Sexism and Racism Around the World

Reducing the Cost and Risk of Dementia

Increased longevity is perhaps one of the greatest success stories of our modern public health system. People around the globe are living longer than ever before thanks to major medical and public health advances and greater access to health care. Sixty-five-year-olds living in developed countries today can expect to live another 19 years on average—that’s age 83 for men and 86 for women. But along with this success comes one of our greatest challenges to healthy longevity. As we age, the risk of neurodegenerative disease increases dramatically. Neurodegenerative diseases are characterized by a progressive deterioration of brain function, with a significant consequent decrease in quality of life for those living with the disease and for their families and loved ones. Alzheimer’s disease is by far the most common type of neurodegenerative disease, affecting millions of people worldwide. Our research determined 7.2 million Americans today live with Alzheimer’s disease or other dementias. Alzheimer’s disease is the most common cause of dementia and accounts for 60 to 80 percent of all cases, which means nearly 5.8 million people are currently living with Alzheimer’s disease in the US. Of those living with Alzheimer’s, 81 percent are age 75 and older. With increased lifespans over the past century, the number of people living with dementia is expected to rise significantly. This research projects that over the next 20 years, the total number of those living with Alzheimer’s disease or other dementias in the US is expected to approximately double from 7.2 million to nearly 13 million, with 8.5 million women and 4.5 million men. The report includes actionable recommendations centered around five primary goals: Goal 1: Promote strategies to maintain and improve brain health for all ages, genders, and across diverse populations Action Item #1: Raise awareness of modifiable risk factors associated with cognitive decline (e.g., hypertension, diabetes, diet, exercise, sleep, obesity, depression, and social engagement) through public awareness campaigns. Action Item #2: Develop tools and resources for physicians and other health professionals to promote healthy brains for patients of all ages before and after symptoms of cognitive impairment present. Action Item #3: Tailor and disseminate culturally sensitive messages with a particular focus on underserved populations, including women and minorities. Action Item #4: Increase community capacity to promote brain health messages and to support interventions at state and local levels. Goal 2: Increase access to cognitive screening and early diagnosis Action Item #5: Identify and address the stigma surrounding dementia and cultural barriers that inhibit screenings and early diagnosis among diverse populations. Action Item #6: Develop a national Medicare dementia prevention and detection strategy to spread awareness of risk reduction strategies, increase regular cognitive assessments, and improve early detection rates. Action Item #7: Optimize cognitive screening tools, referral pathways, and workflows for health-care providers (e.g., cardiologists, OB/ GYNs, and community health workers) making sure to focus on those who serve women and minorities. Action Item #8: Conduct more research on screening and treatment for mild cognitive impairment. Develop an evidence base to demonstrate links between cognitive screenings, early diagnosis, and improved outcomes for people diagnosed with dementia early. Action Item #9: Develop more reliable, affordable, and minimally invasive diagnostic tests to improve rates of early diagnosis and more accurately monitor responses to services, supports, and treatments. Goal 3: Increase opportunities for diverse participation in research and prioritize funding to address health disparities Action Item #10: Ensure that gender- and sex-based differences are integrated into the design, analysis, and reporting of biomedical research and more emphasis is placed on understanding why women are more likely than men to develop dementia. Action Item #11: Increase culturally sensitive recruitment and retention efforts of women, communities of color, and people with IDD in clinical trial research through tailored awareness and engagement strategies. Explore strategies to bring clinical trials into underrepresented communities, including the utilization of mobile technologies. Action Item #12: Build research capacity and a recruitment infrastructure in study sites that are conducting clinical trials on dementia, including workforce development. Action Item #13: Ensure data collection and sharing across subgroups of racial and ethnic minorities, as well as people with IDD, and stratify by gender to promote a more precise understanding of Alzheimer’s pathologies among high-risk populations. Action Item #14: Increase investment in prevention and risk reduction research. Goal 4: Build a dementia-capable workforce across the care continuum Action Item #15: Reauthorize and increase funding for GWEPs to improve health outcomes for older adults by developing a health-care workforce that maximizes patient and family engagement and integrates geriatrics with primary care. Prioritize communities that have growing populations of older Americans and a particular shortage of geriatric specialists. Action Item #16: Spread Age-Friendly Health Systems for older adults with dementia. Action Item #17: Develop and train workers to provide high-quality care to people living with dementia. Action Item #18: Increase the cultural competency of the existing dementia workforce to ensure culturally sensitive care, services, and research opportunities are provided to high-risk populations. Action Item #19: Provide paid and unpaid caregivers with the tools, information resource centers, and training to meet the unique challenges of caring for people living with dementia. Action Item #20: Pilot new payment and delivery models to improve comprehensive, coordinated, and person-centered care for people living with dementia and provide services in the home and out of more costly settings of care, where possible. Goal 5: Establish services and policies that promote supportive communities and workplaces for people with dementia and their caregivers Action Item #21: Reduce the stigma associated with dementia through increased community engagement between people living with dementia and those who are less familiar with the condition. Include people with dementia in discussions about how to improve their lives and increase funding for community-based services to support them. Action Item #22: Educate individuals, family members, and financial services professionals about early warning signs of dementia and implement safeguards to protect against financial exploitation. Action Item #23: Expand DFA’s national network of communities, organizations, and individuals to foster the ability of people living with dementia to remain in communities and engage and thrive in day-to-day living. Action Item #24: Support and promote bipartisan federal and state policy efforts to expand paid family and medical leave for elder care. Action Item #25: Create a National Employer Task Force on Eldercare to explore innovative caregiver support strategies. Encourage employers to provide benefits such as flexible work schedules, respite care, and paid family and medical leave.