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Alaska Commission on Aging
2008 SeniorData Presentation
Presented to the Alaska Mental Health Trust
AuthorityMay 29, 2008
Our Purpose
The mission of the Alaska Commission on Aging is to ensure the dignity and independence of all older Alaskans, and to assist them, through planning, advocacy, education, and inter-agency cooperation, to lead useful and meaningful lives.
Alaska Commission on AgingCommission Members
• Banarsi Lal, Chair• Sharon Howerton-Clarke, Vice Chair (and FY 2009 Chair-Elect)• Frank Appel, Public Member• Pat Branson, Provider Member• Tara Jollie, Department of Commerce, Community & Economic Development
Designee• Betty Keegan, Public Member• Iver Malutin, Public Member• Rod Moline, Director, Senior & Disability Services, DHSS Designee• Paula Pawlowski, Public Member• Ed Zastrow, Chair, Pioneer Home Advisory Board
StaffDenise Daniello, Executive DirectorMaryAnn VandeCastle, Planner II
Lesley Bullock, Planner ISherice Ridges, Administrative Assistant
Purpose of Presentation
The intent of this presentation is to provide an overview of the status of Alaska seniors living with Alzheimer’s Disease and Related Dementias (ADRD), including their estimated numbers, characteristics, and the types of services available.
Alaska Senior Demographics
A Growing Population of Seniors
• Alaska’s age 60+ population grew by 43% between 2000 and 2007.
• Our senior population is growing faster than that of any other state except Nevada.
Data Source: Alaska Department of Labor population estimates, 2000-2007
53,61655,763
58,695 61,99265,088
68,169 71,56876,440
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
2000 2001 2002 2003 2004 2005 2006 2007
Alaskans Age 60+, 2000 - 2007
Alaska Seniors by Gender and Age Group
Data Source: Alaska Department of Labor 2007 population estimates (2008)
0
5,000
10,000
15,000
20,000
25,000
30,000
60 - 64 65 - 74 75 - 84 85+
2007 Alaska Seniors by Age Group and Gender
Male Female
Seniors represent all regions
of the state. Map: Alaska Dept. of Health & Social Services regions
Data Source: Alaska Dept. of Labor 2007 population estimates (2008)
Alaska Seniors by Region, 2007
3%14%
1%
24%
1%
3%
2%13%
39%
Region I Region II Region III
Region IV Region V Region VI
Region VII Region VIII Region IX
And they come from all races, though
over 75% are white. Data Source: Alaska Dept. of Labor 2006 population estimates (2007)
Alaska Seniors by Race, 2006
14%
2% 6% 2%
76%
White Alaska Native
African-American Asian/Pac.Islander
Two or More Races
The vast majority of seniors age 65+ are covered by Medicare.
Medicare Figures: Centers for Medicare and Medicaid ServicesSenior Population Estimates: Alaska Dept. of Labor, 2001-2005
36,167
942
37,596
1,016
39,038
1,115
40,854
806
41,469
1,917
32,000
34,000
36,000
38,000
40,000
42,000
44,000
2001 2002 2003 2004 2005
Alaska Seniors with Medicare Coverage
Medicare No Medicare
Alzheimer’s Disease and Related
Dementias (ADRD)
ADRD reflects a number of profound
changes in the brain.
Source: Alzheimer’s Association 2008
Related Disorders Include:
• Vascular Dementia• Mixed Dementia (Alzheimer’s Disease &
Vascular Dementia)• Parkinson’s Disease-Associated Dementia• Wernicke-Korsakoff• Pick’s Disease• Lewy Body Dementia• Huntington’s Disease (or Creutzfeldt-Jakob
Disease)
Alzheimer’s is a disease.
• It’s not a normal part of the aging process.
• Alzheimer’s is the result of a disease process and is fatal.
Source: Quadagno 2005
Alzheimer’s Disease Versus Normal Changes in Memory:
Normal Aging:• Forgetting to set the alarm
clock• Forgetting someone’s name
and remembering it later• Forgetting where you left
your keys and finding them after searching
• Forgetting where you parked your car
Possible AD:• Forgetting how to set the
alarm clock• Forgetting a name and never
remembering it, even when told
• Forgetting places where you might find your keys
• Forgetting how you came to be in a particular location
Source: Hooyman & Kiyak 2002
Stages of Alzheimer’s Disease
• Stage 1 – Normal Function No cognitive problems noted by individual or medical
provider.
• Stage 2 – Very Mild Cognitive Decline Complaints of mild forgetfulness and some work
difficulties; difficulty finding the right word
• Stage 3 – Mild Cognitive Decline Problems with concentration, some difficulty at work
and in traveling alone Source: Alzheimer’s Association
2008
Stages of Alzheimer’s Disease
• Stage 4 – Mild or Early-Stage Alzheimer’s Disease Late confusion stage; increased denial of symptoms;
withdrawal
• Stage 5 – Moderate or Mid-Stage Alzheimer’s Disease
Poor recall of recent events; needs assistance with dressing and bathing
Source: Alzheimer’s Association 2008
Stages of Alzheimer’s Disease
• Stage 6 – Severe, Mid Stage Alzheimer’s Disease More memory problems; more assistance needed
with Activities of Daily Living (ADLs); more personality changes
• Stage 7 – Very Severe or Late-Stage Alzheimer’s Disease
Loss of language; loss of ability to walk; incontinent; may become comatose
Source: Alzheimer’s Association 2008
Suggested Practices Caring for Persons with ADRD
• Emphasize familiarity and routine to build trust and comfort• Maintain clear, concise, calm communication• Pay attention to nonverbal communication• Limit Distractions• Long term memory last to be impaired• Focus on individual’s abilities, strengths, and preferences. Allow them
to continue to do what they can to convey respect and dignity.• Keep tasks simple• Exercise patience and understanding
Sources: Hooyman & Kiyak 2002 &
Quadagno 2005
As of 2007, over 5,000 Alaskans are estimated to have ADRD.
Source: ACoA estimate based on national prevalence data
Alaskans with ADRD, 2007 (Estimate)Total = 5,105
586, 11%
2,611, 52%
1,908, 37%
65 - 74 75 - 84 85+
Death rates related to Alzheimer’s disease are on the increase in Alaska.
Source: Alaska Bureau of Vital Statistics 2005 Annual Report
Alzheimer's Disease Age-Adjusted Death Rates: Alaska, 1996 - 2005
22.9
12.8
19.3
22.121.1
17.5
25.4
21.5
11.5
9.1
0.0
5.0
10.0
15.0
20.0
25.0
30.0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
The number of Alaskans with ADRD is projected to nearly quadruple from 2000 to 2030.
Sources: Population projections by Institute of Social & Economic Research(2007) and national ADRD prevalence rates by age group
3,6125,043 5,105
6,364
7,765
9,663
11,850
14,170
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
2000 2005 2007 2010 2015 2020 2025 2030
Projected Number of Alaskans with ADRD, 2000 - 2030
Based on the Behavioral Risk Factor Surveillance System
(BRFSS) for Alaska:
Older Alaskans may be at slightly lower risk for ADRD in light of their lower rates of various cardiovascular risk factors; they also have higher rates of some protective lifestyle factors than older Americans in general.
Slightly fewer older Alaskans have had a heart attack.
4.2%
95.8%
13.3%
86.7%
2.3%
97.7%
12.1%
87.9%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
All U.S. Adults All U.S. Seniors Alaskan Adults Alaskan Seniors
Had Heart Attack - U.S. and Alaskan Adults and Seniors
YES
NO
Older Alaskans suffer from a slightly lower
rate of coronary heart disease.
4.1%
95.9%
13.2%
86.8%
2.5%
97.5%
11.0%
89.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
All U.S. Adults All U.S. Seniors Alaskan Adults Alaskan Seniors
Coronary Heart Disease - U.S. and Alaskan Adults and Seniors
YES
NO
Slightly fewer older Alaskans have had a stroke.
2.6%
97.4%
8.3%
91.7%
1.9%
98.1%
7.0%
93.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
All U.S. Adults All U.S. Seniors Alaskan Adults Alaskan Seniors
Had Stroke - U.S. and Alaskan Adults and Seniors
YES
NO
Slightly fewer older Alaskans have high cholesterol.
37.6%
62.4%
53.7%
46.3%
37.6%
62.4%
51.2% 48.8%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
All U.S. Adults All U.S. Seniors Alaskan Adults Alaskan Seniors
High Cholesterol - U.S. and Alaskan Adults and Seniors
YES
NO
Older Alaskans are significantly more likely to engage in moderate or vigorous
physical activity.
49.5%50.5%
39.3%
60.7% 60.8%
52.3% 52.3%
47.7%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
All U.S. Adults All U.S. Seniors Alaskan Adults Alaskan Seniors
Moderate or Vigorous Weekly Physical Activity - U.S. and Alaskan Adults and Seniors
YES
NO
And older Alaskans are slightly more likely to eat a healthy diet, as measured by the number who eat at
least five fruits and vegetables per day.
24.4%
75.6%
28.7%
71.3%
24.2%
75.8%
29.4%
70.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
All U.S. Adults All U.S. Seniors Alaskan Adults Alaskan Seniors
Five+ Fruits/Vegetables Daily - U.S. and Alaskan Adults and Seniors
YES
NO
An ACoA survey of the public’s knowledge of ADRD and the lifestyle factors which may
prevent it showed that Alaskans are already fairly well-informed.
81.1%
75.0%
81.3%
78.2%
71.0%
72.0%
73.0%
74.0%
75.0%
76.0%
77.0%
78.0%
79.0%
80.0%
81.0%
82.0%
Age 18 - 29 Age 30 - 42 Age 43 - 59 Age 60+
Percent of Each Age Group Correctly Identifying All Lifestyle Factors Which Can Reduce ADRD Risk
But some survey responses point to the need for further community education.
6%
10%
33%
35%
37%
52%
54%
64%
67%
0% 10% 20% 30% 40% 50% 60% 70%
ADRD: Not Normal Aging
Forgetting Keys Not a Sign
Infl ammation-Related
Slight ADRD Risk if Relative Got it
Most Common Dementia
Women More Likely
Head Injury a Cause
Depression Linked to ADRD
People 85+ w/ Dementia
Percent Wrong Answers on ADRD Survey
The Continuum of Long-Term Supports In Alaska
• Community-Based Services (appropriate for all seniors, including ADRD stages 1 and 2)
• Congregate meals• Public transportation• Information/referral/ personal
advocacy• Physical fitness programs• Health promotion/ disease
prevention classes & activities
• Senior employment services• Independent living• Senior centers• Senior volunteer programs• Legal services• Health screening• Social & recreational
activities
The Continuum of Long-Term Care in Alaska
• Home-Based Services (appropriate for homebound seniors and those needing extra support, including ADRD stages 3, 4, and 5
• Home-delivered meals• Assisted transportation• Shopping assistance• Congregate housing• Supported housing• Home repair and
renovation• Senior companion
volunteers• Homemaker/chore
service• Companion programs
The Continuum of Long-Term Care in Alaska
• Intensive Home- and Community-Based Services (appropriate for those with intensive health needs or ADRD stages 5 and 6, as well as their caregivers)
• Adult day services• In-home respite care• Home health care• Personal care• Hospice care• Family caregiver
support• Outpatient care• Rehabilitation• Counseling
The Continuum of Long-Term Care in Alaska
• Services in a Residential Care Setting (appropriate for ADRD stages 5, 6 and 7)
• Assisted living• Facility respite care• Pioneers’ Home• Adult foster care
The Continuum of Long-Term Care In Alaska
• Institutional Services – the most intensive level of care, appropriate for ADRD stages 6 and 7
• Acute care• Nursing home care• Residential hospice
care
Services for Alaskans with
ADRD
State Services for ADRD Seniors:
• Pioneer Homes
• Assisted Living Facilities (Licensed)
• Medicaid Waiver Program
• Personal Care Assistance (PCA)
• Senior Grant Programs
More than half the residents of Alaska’s Pioneer Homes are diagnosed with ADRD.
Source: Alaska Division of Pioneer Homes
79
80
43
38
24
14
30
12
46
30
27
35
0
20
40
60
80
100
120
140
160
Anchorage Fairbanks Juneau Ketchikan Palmer Sitka
Pioneer Home Residents as of April 1, 2008
Dementia No Dementia
Most Pioneer Home residents with ADRD
require the highest level of care.
Pioneer Homes' ADRD Residents by Level of Care
7, 3%
62, 24%
190, 72%
2, 1%
Level 1
Level 2
Level 3
Level Unknown
Who are the Pioneer Home residents with ADRD?
Gender Marital Status70% Female 50% Widowed 11% Single30% Male 21% Married 7% Unknown
11% Divorced
Race Age91% White Average age 86 years old6% Native Average age of admit by year1% Asian 1998 76 years<1% Black 2003 84 years2% Unknown 2008 86 years
Licensed assisted living beds vary widely by region.
Source: Alaska Division of Public Health, Alaska Health Care Data Book: Selected Measures DHSS 2007
585
228
102
82
136
0
104
101
27 0 42
197
15 00
100
200
300
400
500
600
700
800
900
Anchorage Mat-Su Gulf Coast Interior Northern Southeast Southwest
Licensed Assisted Living Beds, Including Pioneer Home Beds
PH
Non-PH
Projected increases in the cost of nursing home and assisted living care over the next 20+ years
are daunting.Source: Genworth Financial 2008 Cost of Care Survey
20082020
2030
$187,813
$337,445
$549,662
$54,809 $98,429$160,331
$0
$100,000
$200,000
$300,000
$400,000
$500,000
$600,000
Projected Nursing Home and Assisted Living Home Costs
Assisted LivingFacility - Private, 1BR
Nursing Home -Semi-PrivateRoom
Seniors make up only a small segment of Medicaid beneficiaries in Alaska.Source: Financial and Management Services, Medicaid Budget Group, Alaska DHSS
Alaska Health Care Data Book Selected Measures, DHSS 2007
Medicaid Beneficiaries by Benefit Group
78,551, 64%22,536, 18%
7,295, 6%
1,830, 1%
13,817, 11%
Children Adults
Elderly Disabled Children
Disabled Adults
Medicaid-eligible individuals who meet level of care requirements may qualify for one of four Medicaid
waivers through SDS.Source: Senior & Disabilities Services
Alaska Health Care Data Book Selected Measures, 2007
181
841
960
1,123
0
200
400
600
800
1,000
1,200
Children w ithComplex Medical
Conditions
Adults w ithPhysical Disabilities
Persons w ithMR/DD
Older Alaskans
DSDS HCB Waivers by Type, 2007
Older Alaskans waiver recipients are
found in every region. Source: Senior & Disabilities Services 2007
Alaska Health Care Data Book Selected Measures, DHSS, 2007
531
155 174
91 111
4417
0
100
200
300
400
500
600
Older Alaskans Waiver Participants by Region
A substantial number of PCA and Medicaid waiver participants have ADRD; in addition to meeting
income requirements, waiver eligibility is based on diagnosis and functional assessment.
Source: Senior & Disabilities Services
305
2,840
668
554
57
761
193
1,096
723
3,173
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
Personal Care Older Alaskans Waiver Adul ts w/ Physical
Disabi l i ties Waiver
Both PCA and Waiver Undupl i cated: Al l PCA
and Waiver
SDS Medicaid Participants with ADRD, by Program
ADRD No ADRD
The largest group of PCA and waiver recipients with ADRD are those in their 80s.
Source: Senior & Disabilities Services Age Group of ADRD Participants in SDS Programs -
PCA or Waiver
46, 6%69, 10%
184, 25%
97, 13% 8, 1%
319, 45%
Under 60 Age 60 - 69 Age 70 - 79
Age 80 - 89 Age 90 - 99 Age 100+
Another much larger group of seniors receives senior grant
services, many of which have no income limitations. Source: Senior & Disabilities Services
Alaska Health Care Data Book Selected Measures, DHSS 2007
5,074
876
2,965
221
74888
3507 899
1271,163
23
0
1,000
2,000
3,000
4,000
5,000
6,000
Anchorage/Mat-Su
Gulf Coast Interior Northern Southeast Southw est
Participants in Senior Grant and OA Waiver Programs by Region, 2007
Senior Grants OA Waiver
Grant recipients take advantage of a wide range of Nutrition, Transportation, and Support services although not all are
available to completely meet demand in each community. Source: Senior & Disabilities Services
7,875
2,710
451
1,650
68641
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
Congregate Meals Home-Del ivered
Meals
Homemaker Service Assisted
Transpor tation
Caregivers Serving
Elder ly
Grandparents
Car ing f or
Chi ldren
Clients Receiving NTS Senior Grant Services, FY 2007
Grant services recipients are diverse in age, race, gender, type of community, and
income level.
11,222
4,546
6,605
4,157
7,750
3,399
7,379
3,033714
5,486
3,046
1,309
0 2,000 4,000 6,000 8,000 10,000 12,000
Total Served
Income Below Pover ty
Female
Male
Rural
Live Alone
White
Native
Other Race
Age 60 - 74
Age 75 - 84
Age 85+
Characteristics of Cluster I and Cluster II Clients, SDS Senior Grants
Priority Issues for Alaskans with ADRD:
• Access to primary health care• Addition of a Medicaid waiver for
individuals with ADRD• Additional funding for senior grant
services for the 80 to 85 percent of seniors who are not eligible for the Medicaid waiver
• Continued statewide long-term care strategic planning, including a plan for the future of the Pioneers’ Homes
Thank you.