Cognitive Decline and Caregiving: Update from the 2015 ......2017/06/20 · June 20, 2017 25 Time...

Cognitive Decline and Caregiving:Update from the 2015 Maryland BRFSS

June 20, 2017Maryland Department of Health and Mental Hygiene

Prevention and Health Promotion AdministrationCenter for Chronic Disease Prevention and Control

Prevention and Health Promotion AdministrationJune 20, 2017

2

Introductions• Anna McCrerey, Bureau Director, Cancer and Chronic

Disease

• Kristi Pier, Director, Center for Chronic Disease Prevention and Control

• Georgette Lavetsky, BRFSS Coordinator, Center for Chronic Disease Prevention and Control

• Colin Simms, Health Policy Analyst, Center for Chronic Disease Prevention and Control


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Objectives• Review data from the cognitive decline and caregiver

modules of the 2015 Behavioral Risk Factor Surveillance System.

• Discuss the effects cognitive decline can have on the population.

• Provide resources to support cognitive decline and caregiving.


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Mission and Vision

MISSION• The mission of the Prevention and Health Promotion Administration is to

protect, promote and improve the health and well-being of all Marylanders and their families through provision of public health leadership and through community-based public health efforts in partnership with local health departments, providers, community based organizations, and public and private sector agencies, giving special attention to at-risk and vulnerable populations.

VISION• The Prevention and Health Promotion Administration envisions a future in

which all Marylanders and their families enjoy optimal health and well-being.


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Behavioral Risk Factor Surveillance System (BRFSS)

• Origin• Established by the CDC in 1984 with 15 states• Assesses population prevalence of chronic health conditions, risk

behaviors, use of preventive services• Non-institutionalized adults age 18+

• Growth• Maryland joined in 1987• National survey (all 50 states, District of Columbia, 3 U.S.

territories)


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Things to keep in mind• Data weighting

• Iterative proportional fitting (raking)

• Data limitations• Self-reported data are not verified• Excludes adults living in institutions (e.g. nursing facilities, group

homes, prisons)

• Data suppression requirements• Based on fewer than 50 survey respondents (n<50)• Relative standard error ≥ 30.0%


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COGNITIVE DECLINEThe experience of confusion or memory loss that is happening more often or is getting worse during the past 12 months(Limited to respondents age 45+)Source: 2015 Maryland Behavioral Risk Factor Surveillance System


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Cognitive Decline ModuleSource: 2015 Maryland Behavioral Risk Factor Surveillance System

• Six questions to assess:• Prevalence of cognitive decline• Impact of cognitive decline• Ability to get help when needed• Communication with health care professionals

• 6,000 Maryland residents were asked the module questions in 2015


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Prevalence of Cognitive DeclineSource: 2015 Maryland Behavioral Risk Factor Surveillance System

10.6 10.1 11.1 10.5 9.4 11.5 8.9 11.3 21.7 10.5 8.8 6.7 31.5

3.4

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Statewide Male Female White NH Black NH Age 45‐54 Age 55‐64 Age 65+ Less than$25,000*

$25,000 to<$50,000

$50,000 to<$75,000

$75,000 ormore

Has adisability*

Does nothave

disability**

Percen

t

Demographic CharacteristicsData suppressed for Hispanic, Asian, and Other race/ethnicity.

*Significantly higher than statewide estimate: Income less than $25,000 per year, Has a disability.**Significantly lower than statewide estimate: Does not have a disability.


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Prevalence of Cognitive DeclineSource: 2015 Maryland Behavioral Risk Factor Surveillance System

10.6 31.5 60.2 28.1 49.4 46.8 41.90.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Statewide Has a disability* Cognitivedisability*

Mobilitydisability*

Vision disability* Self‐caredisability*

Independentliving disability*

Percen

t

*Significantly higher than statewide estimate: Has a disability (one or more than one disability type), Cognitive disability, Mobility disability, Vision disability, Self-care disability, Independent living disability


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Impact of Cognitive DeclineSource: 2015 Maryland Behavioral Risk Factor Surveillance System

19.3 20.6 21.1

50.516.7 15.5 10.8

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Interferes with workor social activities

Given up day‐to‐daychores

Need assistance withday‐to‐day activities

Has one or morefunctional difficulties

Percen

t

Sometimes Always or Usually

36.0 36.131.9


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Ability to Get Help when NeededSource: 2015 Maryland Behavioral Risk Factor Surveillance System

57.5 18.8 23.80.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Always or Usually Sometimes Rarely or Never

Percen

t


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Communication with Health Care ProfessionalsSource: 2015 Maryland Behavioral Risk Factor Surveillance System

48.4 51.60.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Discussed confusion or memory loss with ahealth care professional

Did NOT discuss confusion or memory losswith a health care professional

Percen

t


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Chronic Disease Prevalence Differs by Cognitive StatusSource: 2015 Maryland Behavioral Risk Factor Surveillance System

*Significantly higher among those who reported cognitive decline compared to those who did not: Anxiety disorder, Depressive disorder, Asthma (current), COPD, Cardiovascular disease

33.0 51.2 18.2 19.3 12.1 26.6 29.2 54.19.8 14.0 7.8 8.1 10.1 16.4 10.5 47.60.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Anxiety disorder* Depressivedisorder*

Asthma (current)* COPD* Cancer (otherthan skin cancer)

Diabetes Cardiovasculardisease*

High bloodpressure

Per

cent

Reported cognitive decline Did not report cognitive decline


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What We Can See• Cognitive decline is experienced across every

demographic.

• Cognitive decline is significantly higher in those with lower incomes.

• 1 in 3 adults living with a disability report experiencing cognitive decline.

• Among individuals who report cognitive decline, the prevalence of several chronic diseases is significantly higher


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Impacts

• 1 in 3 adults with cognitive decline needed to give up day-to day household activities or chores as a result of confusion or memory loss

• Individuals may not always be able to get support and assistance.

• Half of Maryland adults with cognitive decline report their health status as fair or poor.


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Best Practices• Encouraging routine primary care appointments

• Assessing cognitive impairment in older adults

• Implementing earlier assessments to patients

• Team-based care approaches and patient centered discussion

• Implement effective care planning services


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Care Planning• Care planning is important.

• Effective January 1, 2017, Medicare now provides reimbursement to clinicians for care planning services provided to individuals with cognitive impairment.

• Legal and Financial Planning through Alzheimer’s Association

• Maryland legislation influencing care planning• House Bill 188


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Questions?


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CAREGIVERA person who, during the past 30 days, provided regular care or assistance to a friend or family member with a health problem or disability

Source: 2015 Maryland Behavioral Risk Factor Surveillance System


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Caregiver ModuleSource: 2015 Maryland Behavioral Risk Factor Surveillance System

• Nine questions to assess:• Prevalence of caregiving• Relationship between caregiver and caregiving recipient• Major health problem, illness, or disability of the caregiving

recipient• Time investment in caregiving• Type of care provided• Unmet needs of the caregiver

• 6,000 Maryland residents were asked the module questions in 2015


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Prevalence of CaregivingSource: 2015 Maryland Behavioral Risk Factor Surveillance System

24.4 24.7 24.1 24.4 27.5 18.1 16.8 37.3 24.8 18.5 26.9 29.9 21.1 26.5 27.1 24.3 22.4 28.3 23.00.0

10.0

20.0

30.0

40.0

50.0

60.0

Percen

t

Demographic Characteristics


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Relationship between Caregiver and Caregiving RecipientSource: 2015 Maryland Behavioral Risk Factor Surveillance System

4.5

6.7

7.9

8.4

9.6

12.3

12.4

37.5

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0

Mother or father‐in‐law

Grandmother or grandfather

Other relative

Brother/sister or brother/sister‐in‐law

Child

Non‐relative/Family friend

Husband or wife

Mother or father

Percent

Data suppressed for Grandchild


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Major Health Problem, Illness, or Disability of Caregiving RecipientSource: 2015 Maryland Behavioral Risk Factor Surveillance System

2.6

4.9

6.0

6.0

6.4

8.1

9.6

46.2

0.0 10.0 20.0 30.0 40.0 50.0 60.0

Chronic respiratory conditions

Diabetes

Heart diease, Hypertension

Arthritis / Rheumatism

Developmental disabilities

Dementia / Cognitive impairment disorders

Cancer

Other

Percent

Data suppressed for Other organ failure or diseases, Mental illness, and Asthma


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Time Investment in CaregivingSource: 2015 Maryland Behavioral Risk Factor Surveillance System

57.2 14.5 12.6 15.70.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Up to 8 hoursper week

9 to 19 hoursper week

20 to 39 hoursper week

40 hours ormore per week

Percen

t

HOW MANY HOURS DO YOU PROVIDE CARE FOR PERSON?

23.3 13.2 16.4 16.3 30.80.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Less than 30days

1 month toless than 6months

6 months toless than 2

years

2 years to lessthan 5 years

More than 5years

Percen

t

HOW LONG PROVIDED CARE FOR PERSON


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Type of Care ProvidedSource: 2015 Maryland Behavioral Risk Factor Surveillance System

53.5 78.40.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Managed personal care Managed household tasks

Percen

t

48.45.2

29.9 16.40.0

10.0

20.0

30.0

40.0

50.0

60.0

Both personaland household

Personal ONLY Household ONLY Neither personalnor housenold

Percen

t


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Unmet Needs of the CaregiverSource: 2015 Maryland Behavioral Risk Factor Surveillance System

Data suppressed for Individual counseling to help cope with giving care, Support groups, Classes about giving care such as giving medications

2.2

10.7

78.1

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0

Respite care

Help in getting access to services

You don't need any of these support services

Percent


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Chronic Disease Prevalence Does Not Differ by Caregiver StatusSource: 2015 Maryland Behavioral Risk Factor Surveillance System

17.6 22.5 9.7 6.1 6.5 11.6 8.2 37.012.1 18.1 8.3 5.7 6.3 10.6 7.7 31.80.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

Anxiety disorder Depressivedisorder

Asthma (current) COPD Cancer (other thanskin cancer)

Diabetes Cardiovasculardisease

High bloodpressure

Percen

t

Caregivers Non‐caregivers


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Cognitive Decline Prevalence Does Not Differ by Caregiver StatusSource: 2015 Maryland Behavioral Risk Factor Surveillance System

11.9 10.20.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Cognitive decline

Per

cent

Caregivers Non-caregivers


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What We Can See• Caregiving is common across various populations.

• 1 in 4 caregivers are currently living with a disability.

• 1 in 10 caregivers report experiencing cognitive decline.

• 1 in 3 caregivers provide care for a parent, which is significantly higher than any other group.

• 1 in 8 caregivers are providing care for a non-relative or family friend.


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Time Impacts of Caregiving• 1 in 5 caregivers have provided care for less than thirty

days.

• 1 in 4 caregivers have provided care to someone for more than five years.

• 1 in 4 caregivers provide care 20 hours or more per week.

• Almost half of caregivers manage both personal and household tasks.


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Supporting Caregivers• The Maryland Department of Human Resources

(DHR) Respite Care Program

• The National Family Caregiver Support Program

• Alzheimer’s and Dementia Caregiver Center• alz.org/care

• Maryland Caregivers Support Coordinating Council


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Further Resources• BeHealthyMaryland.org is now a one-stop resource for

Marylanders seeking information and support on chronic disease prevention and management. You'll find links to classes and workshops, as well as regularly updated chronic disease news bites.


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Questions?

http://phpa.dhmh.maryland.gov


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Maryland Prevention and Health Promotion

Administration

Cognitive Decline and Caregiving: Update from the 2015 ......2017/06/20 · June 20, 2017 25 Time...

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