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Alzheimer's Disease: Is Our Health Care System Ready?

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In the midst of much healthcare reform talk, not enough attention seems focused on ensuring health care systems' preparedness to deal with cognitive health issues -- with Alzheimer's Disease as the most dramatic example -- which are predicted to grow given aging population trends.

Today, September 21st, is World Alzheimer's Day, and USA Today comments on a new report that makes stark predictions:

Global Alzheimer's cases expected to rise sharply (USA Today)

The 2009 World Alzheimer's Report, released today, estimates 35 million people worldwide are living with Alzheimer's and other forms of dementia. The figure is a 10% increase over 2005 numbers.

The number of people affected by Alzheimer's is growing at a rapid rate, and the increasing personal costs will have significant impact on the world's economies and health care systems," said Harry Johns, President and CEO of the Alzheimer's Association. "We must make the fight against Alzheimer's a priority here in the United States and worldwide," he said.

The report by London-based nonprofit Alzheimer's Disease International (ADI), an international federation of 71 national Alzheimer organizations (including the Alzheimer's Association), indicates that the number of people with dementia is expected to grow sharply to 65.7 million in 2030 and 115.4 million in 2050."

The Alzheimer's Association is organizing multiple Memory Walks to raise awareness and funds. You can learn more and join gere. (Perhaps a good opportunity to organize a "walking book group" as Arthur Kramer suggested in the SharpBrains Guide?)

The City of San Francisco, led by its Department of Aging and Adult Services (DAAS), convened since 2008 an Alzheimer's/Dementia Expert Panel to identify gaps and issue recommendations to address the growing crisis in dementia care at the city level, and is about to release a pioneering plan that may well influence public health initiatives in other cities and states. An interim document can be found here: 2020 Foresight-Strategy For Excellence in Dementia Care (pdf)

One of the major areas of focus for that strategy was Education & Prevention, and below we can share a summary of the preliminary findings and recommendations.

ALZHEIMER'S/DEMENTIA EXPERT PANEL

EDUCATION AND PREVENTION SUBCOMMITTEE

FINDINGS AND RECOMMENDATIONS

The subcommittee's charge was to consider how best to educate the San Francisco community about Alzheimer's and related dementias to change attitudes, beliefs, behaviors, standards of practice, and outcomes associated with the disease.

Nine key content areas were identified that should be part of comprehensive education and prevention efforts. Following are these areas with the corresponding key recommendations. More detail is provided in the following section. These content areas and recommendations are not listed in priority order.

o Risk Reduction - Key recommendation: Promote cognitive health and create a culture of "brain fitness" through mental stimulation, social engagement, physical exercise, and diet.

o Early Identification of Dementia - Key recommendation: Educate people about the signs of dementia, how they differ from normal aging, and when and where to seek a diagnosis.

o What To Expect as the Disease Progresses - Key recommendation: Offer diagnosed individuals, caregivers, and health care providers information about what to expect throughout the course of Alzheimer's and related disorders, which will help with future planning.

o Services and Resources - Key recommendation: Ensure that caregivers are aware of and have access to community resources, training and support.

o Caregiver Wellness and Support - Key recommendation: Help caregivers understand the stresses inherent in caring for a person with dementia and provide resources for self-care.

o Disease Management for Mild, Moderate, & Advanced Dementia, Including End-of-Life Issues - Key recommendation: Effective management of early to moderate dementia can slow the advance of cognitive impairment, reduce the impact of co-morbidity, and delay entrance into institutional care. Informed medical management of late stage and end-of-life co-morbidities will decrease unnecessary treatment and ease the burden and suffering of the person with dementia and caregiver at the end of life.

o Advanced Care Planning - Key recommendation: Advance care planning can help foster greater patient and caregiver understanding of the patient's medical condition, promote more patient-centered care, and ensure that a person's preferences are honored at the end of life.

o Ethical Issues - Key recommendation: Create an ethics review committee/group to consult on difficult ethical situations involving persons with dementia.

o Emergency Preparedness and Safety - Key recommendation: Promote awareness of steps to take to prepare for an emergency and to address common dangerous behaviors prevalent in persons with dementia so as to avoid catastrophic outcomes.

Education and prevention efforts should target the San Francisco population, though certain interventions will need to focus on specific segments. For example, detailed information about disease management is most appropriate for professional and family caregivers. The general public should understand that dementia is a condition caused by diseases, how to recognize the signs of dementia, and ideally should have some information about available resources.

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Remember: The Alzheimer's Association is organizing multiple Memory Walks; you can learn more and join here.

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