlight: Heart Health and Brain Health. Alzheimers Association. Prevention and Risk of Alzheimers and Dementia. Accessed July 16, 2015 from website: http://www.alz.org/research/science/alzheimers_prevention_and_risk.asp 22 Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity. Physical Activity is Essential to Healthy Aging. Accessed September 1, 2015 from website: 24 http://www.cdc.gov/physicalactivity/basics/older_adults/ 20 21 RISK REDUCTION: AVOIDANCE/MANAGEMENT Prevent onset of or effectively manage conditions that can increase risk for Alzheimers
o Diabetes o High blood pressure (hypertension) o Midlife obesity Baumgart, M., Snyder, H., Carrillo, M., Fazio, S., et.al, Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective. Alzheimers & Dementia 11 (2015) 718-726. 23 25 RISK REDUCTION: ACTIVE BRAIN 24
Mental stimulation: o Learning new information and skills o Volunteering o Reading o Playing challenging games Social connections 24 National Institute on Aging. (2015) Alzheimers Disease: Unraveling the Mystery. 26
DISCUSSION QUESTION How could public health play a role in promoting risk reduction and cognitive health? 27 PUBLIC HEALTH: RISK REDUCTION Health education and promotion campaigns o Brain and cardiovascular health o Detection/treatment of diabetes and high blood pressure o Smoking cessation Programs and policies o Injury prevention
o Cardiovascular health Alzheimers Disease International. World Alzheimer Report 2014: Dementia and Risk Reduction, An Analysis of Protective and Modifiable Factors, Summary Sheet. 28 26 Alzheimers Association and Centers for Disease Control and Prevention. (2013) The Public Health Road Map for State and National Partnerships, 2013-2018. 25 TOOL #3: EARLY DETECTION & DIAGNOSIS ALZHEIMERS DISEASE WHAT IS THE ROLE OF PUBLIC HEALTH? 29
DISCUSSION QUESTION Would you want to know if you had Alzheimers disease? Why or why not? 30 WHY PROMOTE EARLY DETECTION? Access to treatment and services Planning Potentially reversible causes Clinical trials
Alzheimers Association. (2013) Combating Alzheimers Disease: A Public Health Agenda. Alzheimers Association. Early Detection. Accessed June 8, 2015 from website: http://www.alz.org/publichealth/early-detection.asp 29 National Institutes on Aging. (2015) Alzheimers Disease: Unraveling the Mystery. 30 U.S. Health and Human Services. National Plan to Address Alzheimers Disease: 2015 Update 27 28 31 EARLY DETECTION: DIAGNOSIS RATES Most people with Alzheimers disease have either:
o Not been diagnosed o Been diagnosed but are not aware of diagnosis Only 35% aware of diagnosis Health disparities 31 32 Alzheimers Association. 2015 Alzheimers Disease Facts and Figures. Alzheimers Association. (2013) Alzheimers and Public Health Spotlight: Race, Ethnicity & Alzheimers Disease. 32 EARLY DETECTION: CHALLENGES
Diagnostic uncertainty Time constraints, lack of support Communication difficulties Fear of causing emotional distress Reluctance to discuss with health care provider 33 34 Alzheimers Association. 2016 Alzheimers Disease Facts and Figures. Alzheimers Association. (2015) Cognitive Data from the 2012 BRFSS. 33 EARLY DETECTION: MOST WANT TO
KNOW 89% of Americans would want to know Of those age 60 and older, 95% would want to know 97% would want to know about a family member 34 35 Alzheimers Association. (2013) Early Diagnosis: The Value of Knowing. DISCUSSION QUESTION What can public health do to promote early detection of
Alzheimers disease? 35 PUBLIC HEALTH: EARLY DIAGNOSIS General education and awareness o 10 Warning Signs Alzheimers Association o Benefits of early detection Education and training
for health care providers Education for newly diagnosed Alzheimers Association. (2013) Early Diagnosis: The Value of Knowing. 36 36 CONCLUSION: PUBLIC HEALTH RESPONSE 3 key public health intervention tools:
o Surveillance/monitoring o Primary prevention o Early detection and diagnosis 37 DEMENTIA CAPABLE SYSTEMS AND DEMENTIA FRIENDLY COMMUNITIES Dementia capable systems o Public health research and translation o Support services o Workforce training Dementia friendly communities
38 FOR MORE INFORMATION For more information, please visit the Alzheimers Association website at: http://www.alz.org 39
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