Expanding Evidence-Based Care for Dementia

Alzheimer's Association Creates Training, Certification Program

The Alzheimer's Association recently launched a new training program with certification exam to advance the deployment of evidence-based dementia care.

Targeted to care professionals in both long-term and community-based settings, Person-Centered Dementia Care Training Program with essentiALZ Exam^®, is based on the nationally recognized Dementia Care Practice Recommendations, which were updated in 2018.

Scope of Alzheimer's

"Today in the United States, there are more than six million age 65 and older living with Alzheimer's dementia," said Monica Moreno, senior director of Care and Support for the Alzheimer's Association. "So many of the general population believe developing Alzheimer's is a normal part of aging, but we know that's not the case."

While age is the greatest risk factor, most seniors do not develop Alzheimer's while approximately 200,000 Americans under age 65 do. Gender and ethnicity also play a role in developing the progressive disease (see Facts & Figures box).

Monica Moreno

Moreno added it's important for people know and understand the warning signs and to eliminate other health concerns. "You want to make sure your symptoms are getting addressed appropriately," she said. Moreno pointed to urinary tract infections and thyroid disease as two potential issues that could cause symptoms that mimic some dementia behaviors.

Person-Centered Care

"Alzheimer's disease affects every person differently. That's what makes it really challenging for caregivers," noted Moreno.

She added the new program is designed to educate caregivers on evidence-based best practices around assessment, detection and care planning including medical management, dementia-related behaviors, activities of daily living, supportive environments, transition and coordination of services and other recommendations.

"All of that information can prepare and empower caregivers to be better prepared for the future," pointed out Moreno. "They're actually being proactive instead of reactive."

While many individuals with Alzheimer's still live in the community, care needs do increase as the disease progresses. "Statistically, about 48 percent of nursing home residents have some form of dementia, and about 42 percent residing in assisted living have Alzheimer's or another form of dementia," said Moreno.

It's particularly important in long-term care settings where those providing care aren't intimately familiar with someone's history to make an effort to learn about the person as an individual. "The practice recommendations are grounded in person-centered care," Moreno stated. "The diagnosis is only part of who they are ... it's not who they are."

Personal preferences and life experiences should shape approaches. Moreno cited an example of a resident who unlaced her shoes and tied the closet door shut each day. If caregivers touched her closet, she became extremely agitated. As it turns out, the woman had been forced to flee with the clothes on her back earlier in life. That experience impacted how she felt about her possessions.

"She didn't want them to even take clothes to the laundry, but it would not be serving her to allow her to wear soiled clothes," Moreno recalled. "So, they devised a strategy to get her clothes while she was in an activity and get the clean clothes back before she even knew they were gone."

A simple accommodation, it made a big difference in the woman's quality of life.

Creating the Program

"The training is reflective of the practice recommendations. While these recommendations were peer reviewed and evidence based, which was critically important, it wouldn't move the needle if they just sat on a shelf," Moreno said of the impetus to disseminate the information. "There's really a larger footprint we're trying to create."

The goal, she continued, was to access professionals across the full array of care settings - nursing homes, assisted living, home care, home health, adult daycare and hospice. At the end of 2020, the Alzheimer's Association debuted the new online training, which has six modules and is self-paced.

Once completed, the essentiALZ Exam^® tests the individual's knowledge with a 45-question exam. Moreno said a score of 90 percent or higher results in a two-year certification.

Individuals who wish to become certified can access the program and exam for less than $60. There are also packages for providers committed to training staff. And, Moreno continued, the association has a curriculum review program that compares an organization's training program to the practice recommendations with feedback on how to address gaps in care. "It's another channel to make sure direct care works have access to content that is reflective of these evidence-based practices," she concluded.

The Latest Facts & Figures

Alzheimer's Disease Facts and Figures, an annual report released by the Alzheimer's Association, reveals the burden of Alzheimer's and dementia on individuals, caregivers, government and the nation's healthcare system. The 2021 publication reports:

Prevalence: An estimated 6.2 million Americans age 65 and older (11.3 percent, or 1:9) are living with Alzheimer's today. That number is projected to hit 12.7 million by 2050.
Risk: Women and people of color are disproportionately affected. Almost two-thirds of Americans with Alzheimer's are women. Older Black Americans are about twice as likely and older Hispanic Americans about 1.5 times as likely to have Alzheimer's or other dementias as older White Americans.
Disparities: Despite increased risk for Alzheimer's and other dementias, Black and Hispanic Americans are less likely to be diagnosed than White Americans. Half or more dementia caregivers - 63 percent of Native Americans, 61 percent of Black Americans, 56 percent of Hispanic Americans and 47 percent of Asian Americans - said they have faced discrimination while trying to navigate healthcare settings for their care recipient. People of color want healthcare providers who understand their unique experiences and backgrounds by fewer than 3 in 5 believe they have access to culturally competent providers.
Mortality: One in three seniors dies with Alzheimer's or another dementia. Between 2000 and 2019, deaths from heart disease decreased 7.3 percent. Deaths from Alzheimer's have increased 145 percent. On top of that, just during the COVID-19 pandemic, Alzheimer's and dementia deaths have increased 16 percent in the U.S.
Cost: In 2021, Alzheimer's and other dementias are projected to cost the nation $355 billion, including a combined $239 billion in Medicare and Medicaid payments. Without a treatment to slow, stop or prevent the disease, the figure is projected to rise to more than $1.1 trillion by 2050.
Caregivers: More than 11 million Americans provide unpaid care for people with Alzheimer's and other dementias. In fact, 83 percent of the help provided to older adults in the U.S. comes from family members, friends or other unpaid caregivers with nearly half of that group providing help to someone to someone living with Alzheimer's or another dementia. Last year, those caregivers provided an estimated 15.3 billion hours of uncompensated care valued at nearly $257 billion.