May 2018

Projection: Caregiver Supports Lead to Medicaid Savings

An economic microsimulation projects an estimated $40 million could be saved over a 15-year period in Minnesota if eligible dementia caregivers received a comprehensive set of caregiver supports. This study, published in The Gerontologist earlier this year, examined how the New York University Caregiver Intervention (NYUCI) program could benefit community-based, Medicaid-eligible people with dementia in Minnesota by helping caregivers keep the individual at home or in the community longer and thus, delaying more expensive residential care. View the study to learn more about the assumptions, methodology, and limitations of the simulation.

The NYUCI program combines individual and family counseling, support groups, and additional telephone consultations to effectively support families caring for people living with dementia. Previous studies of the NYUCI program have identified benefits to caregivers’ physical and mental health as well as associated delays in institutional placement of the care recipient.

Promoting evidence-informed programs like the NYUCI is one way the public health community can implement the Healthy Brain Initiative Road Map, a guidebook that calls on public health to help meet the needs of caregivers for people with dementia. Jointly developed by the Alzheimer’s Association and the Centers for Disease Control and Prevention (CDC), the Road Map also offers actions that public health officials can take to promote brain health and address cognitive impairment throughout their communities. Learn more.

May 17: “Family” Caregiving: The Frontline of Dementia Care

Nearly half of all caregivers who provide help to older adults do so for someone living with Alzheimer’s or another dementia. Who are these caregivers? What challenges do they face as Alzheimer’s progressively undermines cognitive and physical function?  And, what can state public health agencies do to support both the caregiver and the person living with dementia?

Join the Alzheimer’s Association on Thursday, May 17 from 2:00 to 3:00 pm ET for an interactive webinar on dementia caregiving and ways state public health can support both populations. Please register in advance.

The webinar will offer insights from analyses of 2016 Behavioral Risk Factor Surveillance System (BRFSS) Caregiver Module data from 19 states and the District of Columbia. Participants will learn about the New York State Department of Health’s rationale and components of its Alzheimer’s Disease Caregiver Support Initiative (ADCSI), a five-year, evidence-informed initiative. Accomplishments from the first year of ADCSI will be discussed.

Be sure to register online, mark your calendars for this national event for Older Americans Month, and forward this message to any interested colleagues.

Now Available: 2016 BRFSS Caregiver Module State Fact Sheets

Fact sheets for each of the 20 states and territories that ran the Caregiver Module in the 2016 Behavioral Risk Factor Surveillance System (BRFSS) survey are now available at alz.org/publichealth. Surveillance collected routinely through BRFSS provide state-specific data that help observe health trends and direct public health action. 

The Caregiver Module asks questions about a care recipient’s health problems, the length and intensity of caregiving, and caregiving responsibilities. Data from the 2016 survey indicate that dementia caregiving is often long, intense, and intimate.

Each fact sheet has state-specific data on dementia caregiving, including how many caregivers assist with household activities and/or provide personal care to a person living with dementia as well as gender and age breakdowns of the caregivers themselves.  View fact sheets for 2016, 2015, and earlier years.

Resources to Encourage Dementia-Prepared Communities

As more and more communities work to become dementia-capable and dementia-prepared, public health practitioners can utilize several new resources to enhance healthy aging, promote early detection and diagnosis of dementia, encourage advance planning, and help ensure safe transit among people with dementia.

Healthy Aging: From the Administration for Community Living, an updated set of Brain Health Resources are available for public health users to educate older adults about healthy aging, brain injury, and dementia. Resources include presentation slides, educator guides, and handouts. Available for download. 

Talking to a Provider about Cognitive Symptoms: From the CDC National Center for Chronic Disease Prevention and Health Promotion, this infographic can be used to encourage people to discuss cognitive concerns with a health care provider. Available for download.

Developing Advance Plans: From the National Institute on Aging, this infographic checklist helps individuals develop advance care and financial plans before serious illness or loss of cognitive ability. Available for download.

Transportation Toolkit: From the National Aging and Disability Transportation Center, this toolkit offers education and guidance on the unique transportation considerations people with dementia and their caregivers face. Available for download.

Report to HHS: Physical Activity Supports Brain Health

Brain health has been added to the evidence base that informs the U.S. Department of Health and Human Services’ Physical Guidelines for Americans. The Guidelines provide science-based advice on how physical activity can promote health and reduce the risk of chronic disease. The 2018 Advisory Committee’s scientific report includes a chapter dedicated to brain health, noting that there is compelling evidence connecting physical activity to positive cognitive outcomes, including among older adults. The second edition of the Guidelines is anticipated later this year.  

Incorporating brain health messages into existing health and physical activity campaigns is one way public health officials can promote cognitive health and potentially reduce the risk for cognitive impairment. To help support this action recommended by the Healthy Brain Initiative Road Map, public health practitioners can utilize these readymade, evidence-based messages across a variety of common health promotion and health education topics.

Researcher Spotlight: Social, Physical Activity Promotion Among Black Americans         

This edition of Alzheimer’s Public Health News features insightful work coming from the Healthy Brain Research Network (HBRN). Created by the Centers for Disease Control and Prevention (CDC) to further advance the Healthy Brain Initiative, the HBRN is a thematic public health research network that comprises the collaborative strengths, expertise and diversity of its core academic institutions and community and public health partnerships. Learn more about the HBRN.

Developed by the Layton Aging & Alzheimer’s Disease Center at Oregon Healthy & Science University, the Sharing History through Active Reminiscence and Photo-imagery (SHARP) program uses a culturally-celebratory framework to motivate African Americans aged 55 and over to stay physically and socially active for better brain health. SHARP also serves as a platform for mentoring minorities in aging research.

In 2017, 21 participants began the six-month SHARP intervention. In teams of three, participants aimed to walk one-mile routes three times a week in Portland, Oregon’s historically Black neighborhoods. Teams navigated themed routes (such as political life, fashion, and school days) using the SHARP application on a tablet device. Each route had three Memory Markers — GPS-triggered historical neighborhood images with accompanying questions to prompt conversational reminiscence among the team. These Memory Markers depict local Black landmarks like the Billy Webb Elks Club, the Cotton Club, and Dawson Park where a 1963 NAACP march for Medgar Evers launched. Markers also include businesses and services like Maxey’s Barbershop and the Urban League as well as everyday people’s homes.  Discussions of the teams’ memories were recorded for an oral history archive and for integration into community health resources. 

Last month, 18 participants completed the study. Cognitive assessment scores showed improvement for half the study population, even among those experiencing mild cognitive impairment. In addition, research interns were mentored by SHARP’s lead, Raina Croff, PhD, edifying the public health workforce by learning about the impact of gentrification on older African American health, factors motivating participants, administering cognitive assessments, data analysis, and building valuable community relationships.

SHARP is funded by an Alzheimer’s Association Research Grant to Promote Diversity, the CDC Healthy Brain Research Network, and the National Institute on Aging.

New Research Framework Focuses on Biological Definition of Alzheimer’s

Last month, the National Institute on Aging (NIA) and the Alzheimer’s Association published a new research framework, for clinical use, that defines Alzheimer’s disease through biological changes in the brain — such as plaques and tangles — rather than through symptomatic issues like memory loss. This new research framework reflects the evolving view that Alzheimer’s occurs along a continuum beginning with pre-symptomatic changes in the brain and continuing through mild cognitive impairment and, eventually, dementia.

This proposed definition provides a shared definitional framework allowing clinical trials to explore treatment before clinical symptoms are even detectable. While prepared for the scientific research community, developments stemming from use of this framework may lead to identification of new effective modalities for prevention, diagnosis, and treatment of Alzheimer’s. Learn more about the framework.

The Alzheimer’s Public Health E-News is supported (in part) by Cooperative Agreement #5 NU58DP006115-03, funded by the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

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