Beyond The Data: Promoting Well-being in Older Adults

[Thorpe] Welcome to Beyond the Data. I'm Doctor Phoebe Thorpe and here with me today is Matthew Baumgart from the Alzheimer's Association. Matthew, thank you so much for joining us.

[Baumgart] Well, thank you for having me. Glad to be here.

[Thorpe] In the Public Health Grand Round Session today, we learned a lot about healthy aging, but I was astounded at the number of Americans who are growing older. 10,000 Americans are turning 65 each day. Each day. Assuming that hopefully we all do turn older, grow older, what does that mean for us?

[Baumgart] So, could I just, I want to put that 10,000 a day and how many people in context because I find it, and I stop and think about it, incredibly fascinating. And it gets to the issue of what the burden is and what we need to do about it. So there are today.... the number of Americans today living with Alzheimer's disease is greater than the total number of seniors in 1900, and by 2050 the number of people 85 and over with Alzheimer's will be greater than the total number of people with Alzheimer's today. That's how big this population is growing, and what it means is we've got to be able to have the resources and we got to develop the infrastructure that's necessary to address the crisis. So we need to think about: Do we have enough long-term care facilities? Do we have enough assisted-living spaces? And particularly, as were moving more and more into home and community-based care, do we have enough community-based services? And in particular, are those community-based services capable and qualified to handle and deal with people with dementia because it's a different ballgame, if you will, when you're helping and addressing somebody with a cognitive impairment than it is with someone without. So those those sorts of infrastructure things are very important for us to think about now as this baby-boom population, 10,000 a day as you mentioned, balloons the people who need those services.

[Thorpe] I'm glad that you brought up the Alzheimer's because this changing population has helped us kind of refocus that disease, and now we are looking at it more as a continuum and that includes early memory loss. So what should people do if they notice in themselves early memory loss or they notice it in a loved one?

[Baumgart] So, I would say they should do a couple of things. First of all, they should learn about the 10 warning signs and on the Alzheimer's Association website alz.org there is a section on the 10 warning signs because some memory loss is normal with aging. What's not normal is Alzheimer's disease, and to be able to distinguish between oh you know I forgot my keys, I do that and I did that when I was in my 20s every once in a while. Where did I put my keys? So to distinguish between what is normal memory loss, occasionally forgetting things, and something that's symptomatic of a bigger problem is important to understand. So should become aware of what those warning signs are. And then the second thing is, is talk to your healthcare provider. Talk to your physician if you're having memory problems and particularly if those memory problems are getting worse. And if you or your loved one are noticing a change over time in your memory problems, raise it with your healthcare provider.

[Thorpe] And then, are there resources for healthcare providers because, if this is a changing idea of how to approach Alzheimer's, are there resources for healthcare providers?

[Baumgart] You raise a really important point. That it's...that healthcare providers need to become educated on dealing with this. First of all, they should start asking their patients as they age about their memory problems. And the Medicare annual wellness visit in fact now has a provision in it that says "detection of possible cognitive impairment must be part of that annual wellness visit". So providers should be asking as their patients get older, but they also need to become educated about the various assessment tools and their multiple assessment tools to assess people's cognition and potential serious problems in terms of of Alzheimer's disease or dementia. So they should become educated in how to use those assessment tools. And then the third thing is that Medicare now has, as of the beginning of this year, a care planning benefit. So anybody who a physician says is cognitively impaired or has a cognitive problem they should be utilizing that Medicare benefit and engaging in care planning with the individual to get on the right course of care, to talk about medication management, to talk about advanced care directives, and to assess their caregiver situation. Those those are all important things to do, but they can only be done if you start the conversation and if know how to talk about it and how to assess people.

[Thorpe] For the healthcare providers, the thing about the caregivers assessing them and putting them... trying to get them in place. That's also came out in the session in that it's important to have good caregivers, but it's also important to take care of the caregivers. So what can be done...in other words, the caregivers can't give up their health while they're taking care of somebody else. What can we do to help the caregivers stay healthy?

[Baumgart] So I think that's a really important point, and I think that's broader than just Alzheimer's and dementia caregivers. This is caregivers across the board. Caregivers need to be aware that the impact of caregiving can affect their own health. I’ll just throw out a statistic. The cost of caregiving, the burden it puts on the caregivers, results in about 10 billion dollars in higher health care costs for caregivers because of the toll it takes on them. And this is Alzheimer's and dementia caregivers, so it's very very important that they pay attention to their own health. Beyond that, from a systems standpoint, from a medical practice standpoint, I think it's important to start putting caregiver notations in medical records in both the patient's, who has the particular condition in this case say Alzheimer's disease. That patient's medical record ought to indicate who the caregiver is, who the primary caregiver is, so the doctor, when he or she is assessing the patient, can also bring the conversation about the caregiver into play.

[Baumgart] But also…

[Thorpe] That’s ok, we do that in pediatrics, so why can't you do it?

[Baumgart] Exactly, exactly but I also think the caregiver themselves often times might have a different doctor. The fact that they are a caregiver should be in their medical record, so that when a doctor is assessing them during an annual checkup for example and having a conversation with the individual that in that medical record is the fact that they are a caregiver which the doctor will then know might have an impact on their health and can address that fact. If it's not in the medical record they may not know that they're spending a lot of time in a very taxing situation of providing care for someone.

[Thorpe] Of course, everybody is worried about cognitive decline in memory loss. What can individuals do to prevent cognitive decline?

[Baumgart] We get this question a lot as you can imagine. And, I like to divide it. I like to divide the answer into two. One is the disease Alzheimer's and one is in cognitive decline. And Alzheimer's unfortunately we still have a lot to learn, and there still needs to be a lot of study and research. We know basically two things about Alzheimer's. Stay in school. If you're thinking of dropping out, stay in school, go to college, and I say that kind of flippantly. But there is really solid evidence that the more formal education you have the more protective it is. Not only against cognitive decline but also against Alzheimer's disease. The second is to protect your head, so wear a bicycle helmet as an example because the other thing we know is that concussions are a cause of some forms of dementia. So that that's kind of the one category. Unfortunately, we'd like to know more about what you can do to reduce your risk of Alzheimer's. We don't yet know. But we do, as you indicated, know a lot more about what can be done to reduce your risk of cognitive decline. And, between the special workgroup, a special panel that was put together by the Institute of Medicine a couple years ago, as well as a separate independent review the Alzheimer's Association did we found there are a handful of things. If you want to protect yourself from cognitive decline, the bottom line phrase to remember is what's good for your heart is good for your brain, so you should engage in physical activity, and you should manage certain cardiovascular risk factors, in particular smoking, diabetes, and midlife hypertension. And the Alzheimer's Association, in its review, also believes that midlife obesity is a risk factor. So that physical activity in those certain cardiovascular health factors: What's good for your heart is good for your brain.

[Thorpe] That’s kind of easy to remember, and I know from the session today and from talking with you there are a lot of different groups putting forth efforts for this. Can you tell me about some of the good either initiatives or resources where folks might go to if they want to learn more?

[Baumgart] Yes, so I mentioned two websites. One is the Alzheimer's Association that alz.org. It has a lot of resources. It has a portal for people with the disease, a portal for caregivers, it has a portal for professionals, so if you're a public health professional for example you can go onto our website and you'll find information on how to promote early detection and diagnosis, how to promote risk reduction, which we're just talking about. Things that public health traditionally does. If you're a physician, there's information on the assessment tools and how to have a conversation with the patient about their memory problems. The other resource that is really good that I use a lot is The Healthy Aging Program here at CDC, and that's cdc.gov/aging. And it's the healthy brain initiative and Alzheimer's program here at CDC, and has a lot of great resources, things on advanced directives, a lot of data, a lot of other information that you need to know and particularly from a public health perspective.

[Thorpe] Okay, so what we really need to remember to is what's good for your heart is good for your brain.

[Baumgart] That's right. That's right.

[Thorpe] Thank you so much for joining us, appreciate it.

[Baumgart] You're quite welcome.

[Thorpe] And thank you for joining us. See you next time for Beyond The Data.