Preliminary Needs Assessment
Assignment #1 (Preliminary Needs Assessment)
#31: Older Adults
HEALTH BEHAVIOR CHANGE FOCUS: Mental Health: Dementias, Including Alzheimer's disease
Austen Brianna Graham West
Panther ID: 6080915
Assignment Number One
Introduction and Objectives
Objective: Increase the proportion of adults aged 65 years and older with diagnosed Alzheimer’s disease and other dementias, or their caregiver, who are aware of the diagnosis
The number of people age 65 and older in the United States group accounted for 14.9 percent of the total population (USCB, 2017). One quarter of these elderly Americans live in one of three states: California, Florida, and New York with Florida having the highest percentage of senior citizens (WorldAtlas.com, 2018). Dementia and Alzheimer’s disease commonly associated with the aging population is one of the most feared diseases of the older people. This disease is an irreversible and progressive brain disorder that essentially destroys the thinking skills, personality and robs the affected patient of his/her personality and independence. While it is certainly not a normal part of the aging process, it is more common as people get older (Bennett, 2007). Among persons 71 and older, roughly 14% of the population suffers from dementia (Bennett, 2007).
Will this become more of a problem in the future? Yes, since this is mainly a disease associated with age, some exceptions will apply, the fact that the “older” population (those aged 65 years or older) in the USA is expected to double from approximately 35 million today to more than 70 million by 2030, makes the need for education and mindfulness a very acute community health need (Blassman et al, 2007). Nothing will ever stop the aging process, except of course dying, so treating the possible underlying catalysts to the disease, such as depression is very important since Alzheimer’s is not a curable disease.
In a 2010 study in the journal ” Neurology”, Dr. Jane Saczynski of the University of Massachusetts found that depression at a younger age is a significant risk factor for dementia. In fact, the conclusions of this study were “Depression is associated with an increased risk of dementia and AD in older men and women over 17 years of follow-up.” (Scazynski, 2010). What can you do to prevent Alzheimer’s disease? Knowledge is key and providing the ability for the affected population to read the latest evidence for promising prevention strategies, increase physical activity, practice blood pressure control, and engage in other methods of cognitive training will contribute to better mental health overall the ability to develop a “cognitive reserve” to deal with the scourge that is Alzheimer’s and dementia.
Awareness and education are two components of this program. Roughly only 34.8 percent of adults aged 65 or over with a dementia diagnosis, or their caregiver, were aware of the dementia diagnosis in 2007–09. The target is 38.3 percent, and while this might not seem significant, due to other environmental factors it would be tremendous.
Definition and Need
A needs assessment is a process used to determine priorities, make organizational improvements, or allocate resources. It involves determining the needs, or gaps, between where the organization envisions itself in the future and the organization's current state.
This need assessment will encompass the following design:
The program will serve as a community outreach that will build upon the identification, mental health focus community awareness and education design programs, while taking into consideration the fact that older age often involves a level of isolation and an increasing occurrence of a sedentary lifestyle. A study examining the connection between loneliness and risk of developing AD revealed that lonely persons had higher risk of AD compared with persons who were not lonely (Hsiao YH, 2018). The program is shown on a continuum since neither aging nor dementia/Alzheimer is likely to be curable, at least in the foreseeable future for the latter.
Target Population
This health initiative will focus on health promotion, wellness and education with an emphasis on networking and community involvement. Further definition of the groups:
a. The target population is age 65+: Increasing age is most identifiable in cases of dementia, after the age of 65, the prevalence and the incidences of dementia double approximately every 5–6 years (Winblad et al, 2016). The use of area surveys as well as census reports will identify this group although the census is performed every 10 years and some of these people have expired or died.
b. Awareness of other Mental Health Problems associated with Dementia: Occasionally, Alzheimer’s and other dementias occur combined with other diseases such as with other mental problems such as depression, personality disorders, and psychotic conditions these problems might in up to 50% of older adults with Alzheimer’s disease (Friedman, 2009).
c. Design of Community Awareness and education: Inherent in this parcel public outreach and education would be information about health care providers, long-term care, home- and community-based services, insurance coverage, financial assistance and planning, legal protections, family communication, caregiving, roles and tasks, caregiver coping, respite, day-to-day symptom management, and self-care (NCIOM,2017).
d. Programs to address the Isolation and Inactivity: Loneliness is correlated with the development of dementia later in life but is not a top cause of this malady (Wilson, 2007). People with dementia can face significant barriers to engaging in the social life of their area. Many find their local communities don’t offer support or understanding for their condition, and so give up things they love to do out of anxiety or fear. In addition, in many cases the elder person has outlived their family members or friends thus rendering them “elder orphans” – people without a natural family, children or friends. This promotes lack confidence or the elder will feel have nothing to contribute leading to depression and other forms of mental health maladies.
e. Services must be continually evaluated for effectiveness. The development of patient-centered measures ensures quality health care as well as cost controls and the identification of clinical quality improvements (Borson, 2014).
HEALTH RISKS AND HEALTH CONDITIONS and DISEASES
Concomitant Medical Outcomes of Alzheimer’s and Dementia
If a suitable initiative is not achieved the according to Alzheimer’s.net (2019), the following will be a probable outcome for the affected population:
Alzheimer’s disease presents itself differently in individuals. No two people will have the same symptoms of this disease. There are, however, two health conditions that most patients share - difficulty swallowing and incontinence. Alzheimer’s cannot be prevented; however, the goal of any study should be to promote incorporating certain lifestyle habits into the patient’s routine: Eating a low-fat diet, including cold-water fish (tuna, salmon and mackerel) that are rich in omega-3 fatty acids; Increasing intake of antioxidants by consuming plenty of dark-colored fruits and vegetables; Maintaining a healthy blood pressure; Staying mentally and socially active throughout life (Kamarow, 2019).
To distinguish: Dementia and Alzheimer disease and other dementias, presents a major public health challenge in the United States. Dementia is characterized by memory impairment and cognitive decline. Alzheimer disease is the most common cause of dementia. Other dementias, including Lewy body dementia, frontotemporal degeneration, vascular dementia, and mixed dementias, are often indistinguishable from Alzheimer disease in their symptoms and outcomes and may coexist with Alzheimer disease (Kramarow, 2019).
In addition to AD (Alzheimer’s Disease) , this needs assessment in referring to “dementia” will include frontotemporal dementia (FTD), Lewy body dementia (LBD), vascular contributions to cognitive impairment and dementia (VCID), and mixed dementias -- especially AD mixed with cerebrovascular disease or Lewy bodies. It is often difficult for the medical professional and others to distinguish between AD and ADRDs in terms of clinical presentation and diagnosis. Some of the basic degeneration of the brain is quite similar in nature. People with these forms of dementia and their families and caregivers face similar challenges in finding appropriate and necessary medical care and community-based services. As such, many of the actions described in this plan are designed to address these conditions collectively (Galasko, 1994).
Incidence and Prevalence Rates of the Health Risks
Almost universally, the first symptom that people become aware of is memory impairment, however, other factors such as poor attention to detail, visual or motor disturbances, sleep disorders and the inability to complete tasks are often overlooked but are symptoms as well (Department of Health and Human Services, 2019). Although irreversible, 90 percent of all Dementia, Alzheimer’s and other dementias do not present themselves until after the age of 60. The causes can be attributed to environmental, lifestyle/socio-economic factors and genetic factors (Department of Health and Human Services, 2019).
AD and other dementias resulting from genetic factors are not preventable, however, it must be noted that a recent study published in Alzheimer’s and Dementia, The Journal of the Alzheimer’s Association, concluded that you can reduce the risk of cognitive decline and dementia by making positive lifestyle changes. Challenging your mind has long and short-term benefits through staying active in classes either formal or informal, puzzles and games; avoiding brain injury; diet; sleep; cardiovascular health; remaining socially engaged and treating depression are all factors that contribute to positive changes and reduction of risk involving Alzheimer’s and dementia (Alheimers.net, 2019).
Another risk not often thought of is the incidence of something called “skinny fat”. People who are “skinny fat” have a normal body weight but a higher percentage of body fat. Sarcopenia obesity, aka “skinny fat” , increases the risk of dementia (Alzheimers.net,2019) . A slim body doesn’t offer a free pass from chronic conditions, and growing evidence suggests being so-called skinny fat could be just as damaging as being obese.
Disparities in the population demographics:
a. People residing in metropolitan areas have a better awareness and therefore treatment options than people in rural areas.
b. Although more women than men have Alzheimer’s or other dementias, almost two-thirds of Americans with Alzheimer’s are women, the reality is that of the people over the age of 65 there are more women than men. Adjusting for this fact, however, it appears that this disease occurs in 16 percent of older women compared to 11 percent of men (alz.org, 2018).
c. Numbers aside, older African Americans and Hispanics are more likely, on a per-capita basis, than older whites to have Alzheimer’s or dementia (Dilworth-Anderson, 2008).
d. One benefit of education and study is the fact that several studies indicate that the age-specific risk of Alzheimer’s and other dementias in the United States and other higher-income Western countries may have declined with increasing education, lifelong education and improved heart health (Shrivers, 2012).
The “Do-Nothing” Alternative
What is the risk that is associated with not performing your chosen health behavior?
Alzheimer’s and associated dementias are incurable as well as irreversible. There are several drugs on the market that promise to slow the development , however, only time will tell with this disease as most dementias are begin gradually and then over time get exponentially worse. As with most chronic and progressive diseases, the presence of early detection and treatment become tantamount to the quality of life attainable by the patient. Several doctors have indicated that although the detection and treatment might differ regarding educational attainment, the more educated patient will adapt to his/her situation in different ways. The person with a greater level of education will make notes, excuses and adapt by assuming that they are just “forgetful” or “stressed”. In other words, they will make notes and concessions for the malady rather than assuming or succumbing to it. Having more years of formal education might delay the effects memory loss linked to Alzheimer’s disease, but after the conditions presents itself, the well-educated patient will decline at a faster rate (Dunham, 2007).
The level of “cognitive reserve” accounts for individual differences in susceptibility of dementia and Alzheimer’s in. People with a higher amount of education, wealth, and correspondingly services are more tolerant of cognitive changes than those with limited education and resources (Yaakov,2012). People with bigger heads also have a lower incident of Alzheimer’s and dementia because the bigger brain can simply tolerate more disease or injury before it begins to deteriorate (Katzman, 1988). At this point I am glad that I have a big head.
However, in the absence of a large cranium or higher education and given the reality that Alzheimer’s and other dementias are neither curable nor reversible, it is imperative that we give the brain a chance brain to both actively and perhaps passively cope with the changes that inevitably come with the onslaught of this disease. Dementia and Alzheimer’s disease are terminal. Eventually the body will shut down and people die from complications from the illness, such as infections or blood clots. It must be emphasized, however, that with increased health resources and medical technology there will be an exponential increase in cases of dementia as people approach the possibility of living to the age 100. This proposal of a program of health promotion, wellness and education with an emphasis on networking and community involvement will accomplish that end while enhancing the quality of life of those affected by Alzheimer’s and dementia.
Resources:
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Figure 2f from: Irimia R, Gottschling M (2016) Taxonomic revision of Rochefortia Sw. (Ehretiaceae, Boraginales). Biodiversity Data Journal 4: E7720. https://doi.org/10.3897/BDJ.4.e7720. (n.d.). doi:10.3897/bdj.4.e7720.figure2f
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Urinary tract infections
Dehydration and malnutrition
Depression
Immobility
Fall-related injuries
Pneumonia
Identifying the Population 65+
Focus on the Mental Health of Said Individuals
Design Community Awareness and Education
Address Issues of Isolation and Inactivity
Provide Services and Evaluation thereof