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The Tsunami is About to Hit: Public Health Issues with Dementia

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The Population of NC is Getting Older ... Constant humming, vocalizing, or yelling. Contractures and immobility. Public Health Concerns ... – PowerPoint PPT presentation

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Title: The Tsunami is About to Hit: Public Health Issues with Dementia


1
The Tsunami is About to Hit!Public Health
Issues with Dementia
  • The Numbers are On the Rise!
  • A New Epidemic - Alzheimers
  • Whats New What Should We Do?

2
Why do you care?
  • Dementia impacts health
  • Individual
  • Family and loved ones
  • Dementia impacts economics
  • Your personal money
  • Your agencys budget
  • Our countrys resources

3
North Carolina Aging Demographics
  • Prepared by the UNC Institute on Aging
  • Revised with Census 2000 data

Last revised February 2005
4
The Population of NC is Getting Older
  • Older adults are North Carolina's fastest growing
    segment of the population.
  • Reasons include decreasing birth rates, improved
    life expectancies, and migration.
  • More elders will be women, living alone and
    people with lower educational levels
  • There will be fewer health care providers to help
  • Next slides illustrate the statewide trend

5
65 Population in 1990
Counties with more than 15 of total population
over age 65
Statewide 12
Source of data NC Office of State Demographics,
Census 1990Prepared by the UNC Institute on
Aging Last updated June 2001
6
65 Population in 2000
Counties with more than 15 of total population
over age 65
Statewide 12
Source of data NC Office of State Demographics,
Census 2000Prepared by the UNC Institute on
Aging Last updated June 2001
7
65 Population in 2020
Counties projected to have more than 15 of total
population over age 65
Statewide 17
Source of data NC Office of State Demographics,
projectionPrepared by the UNC Institute on
Aging Last updated June 2001
8
Population Shift in North Carolina
Percent of Population by Age Groups
Source of data US Census Bureau Projections NC
State Demographics UnitPrepared by the UNC
Institute on Aging Last updated 2000
9
Life Expectancies in North Carolina (at birth)
Source of data NC State Demographics Unit
(2002)Prepared by the UNC Institute on Aging
Last updated 2005
10
More Older Women than Older Men
Percent of NC population by Gender and Age (2000)
All Ages
Age 65
Age 85
Male40.1
Male25.9
Male49.0
Female51.0
Female59.9
Female74.1
Source of data U.S. Census Bureau, Census 2000
Summary File 1, P13 and PCT12Prepared by the UNC
Institute on Aging Last updated September 2001
11
Education Levels of Older Adults in NC
Source of data U.S. Census Bureau, Census 2000
Supplementary Survey Table PCT033Prepared by the
UNC Institute on Aging Last updated September
2001
12
Net Migration
13
Health Professionals In Short Supply
Source North Carolina Rural Health Research
Program, Cecil G. Sheps Center for Health
Services Research, University of North Carolina
at Chapel HillLast updated 2005
14
Now
  • Lets Talk About Dementia Statistics

15
How common is Dementia?
  • The risk goes up dramatically with increasing age
  • America is aging
  • Alzheimers may increase by 300 over the next 50
    years without medical advances

16
DEMENTIA
Lewy Body Dementia
  • Alzheimers
  • Disease
  • Early - Young Onset
  • Normal Onset
  • Other Dementias
  • Genetic syndromes
  • Metabolic pxs
  • ETOH related
  • Drugs/toxin exposure
  • White matter diseases
  • Mass effects
  • Depression(?) or Other Mental conditions
  • Infections BBB cross
  • Parkinsons

Fronto- Temporal Lobe Dementias
17
So What is Dementia What is Alzheimers?
18
Just a Quick Reminder
  • North Carolina is in the BUCKLE of the Stroke
    Belt
  • Highest Risk for Vascular Dementia ?
  • Having Had a Stroke or TIA

19
So Why be Concerned?
  • It likes older brains
  • It affects everything about the person
  • It is the 3rd most expensive condition to have
  • Over 70 of care is delivered in the community by
    unpaid caregivers - family
  • There is currently
  • NO prevention
  • NO cure
  • NO way to stop the disease

20
Why Be Concerned?
  • In ten years there has been a 10
  • 1 out 5 families are directly affected
  • It affects caregivers health dramatically!
  • 50 have depression
  • 50 have chronic health problems
  • In 40 of cases we lose the caregiver BEFORE
    the person with dementia
  • Early signs are hard to spot
  • only 20 of dementia is spotted early by MDs

21
There are Mimics of Dementia
  • Depression
  • cant think
  • cant remember
  • not worth it
  • loss of function
  • mood swings
  • personality change
  • change in sleep
  • Delirium
  • swift change
  • hallucinations
  • delusions
  • on off responses
  • infection
  • toxicity
  • dangerous

22
So What Does This really Look Like?
  • Two ways of looking
  • Chemical changes
  • Structural changes

23
PET and Aging
ADEAR, 2003
24
Positron Emission Tomography (PET) Alzheimers
Disease Progression vs. Normal Brains
Early Alzheimers
Late Alzheimers
Child
Normal
G. Small, UCLA School of Medicine.
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30
SO What Does This Mean for Public Health
Providers?
  • The Tsunami is About to Hit!
  • What Are We Doing to Prepare?
  • What Should We Be Doing?

31
1
  • Improve Our Understanding of
  • What is Normal What is NOT!

32
2 Improve Our Understanding of Dementia Brain
Failure
  • memory loss
  • language loss
  • impulse control loss
  • emotional control loss
  • circadian rhythm loss
  • initiation is lost
  • self-care skill loss

33
3
  • Begin Planning
  • How to Help

34
Public Health ConcernsEarly Issues
  • Reduce individual risk
  • Improve early diagnosis
  • Screening with follow up
  • Early Diagnosis
  • Medications Treatment
  • Legal Issues - HC PoA, F PoA, Guardianship
  • Financial Issues fraud, abuse, resources
  • Care Options Funding
  • Family Support Education
  • Staff Support and Education

35
Simple Message
  • If its Good
  • for your HEART
  • its GOOD
  • For your BRAIN!

36
Top Three
  • Exercise MORE
  • Use Your BRAIN
  • Eat RIGHT

37
EXERCISE
  • Get MD OK
  • Do WHAT you like!
  • BUDDY up!
  • AEROBIC
  • A little short of breath
  • 15 - 20 minutes at a time
  • 100 minutes a week
  • 70 of your Max Heart Rate
  • (220 your age Max Heart Rate) x .7

38
Use Your Brain!
  • Solve puzzles
  • Take classes
  • Try something new
  • Play an instrument
  • Join a study group or book club
  • Read
  • Play games

39
Eat Right!
  • MORE Fruits Veggies
  • Less fat and sugar
  • MORE WATER!!!
  • Less coffee, tea soda
  • MORE Omega 3 fats (canola, olive, flaxseed)
  • Less trans-fats (partially hydrogenated)
  • MORE Fresh Food Broiled Meat Whole Grains
  • Less fried food packaged food

40
OTHER Things to DO
  • Eat fish once a week
  • Eat antioxidants (vitamin E)
  • Prunes, plums, walnuts, blueberries, almonds,
    green tea, apricots, sunflower seeds, red wine,
    soybeans
  • Get enough Vitamin C Bs
  • Citrus fruits leafy green vegetables
  • Drink ONE GLASS of alcohol/day
  • Stop smoking
  • Lose weight
  • Socialize
  • De-Stress
  • Get depression treated
  • Take meds CAREFULLY

41
Why Do Early Diagnosis?
  • Failure to ID
  • safety issues
  • family disasters
  • disasters
  • mis-diagnosis
  • untreated problems
  • fear stress
  • panic
  • Early Detection
  • drugs may work better
  • personal planning
  • decision making
  • planning
  • treat the treatable
  • counseling support

42
Middle Disease Symptoms
  • Difficult to help fill the day
  • need some help with personal care
  • cant see the need for help
  • easily frustrated and angered
  • easily distracted yet perseverates
  • makes significant errors, un-noticed
  • language is very impaired
  • frequently lost in time place

43
Public Health ConcernsMid-Disease
  • Elopement wandering (gt 60 will)
  • Refusal of assistance help
  • Social isolation
  • Problems with hygiene health management
  • False reports to police and 911
  • Public behavior problems
  • Caregiver burn out
  • Higher risk of abuse neglect
  • harder to figure out

44
End of Disease Issues
  • Constant walking, rocking, or rolling
  • Weight loss
  • Hand skill loss
  • Decreased alertness arousal
  • Difficulty swallowing eating
  • Constant humming, vocalizing, or yelling
  • Contractures and immobility

45
Public Health ConcernsEnd of Disease
  • High cost for care
  • Fewer locations available
  • Most folks run out of money by now
  • High risk of neglect or mis-handling
  • High risk of doing too much try to fix
  • Lack of caregiver understanding of the end of the
    disease
  • Lack of sustainable resources for care

46
Lets finish by talking about individuals NOT the
Whole Picture
  • So What Should Each of Us Do?

47
So WHAT should we do???
  • Remember who has the healthy brain
  • Use your healthy brain
  • Be willing to change your -
  • approach - words
  • routine - actions
  • habits - plans
  • rules - beliefs
  • arrangements - environment

48
What shouldnt we do???
  • Argue
  • Make up stuff that is NOT true
  • Ignore problem behaviors
  • Try a possible solution only once
  • Give up
  • Let them do whatever they want to
  • Force them to do it

49
Some KEY Helping Behaviors
  • A Positive Physical Approach
  • Strong Desirable Visual Cues
  • Short Effective Verbal Cues
  • Minimal Familiar Tactile Cues
  • Use what you know about the person
  • Change the environment to help

50
What Does This Mean to Public Health Programs???
  • You Tell Me
  • You are the Experts in Public Health
  • I just know Dementia!
  • BUT
  • Maybe we should be working together???

51
So
  • Listen to your mothers!
  • Get enough sleep
  • Go outside and play
  • Eat your veggies
  • Be nice to people and make friends

52
For more information
  • Alzheimers AssociationEastern NC Chapter
  • www.alznc.org
  • (919) 832-3732
  • melanie.bunn_at_yahoo.com
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