Alaska Commission on Aging 2008 Senior Data Presentation

1. Alaska Commission on Aging2008 SeniorData Presentation Presented to the Alaska Mental Health Trust Authority May 29, 2008

2. Our Purpose The mission of the Alaska Commission on Aging is to ensure the dignity and independence of all older Alaskans, and to assist them, through planning, advocacy, education, and inter-agency cooperation, to lead useful and meaningful lives.

3. Alaska Commission on AgingCommission Members • Banarsi Lal, Chair • Sharon Howerton-Clarke, Vice Chair (and FY 2009 Chair-Elect) • Frank Appel, Public Member • Pat Branson, Provider Member • Tara Jollie, Department of Commerce, Community & Economic Development Designee • Betty Keegan, Public Member • Iver Malutin, Public Member • Rod Moline, Director, Senior & Disability Services, DHSS Designee • Paula Pawlowski, Public Member • Ed Zastrow, Chair, Pioneer Home Advisory Board Staff Denise Daniello, Executive Director MaryAnn VandeCastle, Planner II Lesley Bullock, Planner I Sherice Ridges, Administrative Assistant

4. Purpose of Presentation The intent of this presentation is to provide an overview of the status of Alaska seniors living with Alzheimer’s Disease and Related Dementias (ADRD), including their estimated numbers, characteristics, and the types of services available.

5. Alaska Senior Demographics

6. A Growing Population of Seniors • Alaska’s age 60+ population grew by 43% between 2000 and 2007. • Our senior population is growing faster than that of any other state except Nevada. Data Source: Alaska Department of Labor population estimates, 2000-2007

7. Alaska Seniors by Gender and Age GroupData Source: Alaska Department of Labor 2007 population estimates (2008)

8. Seniors represent all regions of the state.Map: Alaska Dept. of Health & Social Services regionsData Source: Alaska Dept. of Labor 2007 population estimates (2008)

9. And they come from all races, though over 75% are white.Data Source: Alaska Dept. of Labor 2006 population estimates (2007)

10. The vast majority of seniors age 65+ are covered by Medicare.Medicare Figures: Centers for Medicare and Medicaid ServicesSenior Population Estimates: Alaska Dept. of Labor, 2001-2005

11. Alzheimer’s Disease and Related Dementias (ADRD)

12. ADRD reflects a number of profound changes in the brain. Source: Alzheimer’s Association 2008

13. Related Disorders Include: • Vascular Dementia • Mixed Dementia (Alzheimer’s Disease & Vascular Dementia) • Parkinson’s Disease-Associated Dementia • Wernicke-Korsakoff • Pick’s Disease • Lewy Body Dementia • Huntington’s Disease (or Creutzfeldt-Jakob Disease)

14. Alzheimer’s is a disease. • It’s not a normal part of the aging process. • Alzheimer’s is the result of a disease process and is fatal. Source: Quadagno 2005

15. Normal Aging: Forgetting to set the alarm clock Forgetting someone’s name and remembering it later Forgetting where you left your keys and finding them after searching Forgetting where you parked your car Possible AD: Forgetting how to set the alarm clock Forgetting a name and never remembering it, even when told Forgetting places where you might find your keys Forgetting how you came to be in a particular location Source: Hooyman & Kiyak 2002 Alzheimer’s Disease Versus Normal Changes in Memory:

16. Stages of Alzheimer’s Disease • Stage 1 – Normal Function No cognitive problems noted by individual or medical provider. • Stage 2 – Very Mild Cognitive Decline Complaints of mild forgetfulness and some work difficulties; difficulty finding the right word • Stage 3 – Mild Cognitive Decline Problems with concentration, some difficulty at work and in traveling alone Source: Alzheimer’s Association 2008

17. Stages of Alzheimer’s Disease • Stage 4 – Mild or Early-Stage Alzheimer’s Disease Late confusion stage; increased denial of symptoms; withdrawal • Stage 5 – Moderate or Mid-Stage Alzheimer’s Disease Poor recall of recent events; needs assistance with dressing and bathing Source: Alzheimer’s Association 2008

18. Stages of Alzheimer’s Disease • Stage 6 – Severe, Mid Stage Alzheimer’s Disease More memory problems; more assistance needed with Activities of Daily Living (ADLs); more personality changes • Stage 7 – Very Severe or Late-Stage Alzheimer’s Disease Loss of language; loss of ability to walk; incontinent; may become comatose Source: Alzheimer’s Association 2008

19. Suggested Practices Caring for Persons with ADRD • Emphasize familiarity and routine to build trust and comfort • Maintain clear, concise, calm communication • Pay attention to nonverbal communication • Limit Distractions • Long term memory last to be impaired • Focus on individual’s abilities, strengths, and preferences. Allow them to continue to do what they can to convey respect and dignity. • Keep tasks simple • Exercise patience and understanding Sources: Hooyman & Kiyak 2002 & Quadagno 2005

20. As of 2007, over 5,000 Alaskans are estimated to have ADRD.Source: ACoA estimate based on national prevalence data

21. Death rates related to Alzheimer’s disease are on the increase in Alaska.Source: Alaska Bureau of Vital Statistics 2005 Annual Report

22. The number of Alaskans with ADRD is projected to nearly quadruple from 2000 to 2030.Sources: Population projections by Institute of Social & Economic Research(2007) and national ADRD prevalence rates by age group

23. Based on the Behavioral Risk Factor Surveillance System (BRFSS) for Alaska: Older Alaskans may be at slightly lower risk for ADRD in light of their lower rates of various cardiovascular risk factors; they also have higher rates of some protective lifestyle factors than older Americans in general.

24. Slightly fewer older Alaskans have had a heart attack.

25. Older Alaskans suffer from a slightly lower rate of coronary heart disease.

26. Slightly fewer older Alaskans have had a stroke.

27. Slightly fewer older Alaskans have high cholesterol.

28. Older Alaskans are significantly more likely to engage in moderate or vigorous physical activity.

29. And older Alaskans are slightly more likely to eat a healthy diet, as measured by the number who eat at least five fruits and vegetables per day.

30. An ACoA survey of the public’s knowledge of ADRD and the lifestyle factors which may prevent it showed that Alaskans are already fairly well-informed.

31. But some survey responses point to the need for further community education.

32. Community-Based Services (appropriate for all seniors, including ADRD stages 1 and 2) Congregate meals Public transportation Information/referral/ personal advocacy Physical fitness programs Health promotion/ disease prevention classes & activities Senior employment services Independent living Senior centers Senior volunteer programs Legal services Health screening Social & recreational activities The Continuum of Long-Term Supports In Alaska

33. Home-Based Services (appropriate for homebound seniors and those needing extra support, including ADRD stages 3, 4, and 5 Home-delivered meals Assisted transportation Shopping assistance Congregate housing Supported housing Home repair and renovation Senior companion volunteers Homemaker/chore service Companion programs The Continuum of Long-Term Care in Alaska

34. Intensive Home- and Community-Based Services (appropriate for those with intensive health needs or ADRD stages 5 and 6, as well as their caregivers) Adult day services In-home respite care Home health care Personal care Hospice care Family caregiver support Outpatient care Rehabilitation Counseling The Continuum of Long-Term Care in Alaska

35. Services in a Residential Care Setting (appropriate for ADRD stages 5, 6 and 7) Assisted living Facility respite care Pioneers’ Home Adult foster care The Continuum of Long-Term Care in Alaska

36. Institutional Services – the most intensive level of care, appropriate for ADRD stages 6 and 7 Acute care Nursing home care Residential hospice care The Continuum of Long-Term Care In Alaska

37. Services for Alaskans with ADRD

38. State Services for ADRD Seniors: • Pioneer Homes • Assisted Living Facilities (Licensed) • Medicaid Waiver Program • Personal Care Assistance (PCA) • Senior Grant Programs

39. More than half the residents of Alaska’s Pioneer Homes are diagnosed with ADRD.Source: Alaska Division of Pioneer Homes

40. Most Pioneer Home residents with ADRD require the highest level of care.

41. Who are the Pioneer Home residents with ADRD? Gender Marital Status 70% Female 50% Widowed 11% Single 30% Male 21% Married 7% Unknown 11% Divorced Race Age 91% White Average age 86 years old 6% Native Average age of admit by year 1% Asian 1998 76 years <1% Black 2003 84 years 2% Unknown 2008 86 years

42. Licensed assisted living beds vary widely by region. Source: Alaska Division of Public Health, Alaska Health Care Data Book: Selected Measures DHSS 2007

43. Projected increases in the cost of nursing home and assisted living care over the next 20+ years are daunting.Source: Genworth Financial 2008 Cost of Care Survey

44. Seniors make up only a small segment of Medicaid beneficiaries in Alaska.Source: Financial and Management Services, Medicaid Budget Group, Alaska DHSSAlaska Health Care Data Book Selected Measures, DHSS 2007

45. Medicaid-eligible individuals who meet level of care requirements may qualify for one of four Medicaid waivers through SDS.Source: Senior & Disabilities ServicesAlaska Health Care Data Book Selected Measures, 2007

46. Older Alaskans waiver recipients are found in every region.Source: Senior & Disabilities Services 2007Alaska Health Care Data Book Selected Measures, DHSS, 2007

47. A substantial number of PCA and Medicaid waiver participants have ADRD; in addition to meeting income requirements, waiver eligibility is based on diagnosis and functional assessment.Source: Senior & Disabilities Services

48. The largest group of PCA and waiver recipients with ADRD are those in their 80s.Source: Senior & Disabilities Services

49. Another much larger group of seniors receives senior grant services, many of which have no income limitations.Source: Senior & Disabilities ServicesAlaska Health Care Data Book Selected Measures, DHSS 2007

50. Grant recipients take advantage of a wide range of Nutrition, Transportation, and Support services although not all are available to completely meet demand in each community.Source: Senior & Disabilities Services