Prime Years? Prime Years? Perspectives on the Dementia BoomPerspectives on the Dementia Boom

Karen Bugg RN LMSWKaren Bugg RN LMSWHauenstein Neuroscience ProgramHauenstein Neuroscience Program

Saint Mary’s Health CareSaint Mary’s Health Care

Council on AgingCouncil on AgingMarch 22, 2011March 22, 2011

The Startling RealityThe Startling Reality

Baby BoomersBaby Boomers

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Alzheimer’s DiseaseAlzheimer’s Disease

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EconomicsEconomics

MASSIVE CHANGE/CHALLENGESMASSIVE CHANGE/CHALLENGES

What does “dementia” What does “dementia” mean?mean?

DementiaDementia

Because of memory loss:Because of memory loss:

no longer self-sufficient no longer self-sufficient

requires ongoing help or supervision requires ongoing help or supervision

functional dependencyfunctional dependency

Causes of DementiaCauses of Dementia

Alzheimer’s disease is the most common Alzheimer’s disease is the most common cause of dementiacause of dementia

Other causes are:Other causes are:– Vascular dementiaVascular dementia– Dementia with Lewy bodiesDementia with Lewy bodies– Mixed dementiaMixed dementia

– Frontotemporal dementia (Pick’s)Frontotemporal dementia (Pick’s)

Alzheimer’s diseaseAlzheimer’s disease

A progressive degenerative neurological A progressive degenerative neurological disease.disease.

Most common form of dementia in the Most common form of dementia in the elderly.elderly.

Nearly 60-90% of all dementia cases. Nearly 60-90% of all dementia cases.

Risk FactorsRisk Factors

Advancing ageAdvancing age– 65 or older65 or older

Mild cognitive impairment (MCI)Mild cognitive impairment (MCI)

Family historyFamily history

GeneticsGenetics– Young onset Young onset

Down’s SyndromeDown’s Syndrome

The Alzheimer brainThe Alzheimer brain

Underneath the Underneath the microscope:microscope:– Alzheimer tissue has less Alzheimer tissue has less

nerve cells and synapsesnerve cells and synapses– Plaques (abnormal clusters Plaques (abnormal clusters

of protein fragments) build of protein fragments) build up between nervesup between nerves

– Dead and dying nerve cells Dead and dying nerve cells remain in the brain.remain in the brain.

– Plaques and tangles are Plaques and tangles are the prime suspects of cell the prime suspects of cell death and tissue loss.death and tissue loss.

Alzheimer’s progressionAlzheimer’s progression

The early stages of The early stages of Alzheimer’s may Alzheimer’s may begin up to 20 years begin up to 20 years before a diagnosis is before a diagnosis is mademadeMild to moderate Mild to moderate stages last 2-10 yearsstages last 2-10 yearsSevere Alzheimer’s Severe Alzheimer’s lasts 1-5 yearslasts 1-5 years

Alzheimer’s DiseaseAlzheimer’s Disease

The only disease in the top 10 causes of The only disease in the top 10 causes of death withdeath with– No way to PREVENT itNo way to PREVENT it

– No way to CURE itNo way to CURE it– No way to SLOW its progressionNo way to SLOW its progression

Holds true for the other causes of Holds true for the other causes of dementia . . .dementia . . .

Current Dilemmas in Current Dilemmas in Dementia CareDementia Care

Alzheimer’s disease is under diagnosed, Alzheimer’s disease is under diagnosed, particularly among patients who do not speak particularly among patients who do not speak English as their primary languageEnglish as their primary language

Pre-Alzheimer’s impairments are often attributed Pre-Alzheimer’s impairments are often attributed to “normal” agingto “normal” aging

Denial and fear often delay evaluationDenial and fear often delay evaluation

Typical lag time between symptom onset and Typical lag time between symptom onset and diagnosis is two yearsdiagnosis is two years

Most patients are not diagnosed by their primary Most patients are not diagnosed by their primary care physicianscare physicians

Boomer CharacteristicsBoomer Characteristics

Comprise 77,000,000 of the US Comprise 77,000,000 of the US population.population.

Most describe good or very good health.Most describe good or very good health.

Have some college education.Have some college education.

Has children and grandchildren.Has children and grandchildren.

Boomer CharacteristicsBoomer Characteristics

Hanging on to employment rather than Hanging on to employment rather than retiring.retiring.

Not financially prepared for retirement.Not financially prepared for retirement.

High debt loads.High debt loads.

Employment situation is grim.Employment situation is grim.

Boomers and ADBoomers and AD

14-17% are caring for their parents.14-17% are caring for their parents.

Over 60% are caregivers of someone with Over 60% are caregivers of someone with dementia.dementia.

1 in 8 Boomers will get Alzheimer’s after 1 in 8 Boomers will get Alzheimer’s after they turn 65.they turn 65.

At age 85, 1 in 2 Boomers.At age 85, 1 in 2 Boomers.

5.3 M now; 16 M by 2050.5.3 M now; 16 M by 2050.

Caregiver BurdenCaregiver Burden

11 million in 2009; over 500 thousand 11 million in 2009; over 500 thousand in Michiganin Michigan

2/3 are women.2/3 are women.

Over 60% older caregiver spouses die Over 60% older caregiver spouses die before their care recipient.before their care recipient.

Unpaid care valued at $7 billion in MI;Unpaid care valued at $7 billion in MI;

$144 billion nationwide.$144 billion nationwide.

ImplicationsImplications

Unsustainable health careUnsustainable health care– Cost of chronic care Cost of chronic care – Rationing?Rationing?

Impact on the labor forceImpact on the labor force– Retiring health care workforceRetiring health care workforce– Impact on working womenImpact on working women

ImplicationsImplications

Lack of affordable and accessible Lack of affordable and accessible resources in-home and long-term care.resources in-home and long-term care.– How will Boomer’s afford it?How will Boomer’s afford it?

– Private vs. public funding?Private vs. public funding?

Need for nursing home care will increase; Need for nursing home care will increase; 75% at age 80 with AD end up in a 75% at age 80 with AD end up in a nursing home.nursing home.

How will we respond?How will we respond?

Seek accurate diagnoses.Seek accurate diagnoses.

Innovate and redesign services for the Innovate and redesign services for the aging Boomers.aging Boomers.

Incorporate technology.Incorporate technology.

Educate/train/retain in-home caregivers Educate/train/retain in-home caregivers and staff.and staff.

Look to new labor markets.Look to new labor markets.

How will we respond?How will we respond?

Advocate for research.Advocate for research.

Remain aware of bioethical issues.Remain aware of bioethical issues.

Keep abreast of health care reform.Keep abreast of health care reform.

Link with accountable care organizations Link with accountable care organizations when appropriate.when appropriate.

(Partner with medical providers).(Partner with medical providers).

In the Meanwhile. . .In the Meanwhile. . .

Work to transform people’s negative Work to transform people’s negative attitudes about Alzheimer’s diseaseattitudes about Alzheimer’s disease

Take action to help those living with Take action to help those living with Alzheimer’s disease.Alzheimer’s disease.– Find ways to reduce their angst.Find ways to reduce their angst.– Make the world a safer place for those with Make the world a safer place for those with

memory loss.memory loss.