Alzheimer's disease and related dementias (ADRD) combine to form an urgent healthcare challenge facing the aging population of 21st Century America. In the U.S. during 2008, one person received an ADRD diagnosis every 71 seconds;by 2050, that number will be one every 33 seconds. Authorities cited in the body of this application report ADRD are the third most costly disease sets in the U.S. In spite of ongoing research efforts, at present there is no way to prevent onset of ADRD, and death is the only certain cure. Caregiving options are complicated because the cognitive and physical declines of those with late-stage ADRD differ for each person, and no single care routine or protocol is predictably effective. Further, the challenges associated with late-stage ADRD care cause immense stress and increased burden to Certified Nursing Assistants (CNAs). Many medical directors and other ADRD facility professionals often lack either the preparation or the time to respond to CNAs'requests for help in managing patient care with those in late-stage ADRDs. Various authorities experienced in ADRD care, however, suggest measurable positive effects result when CNAs receive ongoing education and skill training in this area. This Phase II effort aims therefore to educate CNAs in the knowledge and skills they need to care effectively for those in late-stage ADRD decline and to do so through an innovative, Internet-based training program presenting 10 topical module hours of challenging, informative, application-based curriculum. This product exceeds traditional passive methods of CNA education and in-service training and provides instead multi-media features such as interviews, care models, real-life streaming videos, and online interaction. Through this training program, CNAs gain convenient, 24/7, private access to an entire team of intervention consultants and therapeutic support specialists experienced in managing late-stage ADRD-related care. The dispersed effects of improved CNA practice may also facilitate a multi-level intervention with power to affect in many positive ways the care recipients themselves as well as their loved ones. In addition to its strong commercial potential, the proposed Phase II training product has the capacity to benefit public health in venues as diverse as long-term care facilities, assisted-living facilities, community colleges, military and veterans'hospitals and services, medical offices, healthcare agencies, and both rural and urban healthcare settings. During Phase II, a randomized controlled trial (RCT) will test efficacy of the completed intervention, and commercialization will be undertaken during Phase III. Given the applicant organization's collaboration with the national office of the Alzheimer's Association, one of the parallel benefits of all phases of this effort may well be the reduction of both direct and indirect costs of ADRD to U.S. health care systems.
The proposed effort is relevant to the nation's public health because during 2008, 5.2 million Americans of all ages have Alzheimer's disease and related dementias (ADRD), which translates to one ADRD diagnosis every 71 seconds (Alzheimer's Disease Facts and Figures, 2008, p. 8). The economic cost of ADRD includes $148 billion in direct costs to Medicare and Medicaid (not including the costs paid for by the Department of Veterans'Affairs, private health care, and long-term care insurance), and an estimated $267 billion savings to the national healthcare system because 9.8 million family members deliver at least 70 percent of the care for those with ADRD at home without reimbursement instead of in nursing homes. Further, late-stage ADRD care is strongly associated with psychosocial costs to caregivers, who must respond directly to residents in the cognitive declines characteristic of late-stage dementia (Alzheimer's Disease Facts and Figures, 2008).