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.

Public Health Relevance

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.

National Institute of Health (NIH)
National Center for Chronic Disease Prev and Health Promo (NCCDPHP)
Health Promotion and Disease Prevention Research Centers (U48)
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Special Emphasis Panel (ZDP1-EEO (G))
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University of North Carolina Chapel Hill
Family Medicine
Schools of Medicine
Chapel Hill
United States
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Smith, Matthew Lee; Durrett, Nicholas K; Schneider, Ellen C et al. (2018) Examination of sustainability indicators for fall prevention strategies in three states. Eval Program Plann 68:194-201
Birken, Sarah A; Rohweder, Catherine L; Powell, Byron J et al. (2018) T-CaST: an implementation theory comparison and selection tool. Implement Sci 13:143
Escoffery, Cam; Lebow-Skelley, E; Haardoerfer, R et al. (2018) A systematic review of adaptations of evidence-based public health interventions globally. Implement Sci 13:125
Wheeler, Stephanie B; Leeman, Jennifer; Hassmiller Lich, Kristen et al. (2018) Data-Powered Participatory Decision Making: Leveraging Systems Thinking and Simulation to Guide Selection and Implementation of Evidence-Based Colorectal Cancer Screening Interventions. Cancer J 24:136-143
Weiner, Bryan J; Rohweder, Catherine L; Scott, Jennifer E et al. (2017) Using Practice Facilitation to Increase Rates of Colorectal Cancer Screening in Community Health Centers, North Carolina, 2012-2013: Feasibility, Facilitators, and Barriers. Prev Chronic Dis 14:E66
Wheeler, Stephanie B; Davis, Melinda M (2017) ""Taking the Bull by the Horns"": Four Principles to Align Public Health, Primary Care, and Community Efforts to Improve Rural Cancer Control. J Rural Health 33:345-349
Smith, Matthew Lee; Schneider, Ellen C; Byers, Imani N et al. (2017) Reported Systems Changes and Sustainability Perceptions of Three State Departments of Health Implementing Multi-Faceted Evidence-Based Fall Prevention Efforts. Front Public Health 5:120
Leeman, Jennifer; Myers, Allison; Grant, Jennifer C et al. (2017) Implementation strategies to promote community-engaged efforts to counter tobacco marketing at the point of sale. Transl Behav Med 7:405-414
Vaughn, Amber E; Mazzucca, Stephanie; Burney, Regan et al. (2017) Assessment of nutrition and physical activity environments in family child care homes: modification and psychometric testing of the Environment and Policy Assessment and Observation. BMC Public Health 17:680
Wheeler, Stephanie B; Kuo, Tzy-Mey; Meyer, Anne Marie et al. (2017) Multilevel predictors of colorectal cancer testing modality among publicly and privately insured people turning 50. Prev Med Rep 6:9-16

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