Cognitive impairment in older adults is a major public health concern affecting more than 16 million adults in the United States. Predictions are that nearly one in five people over age 65 will develop dementia at some point in their lifespan, with a doubling prevalence every five years of age. The Centers for Disease Control and Prevention's Healthy Brain Roadmap includes action items focused on better understanding and reporting of the public health burden of cognitive impairment. The CDC Roadmap and the NIH Cognitive and Emotional Health Project each emphasize the importance of maximizing secondary analyses of existing datasets to increase understanding of the impact of cognitive impairment. The DHHS Strategic Framework on Multiple Chronic Conditions notes the importance of moving from a single disease approach to chronic conditions to an approach that appreciates that 25% of Americans, particularly those over age 65, suffer from more than one chronic condition and that two-thirds of health care spending is for the 27% of people with multiple chronic conditions. The majority of persons living with dementia are living with two or more co-occurring chronic conditions. The DHHS Framework echoes the call within the CDC Roadmap and NIH Cognitive and Emotional Health project for increasing use of datasets to understand the epidemiology and impact of chronic conditions. Better understanding of important combinations of chronic conditions combined with definitions of appropriate health outcomes are the first steps in development of public health interventions to improve the health of persons affected by multiple chronic conditions. This proposed project aims to analyze existing information and data: 1) to better understand dementia's co- occurrence with leading ceases of death and how it fits into the DHHS MCC Framework, and 2) to assess what is known about the use of cognitive assessment tools in a healthcare systems to assist in the identification of dementia cases and how this assessment informs chronic disease management efforts. We will conduct two secondary data analyses to address these questions using existing data from the Cardiovascular Health Study and from the Emory Alzheimer's Disease Research Center and Health Care System. The overall goal is to inform public health practice and policy for better serving this population.
Cognitive impairment in older adults is a major public health concern affecting more than 16 million U.S. adults, with nearly one in five people over age 65 predicted to develop dementia at some point in their lifespan. There is increasing need to move from a single disease approach to chronic conditions such as dementia, to an approach that appreciates that 25% of older Americans suffer from more than one chronic condition and that two-thirds of health care spending is for these persons with multiple chronic conditions. This proposed project aims to analyze existing information about 1) dementia mortality and co-occurring chronic conditions and 2) cognitive assessment, dementia diagnosis and co-occurring chronic disease management, towards the goal of better serving this population.