A Public Health Approach To Alzheimer’s And Other Dementias

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A PUBLIC HEALTH APPROACHTO ALZHEIMER’S AND OTHER DEMENTIASMODULE 3:ALZHEIMER’S DISEASE– WHAT IS THE ROLE OFPUBLIC HEALTH?1

Table of ContentsAbout Module 3 .3Learning Objectives .3Competencies .4Layout of Module 3 Faculty Guide . .5How to Use the Materials 5Student Engagement Options .6Discussion Questions .6Learning Activities .6Additional Reading 7Slide Guide .8PowerPoint Slides .56Sample Test Questions . 76Selected Case Studies-Module 3 .77Alzheimer’s Disease Video Resources .902

ABOUT MODULE 3This module is part of the Alzheimer’s Association curriculum, A Public Health Approachto Alzheimer’s and Other Dementias. Developed as part of a cooperative agreementwith CDC’s Healthy Aging Program, and in partnership with Emory University’s RollinsSchool of Public Health, this curriculum addresses cognitive health, cognitiveimpairment, and Alzheimer’s disease and is for use by undergraduate faculty in schoolsand programs of public health.Module 3: Alzheimer’s Disease – What is the Role of Public Health? briefly describesthe Alzheimer’s disease epidemic in the U.S., followed by a discussion of three tools ofpublic health that may play significant roles in mitigating the Alzheimer’s disease crisis.The three public health intervention tools discussed are:1. Surveillance/monitoring2. Primary prevention3. Early detection and diagnosisEach tool is described and applied to the context of a public health response toAlzheimer’s disease and dementia. Progress to date and challenges associated witheach tool are addressed.LEARNING OBJECTIVESAt the end of Module 3: Alzheimer’s Disease – What is the Role of Public Health?students will be able to: List three key tools public health can apply to the Alzheimer’s epidemic. Describe surveillance/monitoring and how public health practitioners canapply it in response to Alzheimer’s disease. Name the two Behavioral Risk Factor Surveillance System (BRFSS) modulesthat pertain to cognitive decline and caregiving. Describe primary prevention and how public health practitioners may apply itin response to Alzheimer’s disease. Explain why it is important to promote early detection of Alzheimer’sdisease.3

Module 3: Alzheimer’s Disease- What is the Role of Public Health?COMPETENCIESModule 3 promotes basic learning that supports the development of certaincompetencies:Association for Gerontology in Higher Education (AGHE): 1.2.4 Recognize common late-life syndromes and diseases and their related biopsycho-social risk and protective factors.Association of Schools and Programs of Public Health (ASPPH): Domain 2: Describe how the methods of epidemiology and surveillance are usedto safeguard the population’s health. Domain 3: Endorse lifestyle behaviors that promote individual and populationhealth and well-being.Council on Linkages Between Academia and Public Health Practice: 3A8. Describes the roles of governmental public health, health care, and otherpartners in improving the health of a community. 8A3. Describes the ways public health, health care, and other organizations canwork together or individually to impact the health of a community. 8A4. Contributes to development of a vision for a healthy community (e.g.,emphasis on prevention, health equity for all, excellence and innovation).National Association of Chronic Disease Directors (NACDD): Domain 7: Identify relevant and appropriate data and information sources forchronic disease. Domain 7: Articulate evidence-based approaches to chronic disease preventionand control.National Commission for Health Education Credentialing, Inc. (NCHEC): 1.7.4 Identify emerging health education needs. 7.1.1 Identify current and emerging issues that may influence health and healtheducation.Disclaimer: This publication was supported by Cooperative Agreement Number 5U58DP002945-05,funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of theauthors and do not necessarily represent the official views of the Centers for Disease Control andPrevention or the Department of Health and Human Services.The mark "CDC” is owned by the US Dept. of Health and Human Services and is used with permission. Useof this logo is not an endorsement by HHS or CDC of any particular product, service, or enterprise.FACULTY GUIDE4

Module 3: Alzheimer’s Disease- What is the Role of Public Health?LAYOUT OF MODULE 3 FACULTY GUIDEThis guide is laid out in the following sections: Slide Guide with talking points Sample test questions Case studies Video resourcesNote: Some slides in this module duplicate content from other modules and may beremoved as needed.HOW TO USE THE MATERIALS This module is one of four modules in this curriculum that were designed for useeither as a set or as stand-alone modules. Users are free to make changes to the materials to fit their needs, including:adding, modifying or removing content, graphics, talking points, discussionquestions or learning activities. The Faculty Guide for each module includes a slide guide that contains theinformation as presented in the slide, talking points, space for presenter notes,and references. The talking points included in the Faculty Guide should not be read word forword; each presenter should review the materials before delivering the materialto ensure familiarity and deliver the information in his/her own style. Delivery time will generally be 60-90 minutes per module, depending on classengagement, presenter style, and the addition or elimination of any content,discussion questions, or learning activities. Discussion questions are included in the slide deck of each module. These maybe modified or removed at the discretion of the presenter. Questions may alsobe used for other activities such as small group discussion or individual writingassignments. Video resources, a list of articles and case studies are also included to help inlearning more about the topics presented in each module. Test questions are provided with each module as an additional resource forfaculty. All materials are 508 compliant. (Note: if changes are made to the curriculum, itis recommended that changes continue to follow 508 compliance guidelines. Formore information on 508 compliance visit the Department of Health and HumanServices website: essible/checklist/)FACULTY GUIDE5

Module 3: Alzheimer’s Disease- What is the Role of Public Health?STUDENT ENGAGEMENT OPTIONSIn addition to the PowerPoint slide deck and guide, there are additional resourcesincluded in this guide. These resources are designed to increase student engagementand enhance understanding of the concepts covered in this module. Following the slideguide, there is a series of case studies and a list of video resources. It is recommendedthat the presenter review these resources to determine if these additional materialswould be useful in illustrating the concepts covered in the module.DISCUSSION QUESTIONSThe following discussion questions are included in the slide deck: How could the Cognitive Decline and Caregiver data be used by state and localpublic health? (Slide 18) What are risk factors for Alzheimer’s disease that could be modified/reduced?(Slide 22) How could public health play a role in promoting risk reduction and cognitivehealth? (Slide 27) Would you want to know if you had Alzheimer’s disease? Why or why not?(Slide 30) What can public health do to promote early detection of Alzheimer’s disease?(Slide 35)LEARNING ACTIVITIESThe following learning activities may be used or adapted to enhance student learning: Envision and describe a health education campaign focused on early diagnosis ofAlzheimer’s disease using the “10 Warning Signs.” Describe what would takeplace during the campaign, including target audience, strategy, partners andmaterials. Research health education campaigns that focus on cardiovascular health. Selectone or more and describe how the campaign(s) could be adapted to includebrain health. Your state health official asks you to select just one of the three key public healthintervention tools to address the disproportional impact of Alzheimer’s diseaseon a specific population. In a two-page memo, select a population and one ofthe three key interventions; justify the choice of that intervention to reducehealth disparities.FACULTY GUIDE6

Module 3: Alzheimer’s Disease- What is the Role of Public Health?ADDITIONAL READING101 Careers in Aging. A list with links to many different occupations related to aginghttp://businessandaging.blogs.com/ecg/101 careers in aging/Alzheimer’s Association. (2015). Special Report on Disclosing a Diagnosis ofAlzheimer’s Disease. In 2015 Alzheimer’s Disease Facts and Figureshttps://www.alz.org/facts/downloads/facts figures 2015.pdfAlzheimer’s Association and Centers for Disease Control and Prevention. The HealthyBrain Initiative: The Public Health Road Map for State and National Partnerships, 2013–2018: Chicago, IL: Alzheimer’s Association; .htmAlzheimer’s Public Health Resource Center, Data lection.aspCDC, Behavioral Risk Factor Surveillance System (BRFSS) s-faq.htmCDC, About BRFSS: http://www.cdc.gov/brfss/about/index.htmHP2020: rch-theData#objid 4158;Learn About Careers in Aging. Washington, DC: Association for Gerontology in HigherEducation and The Gerontological Society of ioa/files/learnaboutcareersinaging.pdfWarshaw, G. A., & Bragg, E. J. (2014). Preparing the health care workforce to care foradults with Alzheimer’s disease and related dementias. Health Affairs, 33(4), 3/4/633.abstractWorld Health Organization. Dementia. Report by the Secretariat. EB 139/3. April 2016.Geneva http://apps.who.int/gb/ebwha/pdf files/EB139/B139 3-en.pdfFACULTY GUIDE7

SLIDE GUIDEThis slide guide accompanies the PowerPointpresentation for this module. The right margin has beenwidened to allow the presenter to write notes.SLIDE 1:Module 3: Alzheimer’s Disease –What is the Role of Public Health?TALKING POINTS:This presentation entitled, Alzheimer’s Disease – What isthe Role of Public Health?, is part of a curriculum for publichealth students entitled, A Public Health Approach toAlzheimer’s and Other Dementias. It was developed by theEmory Centers for Training and Technical Assistance for theAlzheimer’s Association with funding from the Centers forDisease Control and Prevention.This presentation will cover specific tools of public healthand how they may be used to address the Alzheimer’s anddementia epidemic.8

Module 3: Alzheimer’s Disease- What is the Role of PublicHealth?SLIDE 2:Learning Objectives List 3 key tools public health can apply to theAlzheimer’s disease epidemic Describe surveillance/monitoring and how publichealth can apply it in response to Alzheimer’s disease Name the 2 BRFSS modules that pertain tocognitive decline and caregiving Describe primary prevention and how publichealth can apply it to Alzheimer’s disease Explain why it is important to promote earlydetection of Alzheimer’s diseaseTALKING POINTS:By the end of the presentation, you will be able to: List 3 key tools public health can apply to theAlzheimer’s disease epidemic Describe surveillance/monitoring and how publichealth can apply it in response to Alzheimer’s disease Name the 2 BRFSS modules that pertain tocognitive decline and caregiving Describe primary prevention and how publichealth can apply it to Alzheimer’s disease Explain why it is important to promote earlydetection of Alzheimer’s diseaseFACULTY GUIDE9

Module 3: Alzheimer’s Disease- What is the Role of PublicHealth?SLIDE 3:CompetenciesAssociation for Gerontology in Higher Education (AGHE): 1.2.4 Recognize common late-life syndromes anddiseases and their related bio-psycho-social risk andprotective factors.Association of Schools and Programs of Public Health(ASPPH): Domain 2: Describe how the methods ofepidemiology and surveillance are used to safeguardthe population’s health. Domain 3: Endorse lifestyle behaviors that promoteindividual and population health and well-being.Council on Linkages Between Academia and Public HealthPractice: 3A8. Describes the roles of governmental publichealth, health care, and other partners in improvingthe health of a community. 8A3. Describes the ways public health, health care,and other organizations can work together orindividually to impact the health of a community. 8A4. Contributes to development of a vision for ahealthy community (e.g., emphasis on prevention,health equity for all, excellence and innovation).TALKING POINTS: (this slide can be edited as needed orremoved)The content in this presentation supports the developmentof the following competencies:Association for Gerontology in Higher Education (AGHE): 1.2.4 Recognize common late-life syndromes anddiseases and their related bio-psycho-social risk andprotective factors.FACULTY GUIDE10

Module 3: Alzheimer’s Disease- What is the Role of PublicHealth?Association of Schools and Programs of Public Health(ASPPH): Domain 2: Describe how the methods ofepidemiology and surveillance are used to safeguardthe population’s health. Domain 3: Endorse lifestyle behaviors that promoteindividual and population health and well-being.Council on Linkages Between Academia and Public HealthPractice: 3A8. Describes the roles of governmental publichealth, health care, and other partners in improvingthe health of a community. 8A3. Describes the ways public health, health care,and other organizations can work together orindividually to impact the health of a community. 8A4. Contributes to development of a vision for ahealthy community (e.g., emphasis on prevention,health equity for all, excellence and innovation).FACULTY GUIDE11

Module 3: Alzheimer’s Disease- What is the Role of PublicHealth?SLIDE 4:Competencies Cont.National Association of Chronic Disease Directors (NACDD): Domain 7: Identify relevant and appropriate data andinformation sources for chronic disease. Domain 7: Articulate evidence-based approaches tochronic disease prevention and control.National Commission for Health Education Credentialing,Inc. (NCHEC): 1.7.4 Identify emerging health education needs. 7.1.1 Identify current and emerging issues that mayinfluence health and health education.TALKING POINTS: (this slide can be edited as needed orremoved)National Association of Chronic Disease Directors (NACDD): Domain 7: Identify relevant and appropriate data andinformation sources for chronic disease. Domain 7: Articulate evidence-based approaches tochronic disease prevention and control.National Commission for Health Education Credentialing,Inc. (NCHEC): 1.7.4 Identify emerging health education needs. 7.1.1 Identify current and emerging issues that mayinfluence health and health education.FACULTY GUIDE12

Module 3: Alzheimer’s Disease- What is the Role of PublicHealth?SLIDE 5:Introduction: Dementia & Alzheimer’s Disease1 Dementia is a decline in mental ability severe enoughto interfere with daily lifeo Caused by damage to brain cells, primarilyaffects older adults Alzheimer’s disease is the most common form ofdementiao Progressive loss of memory and brainfunction, behavior and personality changeso As disease progresses, caregivers provideincreasing aid and assistanceo No cure and limited treatment options Huge financial and emotional burden on people withAlzheimer’s, their families, caregivers, and the healthcare system Public health plays important role in addressingAlzheimer’s disease through surveillance, prevention,detection, and support of dementia-capable systemsTALKING POINTS:Before we begin discussing the role of public health inaddressing Alzheimer’s disease, it may be helpful to know alittle more about Alzheimer’s and dementia.The term dementia is a general term for a decline in mentalabilities that is severe enough to interfere with daily life.Dementia, which is not a disease but a syndrome, ischaracterized by damage to the brain cells due to age, braininjury, other conditions or diseases or heredity.There are several types of dementia and most occur in thoseover 65; however, there are types of dementia that occur inthose younger than 65.Alzheimer’s disease is the most common type of dementia.Alzheimer’s is a progressive disease that ranges from mild to1Alzheimer’s Association. 2015 Alzheimer’s Disease Facts and Figures.FACULTY GUIDE13

Module 3: Alzheimer’s Disease- What is the Role of PublicHealth?severe cognitive impairment that occurs over the course ofseveral years.There is no cure for Alzheimer’s. While there are approveddrug treatments, the goal of treatment is to delay or reducesymptoms, not to cure or reverse the course of the disease.As the person with Alzheimer’s loses memory and function,caregivers, who are most often family members, are neededto provide increasing amounts of assistance. This assistancecan range from helping to manage finances and householdtasks to hands-on care, such as bathing, dressing, feedingand other activities of daily living.Given the nature of the disease and its increasingprevalence, there is a huge financial, emotional andphysical impact on people with Alzheimer’s, their families,caregivers, and the health care system as a whole.Public health plays an important role in addressingAlzheimer’s disease through surveillance, prevention,detection, and support of dementia capable systems.In this presentation, we will be focusing on the role of publichealth.Video supplements: “What is Alzheimer's disease?” TedEd.(run time: 3:49 mins)Link: https://www.youtube.com/watch?v yJXTXN4xrI8Or:“Inside the Brain: Unraveling the Mystery of AlzheimerDisease”. National Institutes of Health, NIH Senior Health.(run time: 4 /whatisalzheimersdisease/video/a2 na.html?intro yesFACULTY GUIDE14

Module 3: Alzheimer’s Disease- What is the Role of PublicHealth?SLIDE 6:Alzheimer’s: A Public Health Crisis Historically viewed as an aging or medical issue Growing recognition of public health crisis:o Large and growing epidemico Significant impacto Ways to interveneTALKING POINTS:Historically, Alzheimer’s and other dementias have beenviewed primarily as medical or aging issues.Yet as more is learned about these conditions and theimpact they are having on society, there is a growingrecognition of Alzheimer’s and dementia as issues in whichpublic health has an important role to play.Alzheimer’s disease is a public health crisis because: The epidemic is large and growing The impact on populations and communities issubstantial There are ways to intervene using a public healthapproach to achieve meaningful improvements inhealth outcomesImage source: U.S. federal government, Wikimedia CommonsFACULTY GUIDE15

Module 3: Alzheimer’s Disease- What is the Role of PublicHealth?SLIDE 7:Alzheimer’s: Epidemic (U.S.)2 Over 5 million adults 1 in 9 adults age 65 1 in 3 adults age 85 By 2050, expected to reach 13.8 millionTALKING POINTS:2 Today, over 5 million adults in the U.S. are living withAlzheimer’s disease, including an estimated 200,000under the age of 65. One in nine adults age 65 and older (11%) currentlyhas Alzheimer’s disease; approximately one in threepeople age 85 and older have the disease. By 2050, t

Council on Linkages Between Academia and Public Health Practice: 3A8. Describes the roles of governmental public health, health care, and other partners in improving the health of a community. 8A3. Describes the ways public health, health care, and other organizations can work together or individually to impact the health of a community.

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