one in eight americans has alzheimer's disease
DESCRIPTION
This is a worshop presentation I made at the 5th Annual Thomas Geriatric Health Symposium at Idaho State University on October 19, 2012 in Pocatello, Idaho. I explain Alzheimer's disease and dementias, behavioral issues, caregiver stress and the impact of the boomer population.TRANSCRIPT
One in Eight Americans Has Alzheimer’s Disease
Workshop: What Will This Mean for Our Healthcare System?
Speaker: Lorie Eber, JD
2012 Facts & Figures Alzheimer’s Disease Facts and
Figures 2012 Video
http://www.youtube.com/watch?v=In1IJocVor8
Alzheimer’s Disease v. Dementia
Q: What’s the difference between Alzheimer’s Disease (AD) and dementia?
A: Dementia is an umbrella term, not a medical diagnosis, for 70 types of brain disease, including Alzheimer’s disease.
My Dad at 94!
THE BASICS
Normal Aging v. DementiaQ: What’s the difference
between the brain changes which are caused by normal aging and dementia?
A: Dementia is the loss of mental abilities that is severe enough to interfere with normal life.
Prevalent Types of Dementia
70% Alzheimer’s Disease
17% Vascular Dementia
13% Frontotemporal, Lewy Body, Parkinson’s, Mixed Dementia
Key Dementia FactsImpairs memory, reasoning,
planning and behavior
Unique to each person
Always fatal
Current Dementia Statistics
6th leading cause of death in US5.4 million in US diagnosedEvery 68 seconds someone is
diagnosedFrequency increases with age:
◦Age 65+ 12.5% ◦Age 75+ 25%◦Age 85+ 50%
Warning Signs of ADMemory changes that disrupt
normal lifeChallenges in planning/solving
problemsDifficulty completing familiar
tasksConfusion with time of placeTrouble with visual images/spatial
relationships
Controllable Risk FactorsCardiovascular risks (caused by
lack of exercise, obesity, smoking, Type 2 diabetes)
Lack of social engagement
Poor diet
Head trauma
Uncontrollable Risk Factors
Biggest risk: age (mostly 65+)
A certain gene (less than 1%)
Diagnosis of Mild Cognitive Impairment
How Diagnosed?Thorough work-up required: focus
is on documenting cognitive decline◦Medical history◦Time and place orientation ◦In depth evaluations of memory,
reasoning, etc.◦Physical exam◦Psychiatric evaluation◦Interviews with relatives
Common Dementia Behaviors
AggressionAnxiety or agitationConfusionRepetitionLack of initiativeSuspicionWandering and getting lostSleep disturbances
Responding to BehaviorsBe flexible, patient and calmExplore triggers: pain,
medications, illness Respond to the emotion, not the
behaviorDon’t argueUse memory aidsAcknowledge requests and
respondDon’t take it personally and get
support
Dementia Role PlayI’m Mary and I have Alzheimer’s
DiseaseVolunteer student plays a nurse
Scenario: Mary has lived in an assisted living facility for 3 years. Her husband died last year and she has one daughter, Jane, who visits. She formerly had a career as a physician.
Role Play re Family Member
I’m Lorie, the daughter of a resident, who has a complaint about her mother’s care
Volunteer student plays physical therapist
Scenario: Resident, who is recovering from a stroke, has Alzheimer’s disease and is non compliant with PT
TreatmentsNo treatment slows or stops
disease progression4 drugs may temporarily improve
symptoms: Aricept, Exelon, Razadyne and Namenda
50% get some relief for 2-7 yearsDrugs don’t work for vascular
dementia
Future TreatmentsClinical trials target plaques &
tanglesOther possible causes:
◦Inflammation◦Deficiency in how brain processes
insulinDrug cocktail?Vaccine?
CAREGIVER BURDEN
Caregiver Numbers15 million
Mostly family and relatives
80% of care by family
44% work full or part-time
Average time: 6+ years
Caregiver StressStartling statistics:
◦Studies show that dementia caregivers are more likely to die within one year of the loved one’s death than those caring for non-demented relatives
◦30% of dementia caregivers die before the loved one
Get help: Alzheimer’s Association
Why So Stressful?Neglect self-careReluctance to ask for helpRequires 24/7 attentionBehavioral issuesStigma of brain diseaseHiding caregiving from employerFinancial burden
Exercise to Assess Caregiver Stress
Watch video carefullyGroups will score “Caregiver
Strain Index”Groups will brainstorm on
practical solutions Share thoughts with everyone
Felicitas Rocha: Video
http://www.youtube.com/watch?v=XljqSBobOco
Exercise: Assess Caregiver Strain
Appoint a spokespersonApply Caregiver’s Strain Index
(handout)Derive a group score
◦Range = 0 (no strain) to 26 (extreme strain)
Be ready to report your group score and basis
Exercise: Suggestions for CaregiverDiscuss specific, practical
solutions to assist caregiver Record the group suggestionsBe ready to share your solutions
with the full group
ELDER ABUSE
Elder AbuseTypes
◦Neglect (most common)◦Physical◦Emotional◦Sexual◦Financial◦Abandonment ◦Self neglect
Elder Abuse Statistics11% of Americans 65+have been
victims of elder abuse, often from family members
Only 1 in every 14 incidents come to the attention of authorities
Financial exploitation is fastest growing; only 1 in 25 cases reported, may be as many as 5 million cases each year
There are approximately 500,000 new elder abuse cases every year
Mandated Reporters If “reasonable cause” to believe a
vulnerable adult has been abused, neglected or exploited
Who must report (examples)◦Physicians◦Nurses◦Facilities and employees of facilities◦Social workers◦Physical therapists◦Home care workers
Required ReportsTo Whom? Idaho Commission on
AgingWhen? ImmediatelyIf serious injury or threat: report
to law enforcement within 4 hours
Penalty for not reporting? misdemeanor
IMPACT OF AGING BOOMERS
AD Projections
2012 Costs of Dementia Treatment
Dementia Patient Hospitalizations
% Change in Causes of Death
Effect of Boomers’ Aging on Health Care System
With no effective prevention or treatment methods, Alzheimer’s disease has the power to bankrupt families, communities and our health care system.
Alzheimer’s Association
Costs of Dementia CareMost dementia care is considered
“custodial care” and not covered by Medicare
Nationwide Average Costs ◦Non-medical home health aide: $19/ hour
◦Assisted living: $3,300/month◦Specialized memory care: $5,000/month
The RealityWe have universal coverage for
long-term care (LTC)It’s being provided by unpaid
family caregivers at homeBut, boomers have fewer
children, will live longer and require more care
What Pays for LTC NowPersonal savings
½ of all costs are paid by Medicaid at skilled nursing facilities
Long-term care insurance (<3%)
CLASS provision of Affordable Care Act: abandoned by Senate Appropriations Committee
Something’s Gotta GiveHow can we solve this problem?
Proposed SolutionsUniversal coverage that includes
LTCAsset-based long-term care
products (annuities linked to LTC benefits)
Establish a federal LTC benefit modeled on Medicare’s prescription drug coverage
Encourage preventative care with tax deductions
Thank You!
Lorie Eber, JD
Gerontologist, Certified Personal Trainer, Speaker, Author, Boomer Blogger on Healthy Living, Healthy Aging & Elder Care
www.AgingBeatsTheAlternative.com