As nation ages, cognitive decline growing as public health issue: Programs work to keep seniors healthy
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* Natalie McGill

It can start with forgetting things such as names and addresses or with trouble concentrating. It can affect decision-making and rob independence.

The “it” is cognitive impairment. And because a growing U.S. senior population means more cases of cognitive decline down the road, it signals an even greater task for health workers who must intervene through prevention, treatment and research to keep senior brains healthy.

One in eight adults ages 60 and older in the past year dealt with memory loss and confusion that became worse after a year, according to the “The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2013–2018,” a 2013 report from the Centers for Disease Control and Prevention and the Alzheimer’s Association. Only 19.3 percent of those adults told a health care provider about those issues, the report said. More than 5 million Americans in 2015 are estimated to have Alzheimer’s disease, a specific type of dementia, according to the Alzheimer’s Association.

![Figure1](http://www.thenationshealth.org/https://www.thenationshealth.org/content/nathealth/45/8/1.1/F1.medium.gif)

[Figure1](http://www.thenationshealth.org/content/45/8/1.1/F1)

Seniors stretch at an exercise class at a medical center in Miami in 2007. Exercise and healthy eating can play roles in slowing the process of age-related cognitive decline.

Photo by Joe Raedle, courtesy Getty Images

Statistics such as those are why the U.S. Department of Health and Human Services set targets for health workers to reach in addressing cognitive decline and related issues in the U.S. senior population. Healthy People 2020, a series of health and wellness goals for Americans to reach by 2020, includes a number of objectives when it comes to senior cognitive health, including:

*   increasing physical activity among people with reduced physical or cognitive function;

*   reducing the number of preventable hospitalizations linked to Alzheimer’s disease and other dementias; and

*   increasing the number of diagnoses of Alzheimer’s disease and other dementias, as well as increasing caregiver awareness of diagnoses.

“Our goal is to intervene as early as possible,” said Richard Isaacson, MD, director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College-New York-Presbyterian Hospital. “From a public health perspective, Alzheimer’s is not just a public health urgency but a public health emergency, considering the adverse patient outcomes coupled with the tremendous associated costs.”

The clinic works with people with age-related cognitive decline, people with dementias, including Alzheimer’s, and entire families to provide family-based education, Isaacson said. The work involves cognitive testing, blood work and identifying risk factors they can modify to improve cognitive health.

The prevention clinic’s clinical program focuses on clinical precision medicine — a targeted approach to health that factors in family history of Alzheimer’s, genetics, lifestyle and comprehensive lab results to address health issues that could lead to or worsen cognitive decline.

“If someone has prediabetes and their primary care doctor says, ‘Well it’s just prediabetes, eat better,’ not on my watch would I tell someone to just eat better,” Isaacson told *The Nation’s Health.* “I will tell them, ‘Well you have prediabetes because you’re insulin resistant. You’re insulin resistant because your percent body fat is elevated.’ So I’m going to take a very targeted and specific approach toward the person and their potential pathology.”

Isaacson and researchers also launched Alzheimer’s Universe, an online Alzheimer’s disease course. Thousands of people from more than 30 countries have accessed [www.alzu.org](http://www.alzu.org) for information on Alzheimer’s disease prevention and recommendations on how to make lifestyle choices that will improve brain health, he said. Work is underway to provide website resources in English and Spanish for underserved populations and racial and ethnic minorities.

Healthy lifestyle behaviors, such as getting more physical activity, have always been on the radar for health workers, said Dan Blazer, MD, PhD, MPH, chair of the committee that authored “Cognitive Aging: Progress in Understanding and Opportunities for Action,” an April 2014 report from National Academy of Medicine, which was then known as the Institute of Medicine. Maintaining a healthy lifestyle through exercise and eating healthy can play a role in slowing the process of age-related cognitive decline and Alzheimer’s disease, according to the National Institute on Aging.

Blazer said health workers are aware of the importance of physical activity and exercise for seniors. Less than 20 percent of seniors get enough physical activity, according to Healthy People 2020. However, there is a gap between making recommendations for seniors and acting on that advice, he said.

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[Figure2](http://www.thenationshealth.org/content/45/8/1.1/F2)

Seniors participate in a Zumba class in July 2011 at the 8th Annual Healthy Living Festival in Oakland, California. Such exercise can be beneficial for cognitive health in seniors.

Photo by Justin Sullivan, courtesy Getty Images

“They may think it means to go out and walk three miles, but you might say, ‘Why don’t you walk around the block three times a day?’” Blazer, a professor of psychiatry and behavioral sciences at Duke University School of Medicine, told *The Nation’s Health.* “Work with the older person so they can incorporate the habits.”

Blazer said a solution may be to structure physical activity in a different way, such as enrolling seniors in group exercises. Researchers at the University of Pennsylvania are working with a local west Philadelphia church to create a Dance for Health initiative to target seniors for group dances such as line dancing, said Jason Karlawish, MD, a researcher at Penn’s CDC-funded Healthy Brain Research Center. The initiative was originally targeted at youth to reduce obesity, he said.

“What we found is that many of the young people were coming with parents or grandparents, and we discovered that’s an opportunity to get older adults dancing, too,” Karlawish told *The Nation’s Health.* “Certainly, physical activity is related to weight management, but it’s also related to brain health. The researchers at Penn have developed ways using line-and related dance activities to engage groups in physically and socially engaging activities.”

To increase the number of Alzheimer’s diagnoses, Karlawish said his fellow researchers and clinicians at the Penn Memory Center, a National Institute on Aging-Alzheimer’s Disease Center, are also working on a CDC-funded project to develop messages that target adult children of senior parents.

“It’s designed to get an adult child who has concerns about their parent’s memory to bring their parent to a memory center,” Karlawish said.

Having dedicated family members such as adult children or friends as caregivers is also key to reducing hospitalizations as well as evidence-based programs such as an Administration on Aging falls prevention program that addresses the risk of traumatic brain injury, said Jane Tilly, DrPH, subject matter expert for brain health and dementia at the Administration on Aging, which is part of the Administration for Community Living.

“We also have a chronic disease self-management education program designed to help people with diabetes, arthritis and other chronic conditions to learn techniques to promote their own health,” Tilly told *The Nation’s Health.* “Those programs by association can help promote brain health.”

The Administration for Community Living also promotes development of dementia-capable communities. The agency conducts public awareness campaigns and works with federal partners, states and local organizations to increase access to services and supports for both people with dementia and their caregivers, Tilly said. The agency also supports other federal agencies that provide training for dementia care training for health workers.

Dementia-friendly communities include businesses, agencies and emergency health services that are knowledgeable about dementia and adapt their services to fill the needs of families caring for people with cognitive decline. Minnesota’s Act on Alzheimer’s initiative has built a network of more than 30 dementia-friendly communities. The communities had members who formed action teams to address gaps in dementia-related care and education and set goals and plans for how local businesses, health agencies and more will fill those gaps.

An action team in St. Louis Park, Minnesota, for example, held a free screening of “Still Alice” a 2014 feature film based on the 2007 book of the same name about a college professor who is diagnosed with Alzheimer’s disease. The team also provided copies of the book to local book clubs and provided bookmarks that detailed the warning signs of Alzheimer’s disease and how the public can help caregivers of people with dementia.

“About 70 percent of people with dementia live in the community with the support of family and friends,” Tilly said. “A dementia-capable system can identify people with dementia and tailor the services and supports it provides to meet the needs and desires of people with dementias. A dementia-capable system will also support caregivers of people with dementia, who tend to be much more stressed than caregivers in general.”

For more information, visit [www.healthypeople.gov/2020/topics-objectives/topic/older-adults](http://www.healthypeople.gov/2020/topics-objectives/topic/older-adults).

*   Copyright The Nation’s Health, American Public Health Association