Prime Years? Perspectives on the Dementia Boom


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Presented by Karen Bugg RN LMSW from Hauenstein Neuroscience Program Saint Mary\'s Healthcare to the Council on Aging of Kent County on March 22, 2011

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  • Dementia describes an amount of memory loss, but not the cause . When a person’s memory declines to a point that he/she is no longer self-sufficient and he/she requires ongoing help or supervision to manage responsibilities or personal care that he/she could once do independently (functional dependency), then he/she has a dementia.
  • Memory loss is NOT a normal part of aging. Chronic disease increases with age. Doubles every year after the age of 65. After age 85, risk is nearly 50% MCI 10-20% over age 65; 15% convert each year Those with first degree relative are 2 to 3 times more likely to develop the disease: Inheritance of a certain ApoE-e4 gene may be a risk factor. Less than 1% have the variation on chromosome 21, 14 and 1.
  • Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC) National Institute of Health Table Published: February 14, 2011
  • On the other hand, more than half (54%) say they are behind on their retirement savings goals and that many who have delayed retirement have been affected by the economy. Most will rely on Social Security for their retirement income (42% of it, on average). NEW METLIFE STUDY EXAMINES DIFFERENCES AMONG THE BABY BOOMERS Westport, CT — March 2, 2010 — Metlife
  • Have not saved enough
  • Women outlive men and comprise 65% of cases. Chronic disease – The nature of health care in the U.S. has changed dramatically over the past century with longer life spans and greater prevalence of chronic illnesses. This has placed tremendous demands on the health care system, particularly an increased need for treatment of ongoing illnesses and long-term care services such as nursing homes; it is estimated that health care costs for chronic disease treatment account for over 75% of national health expenditures. [6 CDC-Kaiser Foundation 3-20-2010.
  • heart disease Diabetes SAN FRANCISCO, December 15, 1999 -- A new study on Caregiver Mortality in the December 15 issue of the Journal of the American Medical Association presents frightening information on the impact of the stresses of long-term care giving. Results of the study, by Richard Schulz, Ph.D. and Scott R. Beach, Ph.D., showed that older spousal caregivers had mortality risks that were a shocking 63 percent higher than noncaregiving control subjects. Family Caregiver Alliance's own studies have shown dramatic evidence of depression among caregivers, but this current research shows that the emotional, financial and physical stresses of care giving can have a deadly impact.
  • Acknowledgements: Prepared by Eric Kimbuende, Usha Ranji, Janet Lundy, and Alina Salganicoff of the Kaiser Family Foundation. Updated: March 2010. BACK TO TOP 1 Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group,  National Health Care Expenditures Data , January 2010. 2 Kaiser Family Foundation and Health Research and Educational Trust.  Employer Health Benefits 2009 Annual Survey . September 2009. 3 Altman, D., L. Levitt, and G. Claxton, Kaiser Family Foundation,  Pulling it Together: An Actuarial Rorschach Test  , 2010. 4 Kaiser Commission on Medicaid and the Uninsured, The Crunch Continues: Medicaid Spending, Coverage and Policy in the Midst of a Recession, 2009. 5 Congress of the United States, Congressional Budget Office. Technological Change and the Growth of Health Care Spending, January 2008. 6 Centers for Disease Control and Prevention.  Chronic Disease Overview. 7 Orszag, P. Congressional Budget Office Testimony: Growth in Health Care Costs.  Delivered before the Committee on the Budget, United States Senate, January 31, 2008. 8 Altman, D. and L. Levitt. February 23, 2003. The Sad History of Health Care Cost Containment As Told in One Chart. Health Affairs  Web Exclusive. 9 Partnership to Fight Chronic Disease, 2009 Almanac of Chronic Disease, 2009.   BACK TO TOP
  • LTC insurance companies no longer offer product to new consumers. Increasing premiums on holders.
  • Prime Years? Perspectives on the Dementia Boom

    1. 1. Prime Years? Perspectives on the Dementia Boom Karen Bugg RN LMSW Hauenstein Neuroscience Program Saint Mary’s Health Care Council on Aging March 22, 2011
    2. 2. The Startling Reality <ul><li>Baby Boomers </li></ul><ul><li>+ </li></ul><ul><li>Alzheimer’s Disease </li></ul><ul><li>+ </li></ul><ul><li>Economics </li></ul><ul><li>MASSIVE CHANGE/CHALLENGES </li></ul>
    3. 3. What does “dementia” mean?
    4. 4. Dementia <ul><li>Because of memory loss: </li></ul><ul><li>no longer self-sufficient </li></ul><ul><li>requires ongoing help or supervision </li></ul><ul><li>functional dependency </li></ul>
    5. 5. Causes of Dementia <ul><li>Alzheimer’s disease is the most common cause of dementia </li></ul><ul><li>Other causes are: </li></ul><ul><ul><li>Vascular dementia </li></ul></ul><ul><ul><li>Dementia with Lewy bodies </li></ul></ul><ul><ul><li>Mixed dementia </li></ul></ul><ul><ul><li>Frontotemporal dementia (Pick’s) </li></ul></ul>
    6. 6. Alzheimer’s disease <ul><li>A progressive degenerative neurological disease. </li></ul><ul><li>Most common form of dementia in the elderly. </li></ul><ul><li>Nearly 60-90% of all dementia cases. </li></ul>
    7. 7. Risk Factors <ul><li>Advancing age </li></ul><ul><ul><li>65 or older </li></ul></ul><ul><li>Mild cognitive impairment (MCI) </li></ul><ul><li>Family history </li></ul><ul><li>Genetics </li></ul><ul><ul><li>Young onset </li></ul></ul><ul><li>Down’s Syndrome </li></ul>
    8. 8. The Alzheimer brain <ul><li>Underneath the microscope: </li></ul><ul><ul><li>Alzheimer tissue has less nerve cells and synapses </li></ul></ul><ul><ul><li>Plaques (abnormal clusters of protein fragments) build up between nerves </li></ul></ul><ul><ul><li>Dead and dying nerve cells remain in the brain. </li></ul></ul><ul><ul><li>Plaques and tangles are the prime suspects of cell death and tissue loss. </li></ul></ul>
    9. 9. Alzheimer’s progression <ul><li>The early stages of Alzheimer’s may begin up to 20 years before a diagnosis is made </li></ul><ul><li>Mild to moderate stages last 2-10 years </li></ul><ul><li>Severe Alzheimer’s lasts 1-5 years </li></ul>
    10. 10. Alzheimer’s Disease <ul><li>The only disease in the top 10 causes of death with </li></ul><ul><ul><li>No way to PREVENT it </li></ul></ul><ul><ul><li>No way to CURE it </li></ul></ul><ul><ul><li>No way to SLOW its progression </li></ul></ul><ul><li>Holds true for the other causes of dementia . . . </li></ul>
    11. 11. Current Dilemmas in Dementia Care <ul><li>Alzheimer’s disease is under diagnosed, particularly among patients who do not speak English as their primary language </li></ul><ul><li>Pre-Alzheimer’s impairments are often attributed to “normal” aging </li></ul><ul><li>Denial and fear often delay evaluation </li></ul><ul><li>Typical lag time between symptom onset and diagnosis is two years </li></ul><ul><li>Most patients are not diagnosed by their primary care physicians </li></ul>
    12. 12. Boomer Characteristics <ul><li>Comprise 77,000,000 of the US population. </li></ul><ul><li>Most describe good or very good health. </li></ul><ul><li>Have some college education. </li></ul><ul><li>Has children and grandchildren. </li></ul>
    13. 13. Boomer Characteristics <ul><li>Hanging on to employment rather than retiring. </li></ul><ul><li>Not financially prepared for retirement. </li></ul><ul><li>High debt loads. </li></ul><ul><li>Employment situation is grim. </li></ul>
    14. 14. Boomers and AD <ul><li>14-17% are caring for their parents. </li></ul><ul><li>Over 60% are caregivers of someone with dementia. </li></ul><ul><li>1 in 8 Boomers will get Alzheimer’s after they turn 65. </li></ul><ul><li>At age 85, 1 in 2 Boomers. </li></ul><ul><li>5.3 M now; 16 M by 2050. </li></ul>
    15. 15. Caregiver Burden <ul><li>11 million in 2009; over 500 thousand in Michigan </li></ul><ul><li>2/3 are women. </li></ul><ul><li>Over 60% older caregiver spouses die before their care recipient. </li></ul><ul><li>Unpaid care valued at $7 billion in MI; </li></ul><ul><li>$144 billion nationwide. </li></ul>
    16. 16. Implications <ul><li>Unsustainable health care </li></ul><ul><ul><li>Cost of chronic care </li></ul></ul><ul><ul><li>Rationing? </li></ul></ul><ul><li>Impact on the labor force </li></ul><ul><ul><li>Retiring health care workforce </li></ul></ul><ul><ul><li>Impact on working women </li></ul></ul>
    17. 17. Implications <ul><li>Lack of affordable and accessible resources in-home and long-term care. </li></ul><ul><ul><li>How will Boomer’s afford it? </li></ul></ul><ul><ul><li>Private vs. public funding? </li></ul></ul><ul><li>Need for nursing home care will increase; 75% at age 80 with AD end up in a nursing home. </li></ul>
    18. 18. How will we respond? <ul><li>Seek accurate diagnoses. </li></ul><ul><li>Innovate and redesign services for the aging Boomers. </li></ul><ul><li>Incorporate technology. </li></ul><ul><li>Educate/train/retain in-home caregivers and staff. </li></ul><ul><li>Look to new labor markets. </li></ul>
    19. 19. How will we respond? <ul><li>Advocate for research. </li></ul><ul><li>Remain aware of bioethical issues. </li></ul><ul><li>Keep abreast of health care reform. </li></ul><ul><li>Link with accountable care organizations when appropriate. </li></ul><ul><li>(Partner with medical providers). </li></ul>
    20. 20. In the Meanwhile. . . <ul><li>Work to transform people’s negative attitudes about Alzheimer’s disease </li></ul><ul><li>Take action to help those living with Alzheimer’s disease. </li></ul><ul><ul><li>Find ways to reduce their angst. </li></ul></ul><ul><ul><li>Make the world a safer place for those with memory loss. </li></ul></ul>