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ACT on Alzheimer’s

Alzheimer’s Disease Curriculum

Module II - Demographics

GUIDELINES AND RESTRICTIONS ON USE OF DEMENTIA CURRICULUM MODULES

This curriculum was created for faculty across multiple disciplines to use in existing coursework and/or to develop as a stand-alone course in dementia. Because not all module topics will be used within all disciplines, each of the ten modules can be used alone or in combination with other modules. Users may reproduce, combine, and/or customize any module text and accompanying slides to meet their course needs.

Use restriction: The ACT on Alzheimer's®-developed dementia curriculum cannot be sold in its original form or in a modified/adapted form.

NOTE: Recognizing that not all modules will be used with all potential audiences, there is some duplication across the modules to ensure that key information is fully represented (e.g., the screening module appears in total within the diagnosis module because the diagnosis module will not be used for all audiences).

© 2016

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Acknowledgement

We gratefully acknowledge the funding organizations that made this curriculum development possible: the Alzheimer’s Association MN/ND and the Minnesota Area Geriatric Education Center (MAGEC), which is housed in the University of MN School of Public Health and is funded by the Health Resources and Services Administration (HRSA).

We specifically acknowledge the principal drafters of one or more curriculum modules, including Mike Rosenbloom, MD; Olivia Mastry, MPH, JD; Gregg Colburn, MBA; and the Alzheimer’s Association.

In addition, we would like to thank the following contributors and peer review team:Michelle Barclay, MATerry Barclay, PhDMarsha Berry, MA, CAEdErin Hussey, DPT, MS, NCSSue Field, DNP, RN, CNEJulie Fields, PhD, LPJane Foote EdD, MSN, RNHelen Kivnik, PhDKenndy Lewis, MSRiley McCarten, MDTeresa McCarthy, MD, MSLynne Morishita, GNP, MSNBecky Olson-Kellogg, PT, DPT, GCSJim Pacala, MD, MSPatricia Schaber, PhD, OTR/LJohn SelstadEricka Tung, MD, MPHJean Wyman, PhD., RN, GNP-BC, FAAN, FGSA

This project is/was supported by funds from the Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services

(DHHS) under Grant Number UB4HP19196 to the Minnesota Area Geriatric Education Center (MAGEC) for $2,192,192 (7/1/2010—6/30/2015). This information or content and conclusions are

those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the BHPr, HRSA, DHHS or the U.S. Government.

Minnesota Area Geriatric Education Center (MAGEC)Grant #UB4HP19196

Director: Robert L. Kane, MDAssociate Director: Patricia A. Schommer, MA

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Overview of Alzheimer’s Disease Curriculum

This is a module within the Dementia Curriculum developed by ACT on Alzheimer’s. ACT on Alzheimer’s is a statewide, volunteer-driven collaboration seeking large-scale social change and community capacity-building to transform Minnesota’s response to Alzheimer’s disease. An overarching focus is health care practice change to ensure quality dementia care for all.

All of the dementia curriculum modules can be found online at www.ACTonALZ.org.

Module I: Disease Description

Module II: Demographics

Module III: Societal Impact

Module IV: Effective Interactions

Module V: Cognitive Assessment and the Value of Early Detection

Module VI: Screening

Module VII: Disease Diagnosis

Module VIII: Dementia as an Organizing Principle of Care

Module IX: Quality Interventions

Module X: Caregiver Support

Module XI: Alzheimer’s Disease Research

Module XII: Glossary

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ACT on Alzheimer's has developed a number of practice tools and resources to assist providers in their work with patients and clients who have memory concerns and to support their care partners. Among these tools are a protocol practice tool for cognitive impairment, a decision support tool for dementia care, a protocol practice tool for mid- to late-stage dementia, care coordination practice tools, and tips and action steps to share with a person diagnosed with Alzheimer's. These best practice tools incorporate the expertise of multiple community stakeholders, including clinical and community-based service providers:

• Clinical Provider Practice Tool• Electronic Medical Record (EMR) Decision Support Tool• Managing Dementia Across the Continuum• Care Coordination Practice Tool• Community Based Service Provider Practice Tool• After A Diagnosis

While the recommended practices in these tools are not location-specific, many of the resources referenced are specific to Minnesota.  The resource sections can be adapted to reflect resources specific to your geographic area. To access ACT practice tools and resources, as well as video tutorials on screening, assessment, diagnosis, and care coordination, visit: http://actonalz.org/provider-practice-tools

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Learning Objectives: Module II

Upon completion of this module the student should:

Identify the demographics of people that are affected by Alzheimer’s disease.

Gain insight of the anticipated increase and impact Alzheimer’s disease will have in the

future.

Module IIDemographics

(The following text is drawn directly from the Alzheimer’s Association, 2015 Alzheimer’s Disease Facts and Figures)

Millions of Americans have Alzheimer’s disease and other dementias. The number of Americans with Alzheimer’s disease and other dementias will grow each year as the number and proportion of the U.S. population age 65 and older continue to increase. The number will escalate rapidly in coming years as the baby boom generation ages.

Estimates from selected studies on the prevalence and characteristics of people with Alzheimer’s and other dementias vary depending on how each study was conducted. Data from several studies are used in this section (for data sources and study methods, see the Appendices of 2015 Facts and Figures). Most estimates are from a new study using the same methods as the study that provided estimates in previous years’ Facts and Figures reports, but with updated data. Although some of the estimates are slightly different than estimates in previous Facts and Figures reports, researchers consider them to be statistically indistinguishable from previous estimates when accounting for margins of error.

Prevalence of Alzheimer’s Disease and Other Dementias

An estimated 5.3 million Americans of all ages have Alzheimer’s disease in 2015. This includes an estimated 5.1 million people age 65 and older and approximately 200,000 individuals under age 65 who have younger-onset Alzheimer’s.

One in nine people age 65 and older (11 percent) has Alzheimer’s disease. About one-third of people age 85 and older (32 percent) have Alzheimer’s disease.

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Of those with Alzheimer’s disease, an estimated 4 percent are under age 65, 15 percent are 65 to 74, 43 percent are 75 to 84, and 38 percent are 85 or older.

The estimated prevalence for people age 65 and older comes from a new study using the latest data from the 2010 U.S. Census and the Chicago Health and Aging Project (CHAP), a population-based study of chronic health diseases of older people. Although this estimate is slightly lower than the estimate presented in previous Facts and Figures reports, it does not represent a real change in prevalence. According to the lead author of both the original and the new studies on the prevalence of Alzheimer’s, “Statistically, [the estimates] are comparable, and, more importantly, both old and new estimates continue to show that the burden [Alzheimer’s disease] places on the population, short of any effective preventive interventions, is going to continue to increase substantially.”

In addition to estimates from CHAP, the national prevalence of Alzheimer’s disease and all forms of dementia have been estimated from other population-based studies, including the Aging, Demographics, and Memory Study (ADAMS), a nationally representative sample of older adults. National estimates of the prevalence of all forms of dementia are not available from CHAP, but based on estimates from ADAMS, 14 percent of people age 71 and older in the United States have dementia.

Prevalence studies such as CHAP and ADAMS are designed so that all individuals with dementia are detected. But in the community, only about half of those who would meet the diagnostic criteria for Alzheimer’s disease and other dementias have received a diagnosis of dementia from a physician. Because Alzheimer’s disease is under-diagnosed, half of the estimated 5.3 million Americans with Alzheimer’s may not know they have it.

The estimates from CHAP and ADAMS are based on commonly accepted criteria for diagnosing Alzheimer’s disease that have been used since 1984. In 2009, an expert workgroup was convened by the Alzheimer’s Association and the NIA to recommend updated diagnostic criteria and guidelines, as described in the Overview section of 2013 Facts and Figures. These proposed new criteria and guidelines were published in 2011. If Alzheimer’s disease can be detected earlier, in the stages of preclinical Alzheimer’s and/or MCI due to Alzheimer’s as defined by the 2011 criteria, the number of people reported to have Alzheimer’s disease would be much larger than what is presented in this report.

Prevalence of Alzheimer’s Disease and Other Dementias in Women and MenMore women than men have Alzheimer’s disease and other dementias. Almost two-thirds of Americans with Alzheimer’s are women. Of the 5.1 million people age 65 and older with Alzheimer’s in the United States, 3.2 million are women and 1.9 million are men. Based on

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estimates from ADAMS, 16 percent of women age 71 and older have Alzheimer’s disease and other dementias compared with 11 percent of men.

The larger proportion of older women who have Alzheimer’s disease and other dementias is primarily explained by the fact that women live longer, on average, than men. Many studies of the age-specific incidence (development of new cases) of Alzheimer’s disease or any dementia have found no significant difference by sex. Thus, women are not more likely than men to develop dementia at any given age.

Prevalence of Alzheimer’s Disease and Other Dementias by Years of Education People with fewer years of education appear to be at higher risk for Alzheimer’s and other dementias than those with more years of education.

Prevalence of Alzheimer’s Disease and Other Dementias in Older Whites, African-Americans and HispanicsWhile most people in the United States living with Alzheimer’s and other dementias are non-Hispanic whites, older African-Americans and Hispanics are proportionately more likely than older whites to have Alzheimer’s disease and other dementias. Data indicate that in the United States, older African-Americans are probably about twice as likely to have Alzheimer’s and other dementias as older whites, and Hispanics are about one and one-half times as likely to have Alzheimer’s and other dementias as older whites.

Despite some evidence of racial differences in the influence of genetic risk factors on Alzheimer’s and other dementias, genetic factors do not appear to account for these large prevalence differences across racial groups. Instead, health conditions such as high blood pressure and diabetes that may increase one’s risk for Alzheimer’s disease and other dementias are believed to account for these differences because they are more prevalent in African-American and Hispanic people. Lower levels of education and other socioeconomic characteristics in these communities may also increase risk. Some studies suggest that differences based on race and ethnicity do not persist in detailed analyses that account for these factors.

There is evidence that missed diagnoses are more common among older African-Americans and Hispanics than among older whites. A recent study of Medicare beneficiaries found that Alzheimer’s disease and other dementias had been diagnosed in 8 percent of white beneficiaries, 11 percent of African-American beneficiaries and 12 percent of Hispanic beneficiaries. Although rates of diagnosis were higher among African-Americans than among whites, this difference was not as great as would be expected based on the estimated differences found in prevalence studies, which are designed to detect all people who have dementia.

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Looking to the Future

The number of Americans surviving into their 80s, 90s and beyond is expected to grow dramatically due to advances in medicine and medical technology, as well as social and environmental conditions. Additionally, a large segment of the American population — the baby boom generation — has begun to reach the age range of elevated risk for Alzheimer’s and other dementias, with the first baby boomers having reached age 65 in 2011. By 2030, the segment of the U.S. population age 65 and older is expected to grow dramatically, and the estimated 72 million older Americans will make up approximately 20 percent of the total population (up from 13 percent in 2010).

As the number of older Americans grows rapidly, so too will the numbers of new and existing cases of Alzheimer’s disease.

In 2000, there were an estimated 411,000 new cases of Alzheimer’s disease. For 2010, that number was estimated to be 454,000 (a 10 percent increase); by 2030, it is projected to be 615,000 (a 35 percent increase from 2010); and by 2050, 959,000 (a 110 percent increase from 2010).

By 2025, the number of people age 65 and older with Alzheimer’s disease is estimated to reach 7.1 million — a 40 percent increase from the 5 million age 65 and older currently affected.

By 2050, the number of people age 65 and older with Alzheimer’s disease may nearly triple, from 5 million to a projected 13.8 million, barring the development of medical breakthroughs to prevent, slow or stop the disease. Previous estimates suggest that this number may be as high as 16 million.

Longer life expectancies and aging baby boomers will also increase the number and percentage of Americans who will be among the oldest-old. Between 2010 and 2050, the oldest-old are expected to increase from 14 percent of all people age 65 and older in the United States to 20 percent of all people age 65 and older. This will result in an additional 13 million oldest-old people — individuals at the highest risk for developing Alzheimer’s.

By 2050, as many as 7 million people age 85 years and older may have Alzheimer’s Disease, accounting for half (51 percent) of all people 65 and older with Alzheimer’s.

In 2015, the 85-years-and-older population includes about 2 million people with Alzheimer’s disease, or 38 percent of all people with Alzheimer’s age 65 and older.

When the first wave of baby boomers reaches age 85 (in 2031), it is projected that more than 3 million people age 85 and older are likely to have Alzheimer’s.

Some communities are taking action to create a supportive environment for people living with dementia and their families. Communities can become “dementia capable” or “dementia

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friendly” by utilizing the ACT on Alzheimer’s Community Toolkit, a collective community process for creating a supportive community environment.

Module II: Questions for Review

1. The prevalence of Alzheimer’s disease in people over the age of 65 is currentlyA. 5%B. 11%C. 2%

2. How many people over the age of 85 currently have Alzheimer’s disease?A. 1/3B. 1/2C. 1/10

3. Alzheimer’s disease is currently:A. Underdiagnosed in the communityB. Overdiagnosed in the communityC. Accurately diagnosed in the community

4. Alzheimer’s disease is more common in:A. Woman than menB. People with fewer years of educationC. African Americans than WhitesD. All of the above

5. Alzheimer’s disease cases will increase from 2000 to 2030 by:A. 20%B. 30%C. 50%

6. The age group with the highest risk for developing Alzheimer’s disease is:A. >85B. 75-85C. 60-75

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