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