Many older adults with Alzheimer s disease and related dementias (ADRD) also have one or more other serious chronic illness, such as heart disease or stroke. The management of these patients is complex, with high risk of adverse outcomes. Moreover, as many as half of persons with ADRD remain undiagnosed, presenting significant challenges to the provision of comprehensive, person-centered care. In light of this, and in line with priorities set forth by the National Plan to Address Alzheimer s disease (NAPA) and The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships (HBI), we propose to work with a panel of experts in public health, chronic disease, primary care, dementia and family support to: (a) focus on the interaction between dementia and four leading causes of death (heart disease, cancer, chronic lower respiratory disease, cerebrovascular disease) and three common and treatable chronic conditions (diabetes, hypertension, depression);(b) review the literature and conduct two focused analyses of existing data;and (c) meet regularly with our expert panel to synthesize findings into Key Recommendations. Our focused literature reviews will be guided by the four goals of the Health and Human Services Strategic framework for Multiple Chronic Conditions (MCC Framework): (i) facilitating research to fill in knowledge gaps;(ii) providing tools to MCC care providers;(iii) maximizing self-care management;and (iv) fostering health care and public health system change. These reviews will provide background on the current state of evidence and inform advisory panel recommendations regarding: the prevalence of dementia with co-occurring conditions, the impact of dementia on chronic care outcomes, the screening and dementia detection strategies most practical for settings with other chronic illness, and effective chronic disease self-management strategies for persons with ADRD. To complement this work and provide a real-world perspective, we will conduct analyses of two existing sources of data. We will examine the prevalence of comorbidities in over 1,000 persons with a dementia diagnosis, using data from the University of North Carolina Health System s Clinical and Translational Science Award (CTSA) Carolina Data Warehouse. Secondly, we will examine interview data from an ongoing study of 120 persons with dementia/caregiver dyads to determine the incidence of chronic illness symptoms and conduct an in-depth analysis of the challenges in self-management of chronic illnesses in persons with ADRD. Working with the expert panel, we will summarize findings and develop Key Recommendations that will identify best-practices and prioritize future research efforts to improve care for persons with dementia and co- occurring disease. These findings will be shared with patients and families, care professionals, researchers and policy makers to increase awareness and promote innovative, integrated approaches to dementia and chronic disease care.
Dementia complicated by co-existing chronic conditions is a significant public health issue with implications for both patients and their families as well as te health care system. Guided by the US Department of Health and Human Services Strategic Framework for Multiple Chronic Conditions, findings from this study will clarify dementia s impact on chronic illness management, highlight specific strategies and interventions that hold the most promise for improving care outcomes and guide future research and policy priorities.
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