It’s no secret that the largest population of older adults is about to come knocking on senior living’s door. What worries dementia care expert Teepa Snow is how unprepared operators may be to handle the incoming “dementia shockwave.”

In a recent webinar on the state of dementia care hosted by workforce education provider Relias, Snow, an occupational therapist and CEO of Positive Approach to Care, said that there are 120-plus types, causes and forms of brain change under the dementia umbrella. 

In 2020, approximately 7 million people aged 65 or more years were living with dementia. That number is anticipated to increase to 9 million by 2030, and 12 million by 2040. And Snow said that 60% to 70% of people moving into long-term care have cognitive changes consistent with the early signs of various forms of dementia. According to the Centers for Disease Control and Prevention’s National Center for Health Statistics, 42% of assisted living residents have Alzheimer’s disease or another form of dementia.

Communities are unprepared

Senior living communities are missing the signs of the disease because they aren’t preparing staff members to recognize them at the earliest stages, Snow said. 

In most cases, she added, certified nursing assistants are required to have the most dementia training of staff members, but that requirement averages only six hours. Most skilled care providers are not required to have any dementia care training, she said. 

“The challenge is, when we’re talking about somebody whose brain is dramatically shifting and abilities are variable, we are asking people to step forward into this role without preparation,” Snow said, adding that the situation sets up staff members for job dissatisfaction. “If we can’t get people to want to work with us, we can’t serve the population.”

The brains of people with dementia change over time, taking an average of 10 years to change from a neurotypical brain to a brain with Alzheimer’s disease, Snow said. And 80% of cases of individuals experiencing brain changes are not identified in the early stages, when interventions would be most effective, she said.

Providing truly person-centered care involves supporting the right culture and environment, building competence through education and training and practice, and working with families, Snow said. The “state of dementia care” is not where it needs to be, she added, but she said she knows it can get to where it needs to be — with collaboration. 

Adding family to the care team

Senior living communities may be admitting people who have more complex care needs than anticipated, resulting not only in untrained and unprepared staff members but unprepared families, Snow said. 

The baby boomers aging into long-term care, she added, will be moving in at a more advanced age than members of previous generations, will have more chronic conditions and will be at higher risk for dementia.

“Not only are there more of us getting older; there are more of us getting older and having brain changes,” Snow said, opining that society already is poorly equipped to understand what aging typically looks like, let alone understand the brain changes that come with dementia.

Educating residents’ family members about the progression of dementia is just as important as training staff, she said. 

“Somewhere around 75% to 80% of family members have little to no awareness that the diagnosis of dementia is going to lead to somebody’s gradual decline no matter what we do,” Snow said. “It will change their ability to live their life.”

Family members are additional team members and need to be involved and engaged with creating a care plan for their loved ones, she said.

The past year has held major breakthroughs in Alzheimer’s treatment, including new drugs to tackle the disease. Now researchers may have found a way to deliver those drugs faster.

Should the technology prove viable, it adds a powerful new wrinkle in how assisted living and memory care providers can aid residents living with Alzheimer’s and help families weigh options.

By using focused ultrasound technology, the researchers were able to “open” the blood-brain barrier and deliver more of a drug, Biogen’s aducanumab (Aduhelm), in certain areas of the patient’s brain. In the brain regions that the ultrasound targeted — the scientists limited the ultrasound to one hemisphere — the treatment was more effective, the study showed. 

Many Alzheimer’s drugs, including aducanumab, target toxic beta-amyloid proteins that have built up in the brain, thought to be responsible for the disease and cognitive decline. 

Early last year, the US Food and Drug Administration approved a new Alzheimer’s drug, lecanemab (Leqembi), that targets amyloid plaques in the early stages of the disease. The drug’s effectiveness is promising enough that it has prompted a review of policies around how and when people can get PET scans. 

The inability for many drugs to effectively cross the blood-brain barrier has meant that many treatments for Alzheimer’s require stronger doses and more frequent therapies, the researchers noted. 

The investigators noted that the pilot study would need to be followed up by further studies before the drug-delivery practice could go into widespread use. 

The research was conducted by scientists at the West Virginia University Rockefeller Neuroscience Institute. 

“This is an exciting time in the treatment of Alzheimer’s disease,” study co-author Marc Haut, PhD, director of the RNI Memory Health Clinic, said in a statement. “We are hopeful that the work we are doing may lead to improvements in outcome for many other patients and their families coping with Alzheimer’s.”

The study was published Thursday in The New England Journal of Medicine.

Newly available non-prescription hearing aids could do more than just return aural function to users: Restoring hearing function can have major overall health benefits and reduces the risk of dementia, experts say.

Almost 25% of adults aged 65 and 74 years, and half of those older than 75, have “disabling” hearing loss, according to the National Institute on Deafness.

Unfortunately, among those who have such significant hearing loss, only one-third use hearing aids, the institute says. 

That is partly due to the fact that many hearing aids are both costly and require prescriptions. Newer models, however, are form-fitting and commercially available, according to a recent story by CNN. 

Those newer models have come following a decision by the US Food and Drug Administration in 2022 to allow consumers to purchase hearing aids online or over the counter. 

Two recent studies have expanded on the link between hearing loss and dementia risk, McKnight’s Senior Living reported last week. 

Prior research also connected hearing loss with a greater risk for falling and overall cognitive decline. Overall, hearing loss was linked to a 7% higher risk for developing dementia and was 20% higher for those with hearing loss who didn’t use hearing aids.

Other research went as far as to report that those who used hearing aids reduced their mortality risk by 24%. 

The newer over-the-counter hearing aid models differ from previous models in several ways, with most options targeting more mild forms of hearing loss. New innovations include more form-fitting designs or are made to look more like earbuds or Bluetooth pieces and less like medical appendages. Some new models include functionality that can be controlled using smartphone apps, McKnight’s reported last year.

It’s yet another acronym senior living and memory care providers should familiarize themselves with: CCT. It stands for computerized cognitive training. 

The terminology refers to digital exercise options that older adults living with dementia can use to improve cognitive function or slow down decline. This is usually by stimulating visual, verbal or working memory.

For the most part, those kinds of exercises have been supervised by caregivers or clinicians. Older adults who took on CCT training independently, however, showed equal progress in bolstering their memory, a new study shows.

“Although the supervised approach showed greater effects,” the study authors wrote, “the unsupervised approach can improve verbal memory while allowing users to receive CCT at home without engaging as many healthcare resources.”

The report suggests that those new CCT programs could benefit older adults living independently, but senior living operators also could look to those options as a way to provide dementia interventions while dealing with staffing shortages and limited resources. 

Newer CCT programs not only are designed to be conducted without clinical supervision; some make use of virtual reality, the study noted. Overall, the CCT programs reviewed in the study required about one to two hours a week over a period of two weeks to six months. 

The researchers did qualify their meta-analysis by suggesting that most of the success stories occurred in older adults who had lower levels of dementia or early-stage Alzheimer’s disease.

Dementia is becoming a major care burden as the number of older adults increases worldwide. In the United States alone, 18% of all assisted living communities now include a specialized dementia care unit, and 11% are devoted to dementia or memory care entirely, according to the National Center for Assisted Living.

The combination of CCT, physical exercise and vitamin D makes for a true triple threat to empower older adults’ cognition, the McKnight’s Clinical Daily reported over the summer.

A new study is uncovering just how tough it can be financially to live with dementia. The report, published Dec. 29 in the Journal of the American Geriatrics Society, found that almost 56% of people with dementia face financial hardships. Those financial challenges are linked with worse reported satisfaction with life and healthcare.

Researchers used data from the Health and Retirement Study, which includes adults aged more than 52 years and spans 2010 to 2020. The study examined data from 534 participants with dementia who shared details on satisfaction with their lives and their healthcare. The researchers compared those data to information from questionnaires from 576 people with newly diagnosed cancer who were receiving treatment.  

The people were asked about financial strain in the past year of their lives and whether it was upsetting; they also were asked whether it was difficult to pay their bills. The data were compared with information from a previous study, which included information from the same people.

According to the findings, 56% of people living with dementia said that they experienced financial hardship, compared with 50.4% of people with cancer. Differences existed between groups in terms of the age of disease onset; an earlier diagnosis was linked to a higher proportion of financial hardship. 

In the dementia group, people who experienced financial hardship in the previous study were less likely to report being completely or very satisfied with life and less likely to say they were satisfied with their healthcare compared with people who didn’t report financial hardship in the previous report. Results were similar in the group of people who had cancer.

People living with dementia may have more intense financial hardship than those with cancer, the authors contended. This situation could be because the costs are incurred for longer periods of time, especially if a person receives a dementia diagnosis at a young age. The more severe hardships also could be due to the lack of long-term care insurance to assist with getting treatment for dementia.

Medicare and private insurance do not cover most long-term care services, the authors noted. Although Medicaid and private long-term care insurances do cover most such services, Medicaid coverage among adults 65+ is very low, at 7.6%, and only approximately 10% of adults have such insurance. Most older adults assume the expenses on an out-of-pocket basis, the authors added.

Nancy Glober, MD, from Indiana University in Indianapolis, and colleagues reviewed electronic medical records to describe the impact of interhospital transfer on older adults with and without ADRD. The analysis included older adults with at least one emergency department visit who were transferred to a tertiary care hospital.

The researchers found that patients with ADRD more often received a geriatrics or palliative care consult. Furthermore, they were significantly less likely to be full code at admission or to be discharged home. Within 48 hours of transfer, patients living with ADRD less often received intensive care or a specialist procedure (odds ratio, 1.87).

“Our findings, which show that older adults with dementia were less likely to receive intensive care or a medical procedure within the first two days of transfer, highlight the need to focus very closely on the patient with dementia and their family to determine if transfer provides optimal care and to build out our infrastructure in a way that supports that,” senior author Malaz Boustani, MD, MPH, also from Indiana University, said in a statement.

Abstract/Full Text