Laurel Waller, Executive Director Impact of Alzheimer’s Disease & Cognitive Impairment on Health Outcomes in Acute Care Laurel Waller, Executive Director lwaller@alz.org | 800.272.3900

Our mission To eliminate Alzheimer's disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health. Our vision A world without Alzheimer’s.

Dementia Alzheimer’s Dementia Alzheimer’s disease A set of symptoms Gradual in onset Decline in cognitive ability, judgement, orientation, function at home/work/community Alzheimer’s disease The most common cause of dementia in people over age of 65

Continuum of Alzheimer’s Disease Normal Alzheimer’s disease Adapted from Sperling et al. 2011

Alzheimer’s disease & related dementias are effecting our care systems, whether we know it or not.

Alzheimer’s disease & related dementias are effecting our care systems, whether we have the capacity or not.

Care Partner Health & Well Being at Risk Physical and emotional impact of dementia caregiving is estimated to have resulted in $9.7 billion in health care costs in the U.S.

Dementia Delirium Depression

Detection Diagnosis

Barriers to Diagnosis Misidentification of early stages of dementia as “normal” part of aging Social skills often maintained early in disease Denial by patient and/or family Social stigma associated with diagnosis Lack of definitive screening and diagnostic testing

8 Domains Affected by Alzheimer’s Memory Where am I? Why am I here? What is connected to my arm? Concentration (Attention, Perception, Abstraction) What should I be doing? Who are all these people? Orientation Where am I? Where is my family? Judgement/Problem Solving I don’t need to stay here. Who will feed my cat? Activities of Daily Living I can get up and walk to the bathroom Mood I can’t sleep in a room with a stranger. I am sad, scared and in pain. Spirituality No one here really knows me and what I need to feel in control

Adverse Health Events 3 to 6 times more likely to develop delirium 1.6 to 5 times more likely to fall 5 times more likely to develop new urinary incontinence 6 times more likely to develop fecal incontinence 5 times more likely to develop pressure sores Driver of costs, adverse health events

Adverse Health Events More likely to have untreated pain 2 to 4 times more likely to lose ability to perform ADLs during a hospital stay Significantly less likely to regain preadmission functional abilities 2 to 4 times more likely to be discharged directly to a nursing home 3 to 7 times more likely to be living in a nursing home 3 months after discharge

Communication/Behavior Increased potential for catastrophic reactions New Environment Overwhelmed Fatigue Pain Behaviors are communication signals

Safety Concerns 6/10 people with Alzheimer’s will wander. Dementia Capable environment Preventing Falls Clear Directions

The CARE Act requires hospitals to: Record the name of family caregivers on the medical record of a loved one Inform the family caregiver when their loved one is discharged to the patient's residence Give the family caregiver education and instruction in all after-care tasks described in the discharge plan ADDITIONAL INFORMATION (do not read as part of presentation) West Virginia specific language A hospital shall provide a patient or the patient's legal guardian with an opportunity to designate one lay caregiver following the patient's admission into a hospital.   The hospital shall record the patient's designation of a lay caregiver, the relationship of the lay caregiver to the patient, and the name and contact information of the patient's designated lay caregiver in the patient's medical record. The hospital shall notify the patient's designated lay caregiver of the patient's discharge to the patient's residence as soon as possible As soon as possible and, in any event, upon issuance of a discharge order by the patient's attending physician, the hospital shall consult with the designated lay caregiver along with the patient regarding the lay caregiver's capabilities and limitations and issue a discharge plan that describes a patient's after-care needs at his or her residence. At minimum, a discharge plan shall include: (1) The name and contact information of the lay caregiver designated under this article; (2) A description of all after-care tasks necessary to maintain the patient's ability to reside at home, taking into account the capabilities and limitations of the lay caregiver; and (3) Contact information for any health care, community resources and long-term services and supports necessary to successfully carry out the patient's discharge plan. The hospital issuing the discharge plan shall provide the lay caregiver with instruction in all after-care tasks described in the discharge plan. At minimum, the instruction shall include: (1) Education and instruction of the lay caregiver by a hospital employee or individual with whom the hospital has a contractual relationship authorized to perform the after care task (2) An opportunity for the lay caregiver and patient to ask questions about the after-care tasks; and (3) Answers to the lay caregiver's and patient's questions provided in a competent manner and in accordance with the hospital's requirements to provide language access services under state and federal law.

Resources Improving Hospital Care for Persons with Demetnia, Nina M. Silverstein & Katie Maslow The Alzheimer’s Health Care Handbook, Mary S. Mittleman, Dr. PH & Cynthia Ep Alzheimer’s Association Facts & Figures Alz.org/Health-Care-Professionals

Care & Support 24/7 Helpline, 800.272.3900 Care Consultations Support Groups Lending Library Community Education Educational Outreach Professional Training

How You Can Help Host a community workshop Join advocacy efforts HOPE for Alzheimer’s Act Free educational materials for staff & patients Alz.org/TrialMatch

Facebook.com/AlzheimersAssociationWVChapter Twitter.com/FightAlzWV Laurel Waller, Executive Director lwaller@alz.org | 304.343.2717