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Hi, and good afternoon, again, everybody. Thank you for joining. This is Lynn Shaull
with the Association of State and Territorial Health Officials, and today's webinar is focusing
on the Healthy Brain Initiative Road Map and the role of state health leaders. And just
as a head's up, as you've probably discovered, all participants on mute. So if you have a
question at any point during the presentations, please feel free to type it into the chat
box, and then at the end, we'll have an open Q&A discussion section, so during that time,
you can press "*7" to unmute your line or continue to type questions in the chat box.
Also, following today's webinar, I will send a link out so everybody can access the PowerPoint
presentations, as well as the recording.
And so for today's agenda, our first presenter will be Lynda Anderson. She's the director
of the Healthy Aging Program in the Division of Population Health at the National Center
for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control
and Prevention. Then, we'll have Jewel Mullen, the commissioner of the Connecticut Department
of Public Health; and then Katherine Morrison, a senior associate director of public health
at the Alzheimer's Association in their public policy division. So thank you again, everyone,
for joining. And with that, I will introduce Dr. Lynda Anderson and ask her to please begin.
Thank you and I just wanna do a sound check for my voice. Is it loud enough?
I can hear you well, Lynda.
Excellent.
Well, we're very pleased to be with you this afternoon, and I really want to extend a special
thank you for ASTHO for sponsoring this webinar and giving us an opportunity to speak with
you. What I want to do today is to provide a brief context, first, before I describe
the new Public Health Road Map. I wanna talk a little bit about the changing demographics
that we're seeing in our country, as well as how we begin the Centers for Disease Control
and Prevention Healthy Brain Initiative. Okay, I'm hitting on the arrow, and I'm not being
able to move it. Okay, let me go back. Excuse me for a second. I'm getting used to the technology.
So let me begin by talking about the population who are over the age of 65, as well as those
over the age of 85, and you'll see a graph that starts from 1900 and really goes up and
projects until 2050. And you'll notice that the 65 and older have been gradually rising
since 1900, and there are currently in 2011, which is shown by the red arrow going up,
about 35 million adults over the age of 65. And what we'll see, it's projected that by
2030 that that number will double to about 72 million older adults, and you'll also notice
how the line really sharply increases between that time, and this is because, really, the
baby boomers, those born between 1946 and '64 are now reaching that age after 2011 in
that growth in that population.
But what's also important to note in this is for the lower one, the one that it's in
light purple, the 85 years and older are one of the fastest growing populations of any
age group, and they will be increasing from about 4.2 million to about 9 million. And
I point this out because those who are 85 and older look quite different from the 65
and older ñ 65- to 84-year population because, one, they have more health risks and, again,
are generally more frail and more likely to experience institutionalization.
So on the next slide, we just wanna point out, from a public health perspective, the
importance of looking at the leading causes of death, and this is a slide from 2010 statistics,
and you'll note that Alzheimer's disease is now the 6th leading cause of death among all
ages. And just recently, in 2007, it overcame diabetes, and so what we're seeing is increase
in the number of people who have Alzheimer's disease, where some of these other major chronic
conditions are decreasing, so, again, pointing out the importance of really, as a public
health issue, Alzheimer's disease and dementia is.
So let me turn, now, to the CDC Healthy Brain Initiative. In 2006, Congress appropriated
funds to CDC's Healthy Aging Program to really address brain health with a focus on lifestyle
issues. So CDC formed a partnership with the Alzheimer's Association, the National Institutes
of Health and their Institute of Aging, the Administration for Community Living ñ many
of you will know that the Administration of Aging is a component of that, as well as AARP
and other national partners, to collaborate on a multifaceted approach to addressing cognitive
health.
And so the goals of this initiative, really, are threefold. One was really to understand,
"What does the public think about cognitive health, as well as the burden the cognitive
impairment?" and looking at this through a public health lens, and one of those systems
that we use is, of course, the Behavioral Risk Factor Surveillance System.
And then the second component is to build a strong evidence base for policy, for communication,
and programmatic interventions for addressing impairment, as well as maintaining cognitive
health, and we tend to think of cognition, really, along a continuum, meaning that people
will have good health and good functioning in terms of thinking, executive function,
in terms of memory, in terms of organizational aspect. And then, on the other far end, we
think of it as impairment and think of things like dementia, as well as Alzheimer's disease.
And then, really, the third component was to translate what we learned through those
into effective public health practice, both by public health partners, as well as our
partners in states and communities.
So in 2006, we held a meeting with many of these partners to really look at the state
of the science. All of our work at CDC, of course, is science driven, and we have a foundation
of science, so we held a public health research meeting, which was put out in a publication,
really, to begin to look at what the issues were around vascular health, as well as some
of the prevention opportunities such as physical activity, and other known things.
And with that, then, and that science foundation, we created the first Road Map which was the
Healthy Brain Initiative: A Road Map for Public Health. And within that, there were 45 action
items related to surveillance, related to applied research, policy, and communication.
And so from 2007 until 2012, CDC and our partners did a number of efforts and initiatives, and
one of those you might ñ and I hope that you're familiar with, and we can talk about
more later ñ is the Healthy People 2020 now has a topic area on dementias, including Alzheimer's
disease, as well as the topic areas in older adult health, have several objectives that
now include cognition.
So in 2013, we created a new road map, first, because it was really time for that initiative
to look at and begin to think about the roles of others, and very ñ two important efforts
were going on. First, in 2011, there was the National Alzheimer's Project Act, which is
really a way to bring ñ headed up by the ASPE at the Health and Human Services ñ to
really bring together federal partners and private entities to really make a difference
in terms of addressing Alzheimer's disease and related dementias. And then, as part of
that, is the national plan to address Alzheimer's disease, and there have been ñ the initial
plan came out in 2012 and then a subsequent plan is in 2013, and this national plan is
updated yearly to look at the progress that's being made.
So given that this national focus, we really decided it was very important to begin to
reach out to states and local entities, many who are already leaders in some of these areas,
but to bring together sort of a state and local focus and abilities to begin to talk
about states. So we formed a leadership committee. And I'll just point out that the Association
of State and Territorial Health Officers were well represented on our leadership committee,
and we had others, such as the National Association of Chronic Disease Directors. And about half
of our leadership committee was made up of state and local leaders to really help us
to plan and to make sure we heard the voices from the state and local communities.
And quite briefly, we used a participatory process to develop this Road Map. It was very
important that we, as a leadership committee, just didn't come together and say what states
should be doing. We really wanted to hear what states thought was happening in there
and where they should be moving forward. So we used a process called concept mapping which
really involves an idea generation, where we heard from about 280 stakeholders getting
their views about what actions we should be taking in states and local communities in
partnership with national organizations and others.
And then those were synthesized down to a more manageable set of ideas and then put
back out to the stakeholders to get their input. And what would the priorities be, as
well as how would this look? And how would we conceive of these different ideas? So initially,
there were about 54 ideas that went back out to states, and those were subsequently narrowed
down to about 35 actions for public health community to really have that focus over the
next five years.
And so pictorially, what I have on the next slide is just showing you how this map looks,
and this is really kind of in a two-dimensional space, but all of those numbers represent
an individual action item that was recommended and came through this process, but they really
cluster around some specific components. They don't just individually float out there, and,
really, they hang together in four particular ways. So one was to ensure a competent workforce.
The other is to educate and empower the nation. The third theme was to monitor and evaluate,
and the fourth theme was to develop policies and mobilize partnerships.
So, as you all know, you're very familiar with the ten essential services of public
health and including the three core public health functions of assessment, policy development,
and assurance, and this wheel is important, and I'll link it back to our concept map in
a minute. But, really, we want to make sure that our work focuses on population health,
that we really stick to our core function in public health of the identification and
monitoring of health, and then making sure that we align our resources and protect health.
So, in using this public health framework, we've really aligned, and that is the blue
circle that you'll see in the middle that has, at the core, applied research and translation,
how we obtain and sort of gain knowledge, along with how do we assure in terms of the
assurance function, the assessment function, and policy development. And then placed around
this are the four components of the concept map ñ again, monitoring and evaluating, educating/empower
the nation, developing policy and mobilizing partnerships, and then ensuring a competent
workforce.
And so in this slide, I really just provide, again, there are 35 different action items
in the Road Map, and we'll talk about those more as we progress today, but I just wanted
to give you four examples, and this is including some work that we're currently doing with
ASTHO. So one example of an action item ñ and these action items, it's very important
that they're not so specific that they wouldn't apply to some states. They're at a level where
specific actions could be placed within them. So again, we want these to be able to apply
across all states and be able to, then, resonate at the local level, as well.
So in terms of "monitor and evaluate," an example is to conduct a national-level review
of the caregiver programs and policies that are consistent with The Guide to Community
Preventive Services and methodologies. An important issue is, "What is the public health
role in looking at this in partnership with many other national partners?"
Another ñ "education and empower the nation" ñ would be to create awareness by contributing
public health information and data about cognitive health and impairment to national reports
and partners. And again, this is a function that many states do, and so this is a way
to get cognitive health a part of thinking about not only the physical health, which
we're very used to doing in public health, as well as the mental or emotional health,
but really having cognition be the third leg of that three-legged stool.
And then, in terms of "develop policy and mobilized partnerships," an example there
would be to integrate cognitive health and impairment into your state and local plan.
So some of you may have an aging plan, and you work with them to look at that and make
sure that impairment is there, to look at coordinated chronic disease plans, and, in
addition to physical health and mental health, do they have cognitive health? Preparedness,
an important area for all of us in thinking about, both, at the local and the state level,
and then falls work, as well as transportation plans. So there are many sectors where this
could be involved and has state leaders involved and influencing.
And then an example from the "workforce" would be to develop strategies to help ensure that
state public health departments have expertise in cognitive health and impairment related
to research and best practices. And this seminar is one of those ways to begin to talk about
that.
And so I'll just mention, in my final slide, some of the current implementation activities
by CDC, and we're develop, now, sort of for our whole initiative, a logic model and narrative
to begin to share with others who may want to use some components of that to sort of
think about this work and how it can be forwarded and how it relates together. And then, we're
selecting priorities at CDC that meet our mission.
And then just a couple examples of one of our big goals is to enhance our own partnerships
and developing new funding opportunities with states and partners. So with ASTHO, we are
reviewing, currently, caregiver strategies. Using a public health lens, we're developing
a number of case studies, as well as sponsoring webinars such as this one. And then our colleagues
at the National Association of Chronic Disease Directors have out a new opportunity grant
to implement to selected action items from the Healthy Brain Initiative, and I've given
the RFA number there, and I hope that we can talk a little bit more about that at the question-and-answer
period. And so with that, I'll just give you our contact information and then turn it back
to Lynn.
Great. Thank you so much, Dr. Anderson, and, yes, we can definitely discuss that a little
bit more at the end. And if folks have questions right now, again, feel free to type those
in the chat box. And up next, we have Dr. Jewel Mullen, the commissioner of the Connecticut
Department of Public Health.
Thank you and good afternoon, everyone. I hope you can hear me all right, as well.
Mm-hmm. We can. Thank you.
So I am especially pleased and privileged to be included in this presentation. I've
been commissioner in Connecticut for 3 years, but it's been almost 20 years since I did
a postdoc as I got my masters of public health degree, and my focus was, then, what was called
"successful aging" with a big focus on community dwelling, older adults, and what I would think
about as the sort of the social determinants of healthy aging. So 20 years later, I have
to say that, periodically, when I, as a public health commissioner, talk about my interest
in healthy aging, people still wonder what public health has to do with that, particularly
as they think about older adults from the framework of a health care system and hospital
readmissions or long-term care or when they throw their hands up and aren't sure what
to do about the booming age of the baby-boom population that Dr. Anderson just characterized
in her presentation.
So it's wonderful to be having this conversation, understanding that the National Public Health
Road Map to maintaining positive health is a call to action and the guide for implementing
a coordinated approach to moving cognitive health into the national public health arena.
And it's wonderful to have the shared leadership of CDC and the Alzheimer's Association because
this collaboration of synergistic thinking is really essential to moving the work forward.
So what we're seeing is a shared vision that's still a work in progress but that builds on
a foundation of work that's been done already, established a framework within which we can
view findings of that work, and helps lay out an agenda for the future. And, for me,
as we have this focus on the Healthy Brain Initiative, it's part of what's important
to me to think about in considering what it takes for people to live and age well in their
community.
So just a little bit about Connecticut ñ Connecticut is a relatively small state ñ
3.5 million people, and 14.2 percent of us ñ or, well, I'm getting there ñ are 65 or
older. That 14 percent is actually a 7.7 percent increase from the 2000 to 2010 census. Data
from the American Community Survey show that 18.2 percent of Connecticut residents are
veterans, and half of those veterans are greater or equal to 65 years of age. And from the
American Community Survey, 33 percent of adults greater or equal to the age of 65 report having
a disability, and among them, 11 percent report that that disability is a cognitive one that
causes them problems with their daily living.
You may have seen, last summer, the America's Health Rankings from the United Health Foundation.
The senior report that accompanied the overall health rankings in which Connecticut was ranked
seventh overall in the health of seniors, and two areas in which we were cited as ranking
highly were in the high prevalence of dental visits and health screenings for our older
adults and the low prevalence of teeth extractions.
And as we do this work in Connecticut and always keep a health equity focus on it, I
do want to point out that, along with those data, what we also understand from a National
Association of Chronic Disease Directors-funded project that enabled us to go out into long-term
care facilities and a community congregate meal settings, like at senior centers, we
actually saw a little bit deeper picture of what the oral health status of adults ñ older
adults in Connecticut was because almost half of the adults in the outpatient meal settings
reported that they had poor condition of their teeth or dentures, and about half had had
partial or full extractions. So we like to look at our aggregate data and continue to
look deeper at the same time.
Also noted in that seniors report as that Connecticut was cited as having a low percentage
of hospice care, not enough hospice care available to our older ñ or to our communities, in
general, that more than a third of people had multiple chronic conditions, and almost
a third reported physical inactivity. Those latter two, the multiple chronic conditions
and physical inactivity, are certainly important for us to continue thinking about as we think
about overall health and the contributions to cognitive dysfunction and decline.
The long-term goal with the Healthy Brain Initiative, to maintain or improve cognitive
performance of all adults, only can be achieved through collaborative and effective partnerships
at the national, state, and local level. On this slide, for the domain of developing policies
and mobilizing community partnerships, we see the Alzheimer's disease plan, having a
state plan on aging, a task force on Alzheimer's disease and dementia, and legislative commission
on aging as some of the strategies that are really key to getting the work done in this
domain. The coordination of contributions by private, nonprofit, and governmental partners
may provide leverage for synergistic opportunities and more comprehensively address and promote
cognitive functioning and the needs of care partners.
I wanna point this out because a lot of times in public health, when we do our work across
the lifespan, after we start to see how we frontload our efforts and budgets on maternal-child
health and early childhood work, you can almost feel as if there aren't enough resources to
get anything done once you get to middle- and older-age adults. So those community partnerships
and public-private partnerships are especially important for us to continue to develop to
answer questions such as, "Well, how are we ever gonna have the resources to move this
work forward?" And beyond that, these are multisectoral efforts that cross so many elements
of people's lives and communities that it's important to have the partnerships working.
Partnership with primary care and public health is especially important for a lot of reasons
which are pretty obvious, and I just wanna point out that part of that also comes to
the issue of early detection and diagnosis in order to provide the best medical care
and outcomes for people at any stage of the disease. And many times, it's going to be
in those communications with the primary care world that people will start to disclose or
family members will bring to light problems that people are having at home with their
memory, with confusion, and with those situations worsening.
Opportunities for partnerships at the national, state, and local level have been talked about
in a number of ways in public health, as we've talked about ñ state innovation model grants,
community health needs assessments, and the integration of public health primary care
or state, or local health agencies move towards accreditation. So within the Affordable Care
Act, the IRS requirement for health care facilities, hospitals, to do community health needs assessments
and collaboration with their local partners gives us another opportunity to ensure that
there's a focus to ask the question whether or not those assessments and plans include
support of Alzheimer and dementia's work.
In the domain of educating and empowering the public, here in Connecticut, there are
some specific things that we have been working on. First, our state health assessment and
state health improvement planning that's been ongoing for about a year and a half now involves
over 100 different organizations who are our partners. We have identified some metrics
and goals that we're going to finalize next month, and in those are some very aging and
cognitively focused measures that we're going to be including. We also have very strong
relationships with home care providers who are partners in helping define what else needs
to happen to ensure healthy living and aging in communities.
Last year, our governor restored the Connecticut Department of Aging, an agency which had been
sunsetted almost two decades ago, and they are a key partner for us in addressing issue
for individuals, as well as the population health of older adults. We have growing, strong
partnerships with foundations in the state who are either funders for aging research
and are now, as well, moving into an emphasis on healthy aging and communities. There's
been strong representation from AARP on our health-reform-related efforts, and we're about
to create our own Connecticut healthy aging state plan. So all these are partnerships.
They're the kinds of partnerships that we also need to continue the work of educating
and empowering not just the nation but people in our own state.
The issues around ensuring a competent workforce have been particularly important to us because
we are in the process of transforming our health care system and the way that has identified
gaps in the health care workforce in a number of domains, and there's been intense conversation
about how we, as a state, are going to prepare the medical community to be there for our
aging population through training for medical students and expanding the numbers of geriatrics
providers in the state. But along with that, knowing that the shortages of providers are
in the thousands, we're focusing a lot on effective team-based care.
This year, we also have legislation just introduced by the governor last week around expanding
scope practice for nurse practitioners. Many of you probably know that this is a somewhat
contentious issue for a number of reasons in many states as people look at what level
of providers should be delivering what type care. Along the way, as we have these conversations,
though, I believe we're going to be able to define a number of ways in which nurse practitioners
can really fill some gaps in our workforce.
At the same time, we have a strengthening, effective collaborate with our AHEC ñ our
Area Health Education Centers ñ who are going to be working with us around a formal curriculum
for training community health workers and navigators who, as we transform health care
system, should become part of the team and whose work should be possibly licensed but
also reimbursed. That's another key workforce component that's going to be necessary for
our older population.
The last thing that I would say as a state health official is that it's so important
for us to really stay in touch with work that's being done in our agencies across programs,
work our staff might be doing that we're not even aware of, whether or not it's contributing
to efforts around patient-centered medical homes, chronic disease self-management program,
injury prevention with a focus on falls prevention, community transformation grants, and good
land use or transportation, oral health ñ as I alluded to before ñ are strengthening
the local health system to work with area agencies on aging who can be especially helpful
to adults with cognitive impairment and particularly essential partners for the caregivers of those
individuals. I feel as if I could go on because I'm so passionate about this, but I know that
it's time for me to actually, if not present, at least pave the way for Katherine Morrison
for the next part of the presentation. Thank you.
Excellent. This is Catherine Morrison. I'm with Alzheimer's Association. Can everyone
hear me?
Yes.
Just a sound check ñ can everyone hear me?
Yes.
Okay, great. Excellent. Sorry ñ new system to learn. Well, thanks so much for joining
us today to hear about the Road Map, to hear about all the good things associated with
it. Thank you, ASTHO, for inviting the association to be part of this webinar and to Lynda for
doing the setup and explaining how we got to this place, and Dr. Mullen did such a great
job of talking about how the Road Map and the domain really fit nicely into our broader
public health work. And there's so much opportunity, as she was saying in the notes that she ended
with, that there's a lot of opportunity ñ just use the Road Map to integrate cognitive
health and Alzheimer's disease and address the needs of caregivers into our broader public
health work.
But I wanna talk about, today, some very specific examples within the four domains, again, of
what states are already doing to implement the road map, and just as a first note, I
would say the biggest thing the states are doing is using the road map as a convening
tool, using it as a booklet and a set of ideas to think about addressing these issues in
the broader public health context. So there's a lot of really exciting work going on around
specific action items. I'm gonna speak to that real shortly, but, also, I would just
say the biggest piece right now, and it's very, very early implementation stage, is
that people are using it to think about and assess their own department's work on these
issues, and that is a critical first step in thinking about the Road Map.
So going to my first slide here, Assure a Competent Workforce, we just heard about how
important that is. I wanna pull up this example from New York State, and W-06 details making
sure physicians are aware of validated cognitive assessment tools. In New York, the commissioner
of health issued a "Dear Colleague" letter to all doctors, hospitals, clinics, medical
schools, and managed care plans for the state detailing the importance of early detection
and those validated cognitive assessment tools.
Now, you can find this on the New York Department of Health's webpage under their Alzheimer's
page. They're one of the few state departments of health that already have information on
Alzheimer's disease on their website. This has stirred a lot of conversation in the state
of New York. People have asked questions. They have asked to be linked to resources,
looking for training, so this has been a real too for helping inform physicians and other
medical care providers and make sure they're connected to resources. I'd also say that
in Georgia the commissioner of health there has also agreed to do a "Dear Colleague" letter,
so this is a very easy thing to do ñ use systems that are already in place to communicate
with these individuals and make sure they know what resources are available out there.
So what is the "monitor and evaluate"? This is obviously the foundation of assessment
and the work that public health does, and we've seen states already using data from
the BRFSS in their needs assessment among all counties of public health. So in the state
of Missouri, a survey went out to all local counties of public health to assess what are
the diverse needs among their constituents, their population among racial, geographic,
different kinds of breakdowns, and so they started that in early January, and they're
going to present the results back to the community in early March. So again, just a very simple
survey looking to ñ it was sent to all public health administrators in each local public
health county in the state of Missouri asking about their needs around cognitive health
and addressing the needs of caregivers.
M-02 talks about BRFSS data and putting it to work, so thinking about how we can incorporate
in all the public health work that we do. And we've seen in a few states ñ in California
and Oregon ñ where they're taking the data to influence their preparedness efforts and
also falls prevention, so specifically in California speaking about the numbers of individuals
who live alone with that increased confusion on memory loss and how to reach those individuals
in terms of falls prevention.
Educate and empower ñ so in all the presentations that we've done, as an association, this is
always the domain that really seems to speak to public health in the biggest way, and I
have a couple pictures here from symposium events that have been conducted around this
domain and around the road map, generally, to really talk about these issues and start
to track priorities. So the topics you'll hear from Minnesota has some very diverse
participants ñ schools of public health, aging public health, academics ñ to come
together to really focus on two or three priorities within that. They're having a follow-up meeting
to that at the end of February. And then the other picture is from Saint Louis University
in Missouri, again a symposium event, invited public health practitioners, aging officials,
into groups to determine priorities, so within this action item really using the Road Map
as a convening tool to establish priorities and to focus energies.
So finally, in Develop Policy and Mobilize Partnerships, P-01 is probably where an area
where we've seen the most impact of the Road Map. And Connecticut and several other states
where the task forces that we're in the midst of planning their state plans ñ or writing
them ñ have really used the Road Map as a tool to think about what should be incorporated
into those state plans, the state Alzheimer's disease plan. So we see a lot of language
that mirrors from those plans and the Road Map, and that's nice to dovetail as many things
as possible so we're coordinating our work.
And then P-03 talks about expanding programs to consider issues like cognitive health and
impairment, and something that we've seen in Oregon, again, is expanding their preparedness
work to address individuals of cognitive impairment specifically to include these issues in a
toolkit that goes off to their local counties of public health. So these are just a few
ideas of how to incorporate the Road Map into the work that you're doing, how to use it,
some ideas that you can copy off of. The slides that will be sent off have some links to find
these resources, to find what other states are doing in this area, so quick and short
'cause I think ñ I'll just pass that along for Lynn to take over, now.
Mm-hmm. Great. Thank you so much to all of our presenters ñ Katherine Morrison, Jewel
Mullen, and Lynda Anderson. So, yes, we definitely ñ we have a few moments for questions or
comments. I wanted to let folks know one has come through the chat box, and Jewel answered
via chat, but it would be great if you could answer verbally, as well. The question was,
"How is mental health integrated in your work?" So if Dr. Mullen could start and then if Miss
Morrison or Dr. Anderson have comments to add, that would be great.
And I have a comment, as well ñ this is Lynda.
Okay. Perfect.
Okay. Can you hear me?
Yes.
Yes.
Great. So we're tackling this from a few different directions. Our epidemiologists are taking
a deeper look at the responses that we received to the BRFSS Cognitive Impairment Module and
is going to make a fact sheet which is going to help us highlight for primary care providers
and others what the needs are and what problems we've identified among both adults who have
identified themselves as cognitively impaired and their caregivers because when we think
about the behavioral health side, we're thinking about it from the perspective of the affected
individual and the family and others that support them. So that's one piece of it.
Another is that we are ñ because Connecticut has been among the states cited for inappropriate
use of psychotropic medications among older adults, particularly in long-term care, we've
had a number of work groups dealing with that right now, and that's really gotten us to
do more trainings with providers around appropriate management ñ behavioral management folks.
Through our state health assessment, we've also identified in Litchfield County, which
has the population with the highest average in median age, issues around binge drinking,
suicide and social isolation, particularly where there's not great transportation.
So that's going to be work that we'll be talking with our area agencies on aging about how
to address some of the social support needs there. But that's, in certain ways, just scratching
the surface, but those are some of the ways in which we'll be doing that from public health.
Of course, we always have to partner with the Department of Mental Health and Addiction
Services, too.
Oh, excellent, Jewel. And this is Lynda Anderson. I'll add on a little bit to that. One of the
things, when we started working on cognitive health, is I said we really sort of looked
at both physical health, mental health, and cognitive health, and our work here at the
Healthy Aging Program, we've actually done a considerable amount of work in mental health,
and we have several briefs on our website that talk about the data on mental health
in terms of states. We have the State of Health in America report that includes measure of
well-being and issues, plus the Guide to Community Preventive Services, which is really CDC's
way to get out information about evidence-based programs.
We had sponsored a review of looking at depression interventions, and, on the site, now, it talks
about those that are evidence-based and what's recommended, and I think your point is well
taken. It's really the cognitive ñ emotional health are very closely intertwined just as
physical health, mental health, and cognitive health. So we're just trying to, in a sense,
add cognitive health to the areas that public health has really done a lot of work in and
so a really excellent question. Thank you.
Great. Thank you. And one other question that has come through the chat is, "Are any states
funding state or local public health to address cognitive impairment?"
Kate, do you know? This is Lynda Anderson. I'm not familiar. Angie Deokar's in the room
with me, and both of us said we're not familiar with that, but I think that would be an important
thing to begin to look at as part of this initiative, as the Road Map was just released
in July, so many of the implementation pieces that Kate has talked about are beginning,
and so that's one of the things that I think we'd love to get a better handle on ñ is
looking at that and being able to share that.
I don't know of any states ñ this is Kate Morrison from the association ñ that are
directly funding ñ have created a funding stream. Now, I know there's a few states that
have someone in their health departments doing Alzheimer's disease work. It's usually paired
with arthritis or some other chronic disease, and it's not a full program. It's just part
of someone's responsibility. So in Texas, they have an Alzheimer's disease coordinator,
for example. The state of Iowa has tried to create a role, and FTE to do ñ to have a
program coordinator, so I think there is definitely some interest and some examples out there
of why that's so important. But again, like Dr. Anderson, I think it's an important thing
for us to do is scan to see ñ where are those resources and capabilities? And how can the
Road Map and the Association, the CDC, and ASTHO all support that?
And this is Jewel Mullen. I would call this question a great ñ a call for a "silo buster"
opportunity because it may be that there is some funding some place, but people don't
think of including public health in it, and it may depend, state-by-state, how strong
partnerships are. I think the AARP can be a great partner at the state and local level
helping reinforce that public health has a role here, particularly if, for many people,
the issues become those around nursing homes, long-term care, without getting enough conversation
about the growing number of people who are going to age in place with or without cognitive
decline. And similarly, if cognition considered a disability, it may be that the work is thought
of as being in a disability agency as opposed to public health. So we, inside government,
you know, are responsible for creating partnerships and breaking down fences between ourselves,
and I think our other partners outside of government can help us do that, as well.
This is Kate again, and a couple people just sent chat messages. North Dakota has funded
care coordinators to augmenting this new staff in the state, and they have a phenomenal care
coordination program that's actually featured ñ highlighted in the Road Map itself. And
then in Mississippi, they have a division, an Alzheimer's division. They do a ton of
great work in the Department of Mental Health around Alzheimer's disease, so definitely
two places to look up and the good work being done in those states. And as Dr. Mullen said,
looking to creative places to find out where those partners are to move the issue forward.
And Lynn, this is Lynda Anderson. I think one of the other things that would be nice
ñ if we could distribute of opportunity grants to implement selected actions out to people
on the phone today in case they haven't seen this. I think that would be helpful, and they
could see where they could partner with others in the state, and those applications are due
on March 14th coming up, but there's still time to reach out and think about particular
projects.
Mm-hmm. Definitely. Yeah, I can include that in the follow-up e-mail with some of the resources
that have been discussed today, as well as the recording. I didn't know if you wanted
to give a little more background on that in case folks haven't heard of it before ñ of
the opportunity grants.
If there's no other questions, let me just take a minute to do that.
Mm-hmm. Yep. Yep.
This is the National Association of Chronic Disease Directors with support from CDC, the
availability of funds for state and territorial health departments, and, really, what we're
trying to do with that is to ñ we have six priorities which were done through a subsequent
process after the concept mapping was done, some Delphi process was done. And so the key
areas that we're looking at is in promote incorporation of cognitive health and impairment
and to state and local health burden reports, you know, again, using the surveillance data
to enhance awareness and action in public health programming, to develop strategies
to ensure that public health has expertise in cognitive health, about developing and
maintaining state Alzheimer's disease plans, and then engaging national and state organizations
to examine policies that may differentially impact persons with dementia, and then to
integrate cognitive health and impairment into state and government plans, and several
of those were ones that I had mentioned.
And so the funds will really support those actions. If there are other actions that states
would like to include, they can go through the Road Map, which everyone has a link to
and look at that and align that with your programs and then make a case for why that
would be an important thing to do.
The other thing I'll point out is we're anticipating around 11 grants, and they will vary between
$15,000.00 ñ kind of a mini sort of grant to get some things going ñ to $50,000.00
to do some more intensive, and our hope is really, again, for these to serve some synergy
across the efforts that Kate had talked about and other initiatives working with those partners
to really, again, that integration of cognitive health into what we're doing ñ not a new
siloed program but to make cognitive health a part of what public health does to serve
the needs of people in their states.
Hello?
Yes, this is Jody Mishan. I'm from Hawaii.
Yes?
I coordinate the state plan on Alzheimer's disease and related dementias that's about
to come out. It's at the designer, right now. I just wanted to share that the Department
of Health, the Executive Office on Aging, is who I work for, and they're a branch of
ñ a department in the Department of Health. The State Health Planning and Development
Agency has subarea councils for every county here, and the Honolulu County subarea council,
I presented to them about the Road Map. And, as you said, as a tool for convening, it's
really effective with great suggestions, and they decided to adopt, as their yearly project,
to do a public awareness campaign.
And it's been expanded recently to include education of PCPs involving the Department
of Geriatrics at the medical school here to create a curricula for early diagnosis and
detection ñ accurate diagnosis. And so it's just at the very beginning, but it's wonderful
because a doctor came; a neurologist said that it would be important to also do the
professional training along with that. So it's kind of exciting. And it really did all
start with this booklet, and it's a wonderful tool and really appreciate having it.
Thank you so much, and we'd love to find out more and continue to follow your initiatives,
as well as others in the states that are doing that. This is exactly what we're hoping that
this will serve ñ as a guide to bring people together and think about these very issues,
so thank you so much.
You're welcome. Thank you.
This is Lynn again, and I know we're reaching the top of the hour. But if anybody has any
last minute questions, please feel free to ask by pressing "*7," and I've also included
my contact information: lshaull@astho.org, and I can get in touch any of the presenters
if you have any follow-up questions that come to you later today as you're eating dinner
or driving home. I just wanted to thank, again, everyone who participated on today's webinar.
Everybody who attended and presented, thank you very much for joining us.
Following, once you close your side box, you'll be taken to a survey ñ evaluation. So if
you could, please fill that out for us. That would be fantastic. As you've said, this is
the first of many webinars that we'll be convening. So the more we learn from you ñ the earlier,
the better. And with that, please plan on joining us next month on March 17th at 3:00
PM Eastern Time, where we'll have the 2nd webinar, and it will be focused on cognitive
health and injury prevention. So thank you again, everyone, for attending and have a
wonderful afternoon.
Thank you very much everyone. Bye-bye.
Bye.
Thank you. Please standby.
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