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Preparing for a Challenging Future

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Currently, 5.3 million U.S. residents – including one-third of those older than 85 – are living with the disease, according to the Alzheimer’s Association. The number of cases is projected to triple by 2050.

GIVEN THAT ALZHEIMER’S DISEASE RISK INCREASES WITH AGE and there is currently no effective prevention strategy or cure, the unfortunate math points to a steep rise in the number of cases in the United States and other countries where the number of older adults is growing rapidly. Currently, 5.3 million U.S. residents – including one-third of those older than 85 – are living with the disease, according to the Alzheimer’s Association. The number of cases is projected to triple by 2050.

As director of professional training and health care services for the nonprofit support and advocacy organization Alzheimer’s Greater Los Angeles, Jennifer Schlesinger (MPH ’07) is on the front lines of efforts to build the capacity of health care and aging-service providers, as well as family caregivers, to handle the growing caseload. Much of her department’s recent focus has been to work with managed-care health plans. Schlesinger is managing a grant from the federal Administration for Community Living and the California Department of Aging to assist the health plans in developing systems of care that meet the needs of individuals with cognitive impairment, along with their family members. The effort is part of a pilot program within the Cal MediConnect Program, a partnership among California’s Medi-Cal program, the federal Medicare program and health plans to promote coordinated health care delivery to elders with cognitive impairment who are in both programs because of their age and financial status. “Our work has been gaining national recognition, which is both exciting and encouraging,” Schlesinger says.

Among other things, her team is working with the managed care plans and their providers to better detect people experiencing cognitive impairment. “With most diseases people go to the doctor, get a diagnosis and receive treatment, but for Alzheimer’s the narrative is very different,” Schlesinger says. “And for myriad reasons, about half of individuals with the disease are never diagnosed.”

For patients who are found to be impaired, Schlesinger’s group is preparing the health plans to identify family caregivers and make sure they are educated and supported. “Most systems of care don’t identify the people who will be providing the support, let alone assess their needs,” Schlesinger says. “As a result, we see high rates of burnout, fatigue, stress and depression 25among family caregivers who are often unsupported. We encourage providers to educate and engage these caregivers in care coordination processes, and then make sure they are connected to psychosocial and other community-
based resources.”

In the broader sense, Schlesinger says, “Public health professionals in the United States need to begin to take Alzheimer’s and related dementias into account when discussing age-related health care issues. When we are developing programs for the management of chronic diseases in older adults, to be effective we will need to consider that many among the target population will also have cognitive impairment, even if it isn’t diagnosed.”