Dementia care world's great healthcare economic challenge for 21st cent apr 2019

11
Dementia Care:Dementia Care:
TheThe World’s Great Healthcare &World’s Great Healthcare &
Economic Challenge for the 21Economic Challenge for the 21stst
CenturyCentury
Theodore T. Suh, MD, PhD, MHSTheodore T. Suh, MD, PhD, MHS
Associate Professor, Division of Geriatric & Palliative MedicineAssociate Professor, Division of Geriatric & Palliative Medicine
Department of Internal Medicine, University of MichiganDepartment of Internal Medicine, University of Michigan
Clinical Faculty, Ann Arbor VA GRECCClinical Faculty, Ann Arbor VA GRECC
55thth
Annual UCSD CGISAnnual UCSD CGIS
April 13, 2019April 13, 2019

22
ObjectivesObjectives
 Define Alzheimer’s disease and dementia.
 Review the current epidemiologic data for these
conditions.
 Discuss the projected demographic and economic
trends regarding dementia and its care in the 21st
century.
 Propose possible solutions to the social and economic
challenges posed by these trends.

3
http://news.cnet.com/i/tim//2010/08/10/800px-Kheops-Pyramid_610x374.jpg

4
U.S. DemographicsU.S. Demographics
 An estimated 20% of the U.S. population will be overAn estimated 20% of the U.S. population will be over
the age of 65 by the year 2030.the age of 65 by the year 2030.
 The fastest growing segment of the U.S. population isThe fastest growing segment of the U.S. population is
those over the age of 85.those over the age of 85.
 While seniors age 65 and older make up about 13% ofWhile seniors age 65 and older make up about 13% of
the U.S. population today, they account for more thanthe U.S. population today, they account for more than
one-third of all health care costs.one-third of all health care costs.
U.S. Census Bureau, www.census.gov

5
The U.S. Population Is AgingThe U.S. Population Is Aging
0
50
100
150
200
250
300
350
1950 1990 2030
>65 years>65 years
≤≤65 years65 years
8.1%
12.7%
20.0%
NumberNumber
of personsof persons
(in millions)(in millions)
US Bureau of Census: Current population report P23-1990, 1996.
US Bureau of Census: Current population report P25-1130, 1996.

6
100
75
50
25
0
0 10 20 30 40 50 60 70 80 90 100
AGE
1900
1840
1980
1975
1950
1940
1920
PERCENTSURVIVING
From the U.S. Bureau of Health StatisticsFrom the U.S. Bureau of Health Statistics

7
www.flatrock.org.nz/.../boom_moves_along.htmwww.flatrock.org.nz/.../boom_moves_along.htm
U.S. Age PyramidsU.S. Age Pyramids
Percent of U.S. Population by Age & Sex: 1970, 1990 and 2010Percent of U.S. Population by Age & Sex: 1970, 1990 and 2010

8
www.flatrock.org.nz/.../boom_moves_along.htmwww.flatrock.org.nz/.../boom_moves_along.htm
U.S. Age PyramidsU.S. Age Pyramids
Percent of Population by Age & Sex, 1990Percent of Population by Age & Sex, 1990

9
http://ec.europa.eu/economy_finance/http://ec.europa.eu/economy_finance/
een/001/images/article00_02a_4668.gifeen/001/images/article00_02a_4668.gif

10
www.uwec.edu/.../ivogeler/wother/ecproj3.htmwww.uwec.edu/.../ivogeler/wother/ecproj3.htm

12
Korea Comes Full Circle in OneKorea Comes Full Circle in One
Generation as Aging Crisis LoomsGeneration as Aging Crisis Looms
From Bloomberg.comFrom Bloomberg.com

13
Korea Comes Full Circle in OneKorea Comes Full Circle in One
Generation as Aging Crisis LoomsGeneration as Aging Crisis Looms
From Bloomberg.comFrom Bloomberg.com

1515
Memory Loss isMemory Loss is NotNot NormalNormal
 Although memory loss becomes more common as weAlthough memory loss becomes more common as we
age…age…
 Up to 50% of those age 85 and olderUp to 50% of those age 85 and older
 After age 65, the likelihood of developing dementiaAfter age 65, the likelihood of developing dementia
doubles every 5 years.doubles every 5 years.
 ……it isit is notnot a universal finding in older adults.a universal finding in older adults.
 What about that other 50%?What about that other 50%?
 ExamplesExamples
 Stanley Kunitz (Poet Laureate of the U.S. at age 95 )Stanley Kunitz (Poet Laureate of the U.S. at age 95 )
 Grandma Moses (folk artist who began painting in her 70s)Grandma Moses (folk artist who began painting in her 70s)

1616
Mild Cognitive ImpairmentMild Cognitive Impairment
(MCI)(MCI)
 Definition:Definition:
 Transition between the state of normal cognition andTransition between the state of normal cognition and
dementiadementia

1717
MCI: Diagnostic Criteria &MCI: Diagnostic Criteria &
PrognosisPrognosis
 Diagnostic Criteria for MCIDiagnostic Criteria for MCI::
 The presence of a new memory complaint  The presence of a new memory complaint
 Impairment in memory for age  Impairment in memory for age
 Normal general cognitive functions  Normal general cognitive functions
 No substantial interference with work, usual socialNo substantial interference with work, usual social
activities, or other activities of daily living activities, or other activities of daily living
 No dementiaNo dementia
 Prognosis for MCIPrognosis for MCI::
 Rate of evolution from mild cognitive impairment toRate of evolution from mild cognitive impairment to
dementia is 10-15% per year.dementia is 10-15% per year.
 Not all patients go on to develop dementia.Not all patients go on to develop dementia.

1818
What is Dementia?What is Dementia?
 A progressive loss of memory and other cognitiveA progressive loss of memory and other cognitive
functions that results infunctions that results in functional impairmentfunctional impairment..
 A decline in the ability to perform activities of dailyA decline in the ability to perform activities of daily
living leading toliving leading to loss of independenceloss of independence..
 Patients often required Assisted Living, and later, SkilledPatients often required Assisted Living, and later, Skilled
Nursing CareNursing Care
 Can be accompanied byCan be accompanied by changes in personality andchanges in personality and
behaviorbehavior..
 Sometimes referred to as “sundowning”Sometimes referred to as “sundowning”
 More prone to developing delirium when acute illness orMore prone to developing delirium when acute illness or
exacerbation of comorbid chronic illness occursexacerbation of comorbid chronic illness occurs

1919
FromFrom http://en.wikipedia.orghttp://en.wikipedia.org

2020
What is Alzheimer Disease?What is Alzheimer Disease?
Which of the following statements is TRUE?Which of the following statements is TRUE?
A. It is the most common form of dementia.A. It is the most common form of dementia.
B. It is what many people associate with dementia.B. It is what many people associate with dementia.
C. On average, it has the longest course of the variousC. On average, it has the longest course of the various
forms of dementia.forms of dementia.
D. On average, it is the most expensive form ofD. On average, it is the most expensive form of
dementia to treat.dementia to treat.
E. B, C and D are true.E. B, C and D are true.
F. All of the above are true.F. All of the above are true.

2121
What is Alzheimer’s Disease?What is Alzheimer’s Disease?
Which of the following statements is TRUE?Which of the following statements is TRUE?
A. It is the most common form of dementia.A. It is the most common form of dementia.
B. It is what many people associate with dementia.B. It is what many people associate with dementia.
C. On average, it has the longest course of the variousC. On average, it has the longest course of the various
forms of dementia.forms of dementia.
D. On average, it is the most expensive form ofD. On average, it is the most expensive form of
dementia to treat.dementia to treat.
E. B, C and D are true.E. B, C and D are true.
F.F. All of the above are true.All of the above are true.

2222
www.alzwisc.orgwww.alzwisc.org

2323
Risk Factors for DementiaRisk Factors for Dementia
 CAIDE StudyCAIDE Study
 1409 individuals studied in midlife and re-examined 201409 individuals studied in midlife and re-examined 20
years later for signs of dementiayears later for signs of dementia
 Major risk factorsMajor risk factors::
 Advanced age (>47 years)Advanced age (>47 years)
 Low level education (<10 years)Low level education (<10 years)
 HypertensionHypertension
 HypercholesterolemiaHypercholesterolemia
 ObesityObesity
Kivipelto et al, Lancet 2006.

2424
Risk Factors for DementiaRisk Factors for Dementia
 Conclusions from the CAIDE studyConclusions from the CAIDE study::
 Dementia is a disease of aging.Dementia is a disease of aging.
 Lifestyle modifications can potentially affectLifestyle modifications can potentially affect
development of dementia in later life.development of dementia in later life.
 Risk factors for heart disease are similar to riskRisk factors for heart disease are similar to risk
factors for dementia.factors for dementia.
 Get an education when you are young!Get an education when you are young!
Kivipelto et al, Lancet 2006.

2525
Alzheimer’s Disease:Alzheimer’s Disease:
Diagnostic CriteriaDiagnostic Criteria
 Major impairment in learning and retaining newMajor impairment in learning and retaining new
information and at least one other domain of cognitiveinformation and at least one other domain of cognitive
impairment: impairment:
 Impairment in handling complex tasks and reasoning abilitiesImpairment in handling complex tasks and reasoning abilities
 Impaired visuospatial ability and geographic orientation Impaired visuospatial ability and geographic orientation
 Impaired language functions Impaired language functions
 Insidious onset and progressiveInsidious onset and progressive
 Not better accounted for by a systemic disease orNot better accounted for by a systemic disease or
another brain diseaseanother brain disease

2626
Alzheimer’s Disease: Clinical CourseAlzheimer’s Disease: Clinical Course
 Early course of Alzheimer's diseaseEarly course of Alzheimer's disease::
 Forgetting recent events and conversations, misplacingForgetting recent events and conversations, misplacing
items, getting lost in familiar surroundingsitems, getting lost in familiar surroundings
 Medication-taking errors ,difficulty managing moneyMedication-taking errors ,difficulty managing money
 Changes in personalityChanges in personality
 Apathy, loss of initiative,loss of interest in previousApathy, loss of initiative,loss of interest in previous
hobbieshobbies
 As the disease progresses…As the disease progresses…
 Assistance preparing meals, paying bills, takingAssistance preparing meals, paying bills, taking
transportation, and keeping housetransportation, and keeping house
 Eventually assistance in basic activities such as bathing,Eventually assistance in basic activities such as bathing,
dressing, toileting, and eatingdressing, toileting, and eating

2727
Alzheimer’s Disease: Clinical CourseAlzheimer’s Disease: Clinical Course
 Terminal stages of the diseaseTerminal stages of the disease::
 MuteMute
 Die from conditions such as sepsis, pneumonia, andDie from conditions such as sepsis, pneumonia, and
congestive heart failurecongestive heart failure
 Mortality rate in patients with Alzheimer's disease isMortality rate in patients with Alzheimer's disease is
about 10% per year.about 10% per year.
 The time from mild dementia to death ranges from aThe time from mild dementia to death ranges from a
few years to up to a decade or more.few years to up to a decade or more.
 For patients in whom mild dementia is diagnosed,For patients in whom mild dementia is diagnosed,
about 10% per year reach the stage of severe dementia.about 10% per year reach the stage of severe dementia.

2828
Alzheimer’s Disease:Alzheimer’s Disease:
GeneticsGenetics

2929
CT scan of a patient with Alzheimer’s Disease showing cortical atrophy, Burns 1995

30
From http://starwars.wikia.com/Death_StarFrom http://starwars.wikia.com/Death_Star

3131
Change in U.S. Leading CausesChange in U.S. Leading Causes
of Death, 2000-2010of Death, 2000-2010
www.dementiatraining4life.comwww.dementiatraining4life.com

3434
Epidemiology of DementiaEpidemiology of Dementia
 Currently, there are 35.6 million people worldwide with
dementia.
 Projection for 2030: 65.7 million people
 Projection for 2050: 115.4 million people
 Currently, nearly 2/3 of dementia patients live in low
and middle-income countries (i.e. the developing
world).
 By 2050, ¾ of dementia patients will live in low and middle-
income countries
Alzheimer’s International World Report 2010 (Alzheimer’s Disease International)

3636
Socioeconomics of DementiaSocioeconomics of Dementia
 Dementia is already significantly affecting every healthDementia is already significantly affecting every health
and social care system in the world.and social care system in the world.
 Direct medical costs for dementia: 16%Direct medical costs for dementia: 16%
 Direct social care costs for dementia: 42%Direct social care costs for dementia: 42%
 Informal (unpaid) care costs for dementia: 42%Informal (unpaid) care costs for dementia: 42%
 Although most of the cost is currently in the developedAlthough most of the cost is currently in the developed
world, the proportion of cost is shifting to developingworld, the proportion of cost is shifting to developing
countries.countries.
 Currently, 70% of worldwide dementia cost is in WesternCurrently, 70% of worldwide dementia cost is in Western
Europe and North America.Europe and North America.

3737
Socioeconomics of DementiaSocioeconomics of Dementia

3838
Economics of DementiaEconomics of Dementia
 Cost (direct and informal) of worldwide dementia careCost (direct and informal) of worldwide dementia care
in 2010: US$604 billion.in 2010: US$604 billion.
 Currently, 1% of the world GNP!Currently, 1% of the world GNP!
 Compared to other health issues:Compared to other health issues:
 Currently, ranks 3Currently, ranks 3rdrd
..
 Worldwide cancer cost (all cancers) from premature deathWorldwide cancer cost (all cancers) from premature death
and disability was estimated as US$895 billion.and disability was estimated as US$895 billion.
 Worldwide heart disease cost from premature death andWorldwide heart disease cost from premature death and
disability was estimated as US$753 billion.disability was estimated as US$753 billion.
Global Economic Cost of Cancer 2010 (Livestrong & American Cancer Society)

3939
Economics of DementiaEconomics of Dementia
 However, the cost of dementia care worldwide isHowever, the cost of dementia care worldwide is
doubling every 5-6 yearsdoubling every 5-6 years..
 If worldwide cost is indexed to just the increased number ofIf worldwide cost is indexed to just the increased number of
people expected with dementia in 2030, it will go up 85%.people expected with dementia in 2030, it will go up 85%.
 Why are costs accelerating faster?Why are costs accelerating faster?
 With economic development, per person costs will increaseWith economic development, per person costs will increase
towards levels seen in high income countries.towards levels seen in high income countries.
 Increases in the number of people with dementia inIncreases in the number of people with dementia in
developing countries will increase at a faster rate than indeveloping countries will increase at a faster rate than in
developed countries.developed countries.

4040
Economic ComparisonsEconomic Comparisons
http://money.cnn.com/magazines/fortune/global500/2010/full_list/index.html

4141
Economic ComparisonsEconomic Comparisons
 If dementia were a country:If dementia were a country:
 Currently, GNP would rank 18Currently, GNP would rank 18thth
(after Turkey).(after Turkey).
 Projection for 2020: would rank 10Projection for 2020: would rank 10thth
(after Italy)(after Italy)
 Projection for 2030: would rank 5Projection for 2030: would rank 5thth
(after Japan)(after Japan)
 Projection for 2040: would rank 3Projection for 2040: would rank 3rdrd
(ahead of India)(ahead of India)
 Projection for 2050: would rank 2Projection for 2050: would rank 2ndnd
(ahead of U.S.)(ahead of U.S.)
 Projection for 2055: would rank 1Projection for 2055: would rank 1stst
(ahead of China)(ahead of China)
http://www.photius.com/rankings/gdp_2050_projection.html
http://en.wikipedia.org/wiki/List_of_countries_by_future_GDP_(nominal)_estimates

42
From http://travel.webshots.comFrom http://travel.webshots.com

4343
What Needs to Be Done?What Needs to Be Done?
 Develop cost-effective packages of medical and socialDevelop cost-effective packages of medical and social
care that meet the needs of dementia patients and theircare that meet the needs of dementia patients and their
caregivers across the course of the illness.caregivers across the course of the illness.
 Reduce informal and social costs of the disease.Reduce informal and social costs of the disease.
 Develop evidence-based prevention strategies.Develop evidence-based prevention strategies.
 Devote more research to developing new medicalDevote more research to developing new medical
treatments for dementia.treatments for dementia.
 Should be proportionate to the economic burden.Should be proportionate to the economic burden.

4444
Dementia Research SpendingDementia Research Spending
 NIH expenditures (2008) for select diseases:NIH expenditures (2008) for select diseases:
 Cancer: $5.6 billionCancer: $5.6 billion
 Heart disease: $2.3 billionHeart disease: $2.3 billion
 Dementia: $0.4 billionDementia: $0.4 billion
 How does worldwide dementia research spendingHow does worldwide dementia research spending
compare with other health problems?compare with other health problems?
 Need 15-fold increase to reach parity with heart diseaseNeed 15-fold increase to reach parity with heart disease
research.research.
 Need 30-fold increase to reach parity with cancer research.Need 30-fold increase to reach parity with cancer research.

4545
Dementia Care: Caregiver ViewsDementia Care: Caregiver Views
 Caregiver perceptions on cost of care vary according toCaregiver perceptions on cost of care vary according to
the stage of the disease.the stage of the disease.
 Mild dementia: 30% need “much care”Mild dementia: 30% need “much care”
 Moderate dementia: 69% need “much care”Moderate dementia: 69% need “much care”
 Severe dementia: 88% need “much care”Severe dementia: 88% need “much care”
 How do dementia caregivers spend their caregivingHow do dementia caregivers spend their caregiving
time (on average)?time (on average)?
 Core personal ADLs: 1.6 hoursCore personal ADLs: 1.6 hours
 Instrumental ADLs: 2.1 hoursInstrumental ADLs: 2.1 hours
 General supervision: 3.7 hoursGeneral supervision: 3.7 hours

4646
Who are the Caregivers?Who are the Caregivers?
 Differs between developed and developing countries.
 In Europe, 85% of caregivers are spouses.
 In Latin America, India & China, majority of caregivers were
adult children or children-in-laws, with ¼ to ½ of households
comprising 3 generations.
 Differs between urban and rural settings.
 In urban China, 1/3 of caregivers were spouses.
 In all sites except rural China, caregivers were usually women,
mainly daughters or daughters-in-law caring for a parent.

4747
Dementia Care: National PriorityDementia Care: National Priority
 Countries where dementia has been named a nationalCountries where dementia has been named a national
healthcare priority:healthcare priority:
 AustraliaAustralia
 FranceFrance
 South KoreaSouth Korea
 United KingdomUnited Kingdom
 Countries yet to name dementia a healthcare priority:Countries yet to name dementia a healthcare priority:
 United StatesUnited States
 ChinaChina
 IndiaIndia

4848
Source: Artist Zhou Yuwei. Courtesy of the International Institute of Social History
Stefan R. Landsberger Collection, http://www.iisg.nl/~landsberger.

4949
Dementia Challenge:Dementia Challenge:
India & ChinaIndia & China
 Social planning in both countries has skewed gender
ratios in favor of men over women.
 Abortion and infanticide suspected.
 On all continents except Asia, women outnumber men.
 Social planning in China has decreased the size of the
generation that will have to take care of “the greatest
dementia generation” by 2050.
 Almost half of all dementia patients in Asia will be in China.
 Almost 1/4 of all dementia patients in Asia will be in India.
Dementia in the Asia-Pacific: The Epidemic is Here (Alzheimer’s Disease International), 2006

5050
2004 Kyoto Declaration2004 Kyoto Declaration
 Provides a practical framework for governments, non-
government organisations and other stakeholders to
take actions regarding dementia care.
 Recommended that all Asia-Pacific governments:
 Adopt the 2004 Kyoto Declaration.
 Develop individually tailored national strategies for dementia.
 Promote research regarding dementia causes, dementia
prevention and ways to provide quality dementia care.
 Recommended collaborative action between regional
governments.
Dementia in the Asia-Pacific: The Epidemic is Here (Alzheimer’s Disease International), 2006

5252
Dementia Treatments at a GlanceDementia Treatments at a Glance
 Cholinesterase inhibitors:Cholinesterase inhibitors:
 Donepezil (Aricept) – pillDonepezil (Aricept) – pill
 Rivastigmine (Exelon) – available as a pill or patchRivastigmine (Exelon) – available as a pill or patch
 Galantamine (Razadyne) – pillGalantamine (Razadyne) – pill
 Tacrine (Cognex)-not used anymore since need toTacrine (Cognex)-not used anymore since need to
take 4 times a day and can cause liver damagetake 4 times a day and can cause liver damage
 Most common side effectsMost common side effects: Nausea, vomiting, loss: Nausea, vomiting, loss
of appetite and increased frequency of bowelof appetite and increased frequency of bowel
movementsmovements

5353
Dementia Treatments at a GlanceDementia Treatments at a Glance
 NMDA Receptor Antagonist:NMDA Receptor Antagonist:
 Memantine (Namenda)Memantine (Namenda)
 Works by regulating the activityWorks by regulating the activity
of glutamate, a differentof glutamate, a different
neurotransmitter involved in learning and memory.neurotransmitter involved in learning and memory.
 Approved in 2003 for treatment of moderate toApproved in 2003 for treatment of moderate to
severe Alzheimer's disease.severe Alzheimer's disease.
 Often used together with a cholinesterase inhibitor.Often used together with a cholinesterase inhibitor.

FDA-Approved MedicationsFDA-Approved Medications
for Various Conditionsfor Various Conditions
0
10
20
30
40
50
60
70
D
em
entia
H
ypertensionH
yperlipidem
ia
D
iabetes
Parkinson'sD
isease
O
steoporosis
# of Drugs
# Drug Classes
# Combo Drugs
54
Adapted from Tarascon PocketAdapted from Tarascon Pocket
Pharmacopoeia®, 2010 EditionPharmacopoeia®, 2010 Edition

5555
Dementia Treatment: FutureDementia Treatment: Future
 5-HT6 Receptor Antagonists5-HT6 Receptor Antagonists
 These receptors are mostly in the brain, especially inThese receptors are mostly in the brain, especially in
the hippocampus and frontal cortex.the hippocampus and frontal cortex.
 May play a role in schizophrenia, anxiety and obesity,May play a role in schizophrenia, anxiety and obesity,
in addition to dementia.in addition to dementia.
 Phase II clinical trials underway.Phase II clinical trials underway.
 Seems to improve cognitive function in patients withSeems to improve cognitive function in patients with
moderate dementia on donepezil (LADDER study,moderate dementia on donepezil (LADDER study,
Lancet Neurology, Oct. 2014).Lancet Neurology, Oct. 2014).

56
“An ounce of prevention is
worth a pound of cure”
- Benjamin Franklin

5757
Dementia (and MCI) PreventionDementia (and MCI) Prevention
 Treatment for risk factors (recall CAIDE), especially:Treatment for risk factors (recall CAIDE), especially:
 HypertensionHypertension
 HyperlipidemiaHyperlipidemia
 ObesityObesity
 Vitamins & other nutrientsVitamins & other nutrients
 Vitamin EVitamin E
 B vitaminsB vitamins
 Omega-3 fatty acids (Omega-3 fatty acids (Shaefer EJShaefer EJ et alet al.,., Arch NeurolArch Neurol 20062006))
 Curcumin (Curcumin (NgNg et alet al.,., Amer J EpidemiolAmer J Epidemiol 20062006))
 DietDiet
 Mediterranean diet (Mediterranean diet (Scarmeas NScarmeas N et alet al.,., NeurologyNeurology 20072007))

5858
Dementia (and MCI) PreventionDementia (and MCI) Prevention
 Mental exercise/ learning (again recall CAIDE)Mental exercise/ learning (again recall CAIDE)
 Multilingualism (Multilingualism (Perquin MPerquin M et alet al.,., AANAAN 20112011))
 Memorization & sequencing (Memorization & sequencing (Willis SLWillis SL et alet al,, JAMAJAMA 20062006))
 Physical exercisePhysical exercise
 Variety not intensity (Variety not intensity (LyketsosLyketsos et alet al.,., Am J EpidemiolAm J Epidemiol 20052005))
 Social dancing (Social dancing (Palo-Bengtsson LPalo-Bengtsson L et alet al.,., J Psychiatr Ment Health NursJ Psychiatr Ment Health Nurs 19981998))
 Stress reductionStress reduction
 IL-6IL-6
 CortisolCortisol
 Social stimulationSocial stimulation
 5 social ties (5 social ties (Bassuk SSBassuk SS et alet al.,., Ann Intern MedAnn Intern Med 19991999))

5959
PACE: Program for All-InclusivePACE: Program for All-Inclusive
Care of the ElderlyCare of the Elderly
 Interdisciplinary team care focused on keeping frailInterdisciplinary team care focused on keeping frail
seniors in the community living in their own homes.seniors in the community living in their own homes.
 ““Nursing home in the home”Nursing home in the home”
 In the U.S., about half of the participants haveIn the U.S., about half of the participants have
dementia.dementia.
 Includes primary care and subspecialist careIncludes primary care and subspecialist care
coordination, integrated with physical rehabilitationcoordination, integrated with physical rehabilitation
services, adult day program, mental health services &services, adult day program, mental health services &
dietary counseling.dietary counseling.
 About 120 programs in the U.S. in 33 states coveringAbout 120 programs in the U.S. in 33 states covering
over 40,000 individuals.over 40,000 individuals.

6060
Caregiver ResourcesCaregiver Resources
 Alzheimer’s Association: 1-800-660-1993Alzheimer’s Association: 1-800-660-1993
www.alz.orgwww.alz.org
 Caregiver Resource Centers 1-800-445-8106Caregiver Resource Centers 1-800-445-8106
www.caregiver.orgwww.caregiver.org
 ADEAR: www.Alzheimer's.org/adearADEAR: www.Alzheimer's.org/adear
 Dementia Clinical Practice Guidelines:Dementia Clinical Practice Guidelines:
www.amda.com/tools/guidelines.cfm#dementiawww.amda.com/tools/guidelines.cfm#dementia
www.guideline.gov/content.aspx?id=8809www.guideline.gov/content.aspx?id=8809

6161
www.suddenlysenior.com/Images/SenilityPrayer250.gif

Dementia care world's great healthcare economic challenge for 21st cent apr 2019

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Dementia care world's great healthcare economic challenge for 21st cent apr 2019

Similar to Dementia care world's great healthcare economic challenge for 21st cent apr 2019 (18)

More from SDGWEP

More from SDGWEP (20)

Recently uploaded

Recently uploaded (20)

Dementia care world's great healthcare economic challenge for 21st cent apr 2019