Changing the Course of the Alzheimer’s Epidemic in L.A. County: Early Detection Counts Campaign
Los Angeles County is sorely underprepared for the aging of our region’s population. The number of older adults in this area is growing dramatically and this has ramifications for our health care system, our families, our schools, and our businesses. Never before have so many lived such long lives. Over the past 100 years, our society has addressed many root causes of early mortality – infectious diseases like polio and TB have declined dramatically. More recently, we’ve seen a dramatic fall in mortality rates from chronic health conditions such as diabetes, heart disease, and certain cancers. A diagnosis of cancer of AIDS is no longer a death notice. We’ve learned ways to decrease risk for diabetes and heart disease and to better manage their care. Now we are seeing the rise of the scourge of the 21st Century, and that is Alzheimer’s disease and related dementias.
Currently, in Los Angeles County there are 165,000 people living with Alzheimer’s disease and more with related disorders. By 2050, this number is expected to triple. Our region will have more people living with Alzheimer’s disease than the entire current population of the cities of Sacramento or Long Beach. Due to poorer health care access and rapidly aging populations, the numbers of local Latinos and Asians with cognitive impairment is going to increase even more quickly. Yet, we know that fewer than 25% of people with Alzheimer’s disease or a related dementia ever get a diagnosis and if a disease isn’t recognized, it cannot be treated. These conditions are the silent epidemic of the new century.
If this epidemic is not checked and care is not improved, then:
• Cognitive impairment will complicate the care of all other chronic conditions, putting a tremendous financial burden on hospitals, on public programs like Medicare and MediCal and on families.
• Caregiving families will be forced to make stark sacrifices, financially and emotionally, to care for their loved ones.
• Children in these families will not receive the attention and resources they need to thrive as families dedicate time and money to keep impaired loved ones at home.
• Families will be forced to provide complex care on their own as there will be insufficient health care and community care providers to meet the epidemic level of need.
However, all is not bleak. Due to the Affordable Care Act (ACA) there are opportunities to address this emerging epidemic through our re-organized health care system. This year, for the first time, the federal government has begun to mandate an Annual Wellness Visit for all Americans. A required part of this medical visit will be a screen for cognitive impairment. If implemented successfully, this new benefit will result in the systematic and early identification of people with cognitive impairment. It will also mean that cognitively impaired people will be referred for diagnosis so that reversible forms of dementia can be identified and treated. For those diagnosed with Alzheimer’s disease or a related condition, it will mean that minimally, their other co-existing conditions (like diabetes and heart disease) will be cared for more appropriately, cutting unnecessary patient suffering, family burden, and health care costs. As more effective treatments for Alzheimer’s come to market, earlier detection will mean that these treatments reach patients earlier in the disease, when they can have a more significant effect.
To impact the health of Angelenos in this first half of the 21st Century, the Alzheimer’s Association, California Southland Chapter proposes to leverage the new Annual Wellness Visits mandated through the ACA to reach L.A.’s physicians and other health care providers with information and tools about:
1. How to screen their patients for cognitive impairment;
2. How to manage these conditions both medically and through family support.
Collaborating with local health care provider associations and health care organizations, the Association will disseminate a brief one-page document that can be distributed as a centerfold in medical providers’ newsletters, posted on their websites, or distributed by health insurers. Following up on this written communication, the Alzheimer’s Association will develop a cadre of volunteers to make office calls and visits to reinforce the importance of early detection and emphasize the availability of training and resources to support providers, patients and caregivers.
What are some of your organization’s most important achievements to date?
Founded by concerned family caregivers in 1980 and incorporated in 1981, the Alzheimer’s Association, California Southland Chapter is an independent affiliate of the national voluntary health organization. The Alzheimer's Association, California Southland Chapter is a pioneer in the development of innovative programs and services specific to the needs of a diverse population effected by dementia. Access to care has been a long-term investment of effort by out organization. In 1992, the California Southland Chapter was the lead and originator of the nation’s first program serving Latinos with dementia, El Portal. This program received numerous national awards including the prestigious Robert Wood Johnson Foundation Community Health Leadership Award. El Portal has been replicated in numerous locations throughout the state and beyond. It has also been replicated in African American, Chinese, Vietnamese, Filipino, and Japanese communities. The Chapter’s program for Asian Americans with Alzheimer’s disease and their caregivers was awarded the 2006 Met Life Foundation/National Center for Caregiving award for innovation in education and Alzheimer’s disease and the 2011 Rosalynn and Arthur Gilbert Foundation’s Caregiving Legacy Award.
The challenge of delivering quality health care to people with dementia has also been addressed successfully by this chapter of the Association. These efforts have also led to national recognition. For example, a quality improvement project with Kaiser Permanente was awarded the American Society on Aging’s 2001 Award for Quality and Innovation in Managed Care and Aging. Our consumer activation project, Partnering with Your Doctor, was honored with the Archstone Foundation-American Public Health Association’s 2003 Award for Excellence in Program Innovation and adopted for national replication by the Alzheimer’s Association. It was also adopted in parts of Great Britain. The local chapter of the Alzheimer’s Association has led three statewide efforts to create and disseminate an evidence-based practice guideline that teaches primary care providers about quality post-diagnostic care for people with Alzheimer’s disease. This California Guideline for Alzheimer’s Disease Management became the stimulant for numerous quality improvement projects in health care organizations throughout California including Kaiser Permanente, Scripps Health Care, UC San Diego Health Care and SCAN Health Plan. This chapter also played a leadership role in the development of the State of California’s Alzheimer’s Disease Plan which was released in 2011.
Please identify any partners or collaborators who will work with you on this project.
The Alzheimer’s Association, California Southland Chapter has forged award-winning collaborations with several L.A. health care systems and with organizations that serve families in our ethnically diverse area. For the Early Detection Counts Campaign, the Association will seek to partner with health care organizations like these to increase awareness and provider skills: L.A. County Medical Association, Community Clinics Association of L.A. County, Los Angeles County Osteopathic Medical Association, Angeles Independent Physicians Association, Health Net, Kaiser Permanente, SCAN Health Plan, Care 1st Health Plan, Molina HP, Care 1st, the County hospitals (Olive View, Rancho & County USC) and the California Association of Physician Groups.
Please explain how you will evaluate your project. How will you measure success?
Evaluation of the project will take place on three levels:
1. First there will be a formative evaluation using a virtual focus group of health care providers to provide feedback on the one page document that will be used to educate providers about the Annual Wellness Visit, screening for cognitive impairment, and supports for patients and caregiving families. This portion of the evaluation will be used to develop the final tool for dissemination.
2. Second, there will be a process evaluation to determine whether the numerical goals of the project have been achieved. These include:
a. Partnership with at least 10 health care associations or organizations for dissemination of the early detection tool.
b. Reaching 80% of all health care professionals in the region through a communication campaign conducted through partnerships with health care associations and organizations.
c. Recruitment of a corps 10 of volunteers to call or visit provider offices and reinforce campaign messaging,
3. Third, there will be an evaluation of impact. A cross-section of the health care providers contacted will be surveyed to determine if they feel better equipped to screen patients for cognitive impairment.
How will your project benefit Los Angeles?
Due to health care reform, there is an opportunity now for transformational change in medical care. This change provides a chance to alter the course of the Alzheimer’s epidemic; to change how people with cognitive impairment are viewed and treated; and to change the quality of life of the people who care for them. Intervention now can save our region millions of dollars in unnecessary costs for hospitalizations and nursing home care. It can remove a predictable threat to the solvency of our public health care system.
Changing the course of the epidemic in L.A. County– Currently, the numbers of people with Alzheimer’s disease and related dementias are poised to skyrocket. Among Latinos and Asians, the increases will be most dramatic. Yet, due to nihilism and lack of accurate information, health care providers are not recognizing the disease and do not diagnose or treat the great majority of cases. These individuals are doubly victimized by their conditions. They suffer the relentless loss of their minds, and are frequently misunderstood and mistreated, by their families and by health care providers. This project will dramatically increase the detection of dementing diseases by our region’s health care providers and result in improved treatment and care.
Saving our health care system – Unrecognized cognitive impairment is expensive. It creates barriers to the management of co-morbid health conditions such as diabetes and cardio-vascular disease. It leads to poor management of the needs of the patient. It drives up expenditures for Medicare, MediCal and private insurance. Several research studies have demonstrated that better detection, treatment and care management can lead to lower expenditures for emergency room visits, hospital stays, and doctor visits. Better care and access to community supports may also reduce expensive and unnecessary stays in nursing homes. This level of care can cost $90,000 or more per year and is born by families and the MediCal program. Better managed care will reduce costs to the private and public health care systems resulting in economic benefit to the government, employers and individual households.
Changing the lives of families - Early detection means that families and patients will gain access to better quality health care and supports. L.A.’s caregiving families will suffer less burden and depression. They will be better shielded from financial devastation because recognition of dementing conditions will help with their management and with the management of co-morbid conditions like diabetes and heart disease. Better understanding of cognitive impairment will allow families more opportunity to plan for the future and get appropriate care. This is turn will lead to reduced absenteeism both at work for adults and in school for children in households dealing with the overwhelming burden of caregiving.
What would success look like in the year 2050 regarding your indicator?
As a result of an investment in the Early Detection Counts campaign there will be a change in the course of the Alzheimer’s epidemic in Los Angeles County. Our vision is a community in which:
• Individuals with cognitive impairment will be screened and if appropriate, sent for a diagnostic work-up.
• All diagnosed people with a dementing disease will have access to treatment for the disease and high quality management of co-morbid illnesses.
• People living with dementia and their families will be connected to community services for support, disease education, and care planning to optimize their lives.
• People living with dementia will receive appropriate community-based care and not receive inappropriate institutional care in hospitals or nursing homes.
• MediCal dollars will be preserved rather than squandered inappropriately.