2019 Alzheimer's disease facts and figures
Tóm tắt
This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report examines the use of brief cognitive assessments by primary care physicians as a tool for improving early detection of dementia. An estimated 5.8 million Americans have Alzheimer's dementia. By mid‐century, the number of people living with Alzheimer's dementia in the United States may grow to 13.8 million, fueled in large part by the aging baby boom generation. In 2017, official death certificates recorded 121,404 deaths from AD, making AD the sixth leading cause of death in the United States and the fifth leading cause of death among Americans age ≥65 years. Between 2000 and 2017, deaths resulting from stroke, heart disease, and prostate cancer decreased, whereas reported deaths from AD increased 145%. In 2018, more than 16 million family members and other unpaid caregivers provided an estimated 18.5 billion hours of care to people with Alzheimer's or other dementias. This care is valued at nearly $234 billion, but its costs extend to family caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Average per‐person Medicare payments for services to beneficiaries age ≥65 years with Alzheimer's or other dementias are more than three times as great as payments for beneficiaries without these conditions. Total payments in 2019 for health care, long‐term care and hospice services for people age ≥65 years with dementia are estimated to be $290 billion. Early detection of Alzheimer's offers numerous medical, emotional and financial benefits—benefits that accrue to affected individuals and their families as well as to society at large. Alzheimer's Association surveys regarding brief cognitive assessments for detection of dementia found that while a large majority of seniors and primary care physicians say the assessments are important, only half of seniors have received an assessment, and only 16 percent of seniors receive regular cognitive assessments. Many educational opportunities exist to facilitate increased use of brief cognitive assessments in the primary care setting.
Từ khóa
Tài liệu tham khảo
National Institutes of Health.National Institute on Aging.What happens to the Brain in Alzheimer's Disease? Available at:https://www.nia.nih.gov/health/what‐happens‐brainalzheimers‐diseaseAccessed September 14 2018
De Reuck J, 2018, Aging and cerebrovascular lesions in pure and in mixed neurodegenerative and vascular dementia brains: A neuropathological study, Folia Neuropathol, 56, 81, 10.5114/fn.2018.76610
National Institute on Aging.What are frontotemporal disorders? Available at:https://www.nia.nih.gov/health/what‐are‐frontotemporal‐disordersAccessed December 19 2018
Stojkovsa I, 2018, Molecular mechanisms of alpha‐synuclein and GBA1 in Parkinson's disease, Cell Tissue Res, 373, 51, 10.1007/s00441-017-2704-y
McKhann GM, 2012, Alzheimer's disease — Modernizing concept, biological diagnosis and therapy, 115, 10.1159/000335402
Fukushima RLM, 2016, Effects of cognitive stimulation on neuropsychiatric symptoms in elderly with Alzheimer's disease: A systematic review, Dement Neuropsychol, 10, 178, 10.1590/S1980-5764-2016DN1003003
Grossberg GT, 2010, The art of sharing the diagnosis and management of Alzheimer's disease with patients and caregivers: Recommendations of an expert consensus panel, Prim Care Companion J Clin Psychiatry, 12
2018 Published by the National Down Syndrome Society New York NY National Down Syndrome Society Aging and Down syndrome: A health and well‐being guidebook
2015, Cognitive Aging: Progress in Understanding and Opportunity for Action
Sajeev G, Diabetes. The AlzRisk Database. Alzheimer Research Forum
Gottesman RF, 2017, Association between midlife vascular risk factors and estimated brain amyloid deposition, JAMA, 17, 1443, 10.1001/jama.2017.3090
Corrada MM, 2017, Age of onset of hypertension and risk of dementia in the oldest‐old: The 90+ Study, Alzheimers Dement, 103, 10.1016/j.jalz.2016.09.007
MHarrington JWeuve JWJackson DBlacker.Physical Activity. The AlzRisk Database. Alzheimer Research Forum Available at:http://www.alzrisk.orgAccessed September 14 2018
Tan ZS, 2017, Physical activity, brain volume, and dementia risk: The Framingham Study, J Gerontol A Biol Sci Med Sci, 72, 789
Stephen R, 2017, Physical Activity and Alzheimer's Disease: A systematic review, J Gerontol A Biol Sci Med Sci, 72, 733
Soni M, 2017, Physical activity pre‐ and post‐dementia: English Longitudinal Study of Ageing, Aging Ment Health, 17, 1
Grzywacz JG, 2016, Workplace exposures and cognitive function during adulthood: Evidence from National Survey of Midlife Development and the O*NET, J Occup Environ Med, 58, 535, 10.1097/JOM.0000000000000727
Harris CD, 2013, Adult participation in aerobic and muscle strengthening physical activities — United States, 2011, Morb Mortal Wkly Rep, 62, 326
Steptoe A, 2005, Aging, Health, and Public Policy
Karp A, 2005, Mental, physical and social components in leisure activities equally contribute to decrease dementia risk, Dement Geriatr Cogn Disord, 21, 65, 10.1159/000089919
Yates LA, 2016, Cognitive leisure activities and future risk of cognitive impairment and dementia: Systematic review and meta‐analysis, Int Psychogeriatr, 9, 1
Sanjeev G, 2016, Late‐life cognitive activity and dementia, Epidemiology, 27, 732, 10.1097/EDE.0000000000000513
Centers for Disease Control and Prevention, 2017, Traumatic Brain Injury‐Related Emergency Department Visits, Hospitalizations, and Deaths — United States, 2007 and 2013, MMWR Surveill Summ, 66, 1
Centers for Disease Control and Prevention.Traumatic Brain Injury & Concussion.Potential Effects Available at:https://www.cdc.gov/traumaticbraininjury/outcomes.htmlAccessed September 14 2018
He W, 2016, International Population Reports, P95/16‐1, An Aging World: 2015
U.S. Census Bureau.National Population Projections: Downloadable Files Available at:https://www.census.gov/data/datasets/2014/demo/popproj/2014‐popproj.html2014Accessed December 18 2018
Administration on Aging.Administration for Community Living U.S. Department of Health and Human Services. A Profile of Older Americans Available at:https://www.acl.gov/sites/default/files/Aging%20and%20Disability%20in%20America/2016‐Profile.pdf2016Accessed December 18 2018
2006, Early‐Onset Dementia: A National Challenge, a Future Crisis
Healthy People 2020. Dementias Including Alzheimer's Disease Available at:http://www.healthypeople.gov/2020/topics‐objectives/topic/dementias‐including‐alzheimers‐disease/national‐snapshotAccessed December 18 2018
Alzheimer's Association.Alzheimer's Disease Facts and Figures. Special report: Disclosing a diagnosis of Alzheimer's disease Available at:https://www.alzheimersanddementia.com/article/S1552‐5260(15)00058‐8/fulltext2015Accessed December 18 2018
Manly JJ, 2004, Critical perspectives on racial and ethnic differentials in health in late life, 95
Lines LM, 2014, Racial and ethnic disparities among individuals with Alzheimer's disease in the United States: A literature review
Freedman VA, 2018, Short‐term changes in the prevalence of probable dementia: An analysis of the 2011–2015 National Health and Aging Trends Study, J Gerontol B Psychol Sci Soc Sci, 73, S48, 10.1093/geronb/gbx144
Sullivan KJ, 2018, Declining incident dementia rates across four population‐based birth cohorts, J Gerontol A Biol Sci Med Sci
Kommer TN, 2018, Time trend in persistent cognitive decline: Results from the longitudinal aging study Amsterdam, J Gerontol B Psychol Sci Soc Sci, 73, S57, 10.1093/geronb/gbx151
Prince MJ, 2015, World Alzheimer Report 2015: The Global Impact of Dementia: An Analysis of Prevalence
Ortman JM, 2014, An Aging Nation: The Older Population in the United States, Current Population Reports, P25‐1140
Heron M, 2018, Deaths: Leading causes for 2016
U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Center for Health Statistics.CDC WONDER online database: About Underlying Cause of Death 1999‐2017 Available at:http://wonder.cdc.gov/ucd‐icd10.htmlAccessed December 18 2018
World Health Organization, 2004, International Statistical Classification of Diseases and Related Health Problems
Romero JP, 2014, Under reporting of dementia deaths on death certificates: A systematic review of population‐based cohort studies, J Alzheimers Dis, 41, 213, 10.3233/JAD-132765
Tejada‐Vera B, 2013, Mortality from Alzheimer's disease in the United States: Data for 2000 and 2010
U.S. Burden of Disease Collaborators, 2018, The state of U.S. health, 1990‐2016: Burden of diseases, injuries, and risk factors among U.S. states, JAMA, 319, 1444, 10.1001/jama.2018.0158
Friedman EM, 2015, U.S. prevalence and predictors of informal caregiving for dementia, Health Aff, 34, 1637, 10.1377/hlthaff.2015.0510
BSpillman JWolff VAFreedman JDKasper.Informal Caregiving for Older Americans: An Analysis of the 2011 National Health and Aging Trends Study Available at:https://aspe.hhs.gov/report/informal‐caregiving‐older‐americans‐analysis‐2011‐national‐study‐caregivingAccessed December 18 2018
Walmart.2018 Annual Report Available at:https://s2.q4cdn.com/056532643/files/doc_financials/2018/annual/WMT‐2018_Annual‐Report.pdfAccessed December 17 2018
McDonald's Corporation Report 2017 Available at:https://corporate.mcdonalds.com/content/dam/gwscorp/investor‐relations‐content/annual‐reports/McDonald%27s%202017%20Annual%20Report.pdfAccessed December 17 2018
Official Data Foundation.CPI inflation calculator Available at:http://www.in2013dollars.com/2017‐dollars‐in‐2018?amount=139765Accessed December 17 2018
Alzheimer's Association.Issues Brief: LGBT and Dementia Available at:https://www.alz.org/media/Documents/lgbtdementia‐issues‐brief.pdfAccessed September 19 2018
Kasper JD, 2014, Disability and Care Needs of Older Americans by Dementia Status: An Analysis of the 2011 National Health and Aging Trends Study
National Alliance for Caregiving in Partnership with the Alzheimer's Association.Dementia Caregiving in the U.S. Bethesda Md Available at:http://www.caregiving.org/wp‐content/uploads/2014/01/Dementia‐Caregiving‐in‐the‐US_February‐2017.pdfAccessed December 18 2018
Unpublished data from the 2015 and 2016 Behavioral Risk Factor Surveillance System survey analyzed by and provided to the Alzheimer's Association by the Alzheimer's Disease and Healthy Aging Program (AD+HP) Centers for Disease Control and Prevention (CDC)
National Poll on Healthy Aging.Dementia Caregivers: Juggling Delaying and Looking Forward Available at:http://www.healthyagingpoll.org/sites/default/files/2017‐10/NPHA_Caregivers‐Report‐PROOF_101817_v2.pdfAccessed December 18 2018
National Alliance for Caregiving and AARP.Caregiving in the U.S.: Unpublished data analyzed under contract for the Alzheimer's Association.2009
Alzheimer's Association.2014 Alzheimer's Disease Facts and Figures. Special Report: Women and Alzheimer's Disease Available at:https://www.alzheimersanddementia.com/article/S1552‐5260(14)00062‐4/fulltextAccessed December 18 2018
Sorensen Pinquart M, 2006, Gender differences in caregiver stressors, social resources, and health: An updated metaanalysis, J Gerontol B Psychol Sci Soc Sci, 61, P33, 10.1093/geronb/61.1.P33
Ma M, 2017, Alzheimer's disease and caregiving: A meta‐analytic review comparing the mental health of primary carers to controls, Aging Ment Health, 5, 1
National Alliance for Caregiving AARP.Caregiving in the U.S. Available at:http://www.caregiving.org/wpcontent/uploads/2015/05/2015_CaregivingintheUS_Final‐Report‐June‐4_WEB.pdf2015Accessed December 18 2018
Liu W, 2009, Aging families and caregiving, 85
Goren A, 2016, Impact of caring for persons with Alzheimer's disease or dementia on caregivers' health outcomes: Findings from a community based survey in Japan, BMC Geriatr, 16, 122, 10.1186/s12877-016-0298-y
Alzheimer's Association.2016 Alzheimer's Disease Facts and Figures. Special Report: The Personal Financial Impact of Alzheimer's Disease on Families Available at:https://www.alzheimersanddementia.com/article/S1552‐5260(16)00085‐6/fulltextAccessed October 25 2018
Vitaliano PP, 2017, Objective and subjective cognitive problems among caregivers and matched non‐caregivers, Gerontologist, 57, 637
Polenick CA, 2018, Stressors and resources related to medication management: Associations with spousal caregivers' role overload, Gerontologist
Badana ANS, 2017, Racial differences in caregiving: Variation by relationship type and dementia care status, J Aging Health
Mausbach BT, 2014, Why does placement of persons with Alzheimer's disease into long‐term care improve caregivers' well‐being? Examination of psychological mediators, Psychol Aging, 29, 776, 10.1037/a0037626
Peng H‐L, 2012, Sleep disturbance in family caregivers of individuals with dementia: A review of the literature, Perspect Psychiatr Care, 49, 135, 10.1111/ppc.12005
MetLife Mature Market Institute.The MetLife Study of Alzheimer's Disease: The Caregiving Experience.2006 Available at:http://docplayer.net/20982840‐The‐metlife‐study‐of‐alzheimer‐s‐disease‐the‐caregiving‐experience.htmlAccessed December 18 2018
Kiecolt‐‐Glaser JK, 1995, Slowing of wound healing by psychological stress, Lancet, 346, 1194, 10.1016/S0140-6736(95)92899-5
AARP.Family Caregiving and Out‐of‐Pocket Costs: 2016 Report Available at:https://www.aarp.org/content/dam/aarp/research/surveys_statistics/ltc/2016/family‐caregiving‐costsfact‐sheet.doi.10.26419%252Fres.00138.002.pdfAccessed December 18 2018
Maslow K, 2012, Translating Innovation to Impact: Evidence‐Based Interventions to Support People with Alzheimer's Disease and their Caregiver at Home and in the Community
Rosalynn Carter Institute for Caregiving.Caregiver Intervention Database Available at:http://www.rosalynncarter.org/caregiver_intervention_database/Accessed December 18 2018
Liew TM, 2018, Reappraising the efficacy and acceptability of multicomponent interventions for caregiver depression in dementia: The utility of network meta‐analysis, Gerontologist
Menne HL, 2014, Statewide implementation of “reducing disability in Alzheimer's disease”: Impact on family caregiver outcomes, J Gerontol Soc Work, 57, 626, 10.1080/01634372.2013.870276
Primetica B, 2015, Evidence‐Based Program replication: Translational activities, experiences, and challenges, J Appl Gerontol, 34, 652, 10.1177/0733464813508888
Teri L, 2018, Translating an evidence‐based multicomponent intervention for older adults with dementia and caregivers, Gerontologist
Fauth EB, 2017, External validity of the New York University Caregiver Intervention: Key caregiver outcomes across multiple demonstration projects, J Appl Gerontol
Boots LM, 2015, A systematic review of internet‐based supportive interventions for caregivers of patients with dementia, Int J Geriatr Psychiatry, 29, 331, 10.1002/gps.4016
U.S. Department of Health and Human Services.National Research Summit on Care Services and Supports for Persons with Dementia and their Caregivers Available at:https://aspe.hhs.gov/national‐research‐summit‐care‐services‐and‐supports‐persons‐dementia‐and‐their‐caregiversAccessed November 13 2018
Zarit SH, 2017, Past is prologue: How to advance caregiver interventions, Aging Ment Health, 16, 1
Zarit SH, 2009, Aging families and caregiving, 131
Whitlatch CJ, 2018, Meeting the informational, educational, and psychosocial support needs of persons living with dementia and their family caregivers, Gerontologist, 58, S58
Meyer OL, 2017, Acculturation level and caregiver outcomes from a randomized intervention trial to enhance caregivers' health: Evidence from REACH II, Aging Ment Health, 24, 1
Fields NL, 2016, The Senior Companion Program Plus: A culturally tailored psychoeducational training program (innovative practice), Dementia (London)
Khatutsky G, 2011, Understanding direct care workers: A snapshot of two of America's most important jobs: Certified nursing assistants and home health aides
Stone R, 2012, Universal Coverage of Long‐Term Care in the United States: Can We Get There from Here?, 155
Jones AL, 2009, The National Nursing Home Survey: 2004 Overview, Vital Health Stat, 13, 1
Kramer NA, 2000, Professional psychology in long‐term care, 227
Institute of Medicine, 2008, Retooling for an Aging America: Building the Health Care Workforce
American Health Care Association.Staffing Survey Report. 2011
Elvish R, 2018, ‘Getting to know me’: The second phase roll‐out of a staff training programme for supporting people with dementia in general hospitals, Dementia (London), 17, 96, 10.1177/1471301216634926
Bray J, 2015, Enabling hospital staff to care for people with dementia, Nurs Older People, 27, 29, 10.7748/nop.27.10.29.s21
Eldercare Workforce Alliance, 2012, Geriatrics Workforce Shortage: A Looming Crisis for our Families
The American Geriatrics Society.Current Geriatrician Shortfall Available at:https://www.americangeriatrics.org/sites/default/files/inline‐files/Current‐Geriatrician‐Shortfall_0.pdfAccessed December 18 2018
The American Geriatrics Society.Projected Future Need for Geriatricians Available at:https://www.americangeriatrics.org/sites/default/files/inline‐files/Projected‐Future‐Need‐for‐Geriatricians_1.pdfAccessed December 18 2018
American Association of Nurse Practitioners.NP Fact Sheet Available at:https://www.aanp.org/all‐about‐nps/np‐factsheetAccessed December 18 2018
Cross AJ, 2018, The psychosocial impact of caregiving in dementia and quality of life: A systematic review and meta‐synthesis of qualitative research, Psychol Health, 27, 1
National Academies of Sciences, 2016, Engineering, and Medicine. Families Caring for an Aging America
Gaugler JE, 2015, Family Caregiving in the New Normal
The Lewin Group.Process Evaluation of the Older Americans Act Title IIIE‐National Family Caregiver Support Program: Final Report Available at:https://acl.gov/sites/default/files/programs/2017‐02/NFCSP_Final_Report‐update.pdf2016Accessed December 18 2018
Unpublished tabulations based on data from the Medicare Current Beneficiary Survey for 2011.Prepared under contract by Avalere Health March 2016
Unpublished tabulations based on data from the National 5% Sample Medicare Fee‐for‐Service Beneficiaries for 2014.Prepared under contract by Avalere Health January 2016
Bynum JPW, 2016, Our Parents, Ourselves: Health Care for an Aging Population. A Report of the Dartmouth Atlas Project
U.S. Centers for Medicare & Medicaid Services.State Level Chronic Conditions Table: Prevalence Medicare Utilization and Spending Available at:https://www.cms.gov/Research‐Statistics‐Data‐and‐Systems/Statistics‐Trends‐and‐Reports/Chronic‐Conditions/CC_Main.html2015Accessed December 18 2018
Medicare. Glossary.Medicare: The Official U.S. Government Site for Medicare Available at:http://www.medicare.gov/HomeHealthCompare/Resources/Glossary.htmlAccessed December 18 2018
Genworth.2017 Cost of Care: Annual Costs Available at:https://www.genworth.com/dam/Americas/US/PDFs/Consumer/corporate/cost‐of‐care/179703_2017CofC_Annual_092717.pdfAccessed December 18 2018
Genworth.Cost of Care Survey 2018: Median Cost Data Tables Available at:https://pro.genworth.com/riiproweb/productinfo/pdf/282102.pdfAccessed December 18 2018
Penn Lendon J, 2018, Variation in adult day services center participant characteristics, by center ownership: United States, 2016, NCHS Data Brief
Rome V, 2015, Variation in operating characteristics of adult day services centers by center ownership: United States, 2014, NCHS Data Brief, 1
Caffrey C, 2018, Variation in residential care community resident characteristics, by size of community: United States, 2016, NCHS Data Brief, 1
Caffrey C, 2015, Variation in operating characteristics of residential care communities by size of community: United States, 2014, NCHS Data Brief
Harris‐Kojetin L, 2016, Long‐term care providers and services users in the United States: Data from the National Study of Long‐Term Care Providers, 2013–2014, Vital Health Stat, 3, x–xii
U.S. Centers for Medicare & Medicaid Services.Nursing Home Data Compendium 2015 Edition Available at:https://www.cms.gov/Medicare/Provider‐Enrollment‐and‐Certification/CertificationandComplianc/Downloads/nursinghomedatacompendium_508‐2015.pdfAccessed December 18 2018
American Health Care Association.LTC Stats: Nursing Facility Operational Characteristics Report.Table 5: Nursing Facility Beds in Dedicated Special Care Units;2014
Eiken S, 2018, Medicaid Expenditures for Long‐Term Services and Supports in FY 2016. IAP Medicaid Innovation Accelerator Program
Bynum J, 2009, Unpublished; provided under contract with the Alzheimer's Association
Nickel F, 2018, Health economic evaluations of non‐pharmacological interventions for persons with dementia and their informal caregivers: A systematic review, BMC Geriatr, 18, 69, 10.1186/s12877-018-0751-1
Jacobson G, 2017, Income and Assets of Medicare Beneficiaries, 2016‐2035
U.S. Department of Health and Human Services.What is Long‐Term Care Insurance? Available at:http://longtermcare.gov/costs‐how‐to‐pay/what‐is‐long‐term‐care‐insurance/Accessed December 18 2018
U.S. Centers for Medicare & Medicaid Services.Your Medicare Coverage. Long‐Term Care Available at:https://www.medicare.gov/coverage/long‐term‐care.htmlAccessed December 18 2018
National Association of Insurance Commissioners and the Center for Insurance Policy and Research, 2016, The State of Long‐Term Care Insurance: The Market, Challenges and Future Innovations
Reaves EL, 2015, Medicaid and Long‐Term Services and Supports: A Primer
U.S. Centers for Medicare & Medicaid Services.Medicare Provider Utilization and Payment Data: Hospice Providers Available at:https://www.cms.gov/Research‐Statistics‐Data‐and‐Systems/Statistics‐Trends‐and‐Reports/Medicare‐Provider‐Charge‐Data/Hospice.htmlAccessed November 11 2018
U.S. Centers for Medicare & Medicaid Services. Hospices Available at:https://www.cms.gov/Medicare/Provider‐Enrollment‐and‐Certification/CertificationandComplianc/Hospices.htmlAccessed November 11 2018
U.S. Centers for Medicare & Medicaid Services Medicare Learning Network.Update to Hospice Payment Rates Hospice Cap Hospice Wage Index and Hospice Price for FY 2018. MLN Matters MM10131 Available at:https://www.cms.gov/Outreach‐and‐Education/Medicare‐Learning‐Network‐MLN/MLNMattersArticles/downloads/MM10131.pdfAccessed November 11 2018
Miller SC, 2001, Hospice enrollment and hospitalization of dying nursing home patients, Am J Med, 11, 38, 10.1016/S0002-9343(01)00747-1
Gilligan AM, 2013, Health disparities in cost of care in patients with Alzheimer's disease: An analysis across 4 state Medicaid populations, Am J Alzheimers Dis Other Demen, 28, 84, 10.1177/1533317512467679
Amjad H, 2016, Continuity of care and health care utilization in older adults, JAMA Intern Med, 176, 1371, 10.1001/jamainternmed.2016.3553
Alzheimer's Association.Changing the Trajectory of Alzheimer's Disease: How a Treatment by 2025 Saves Lives and Dollars Available at:https://www.alz.org/help‐support/resources/publications/trajectory_reportAccessed December 18 2018
Alzheimer's Association.Why Get Checked? Available at:https://www.alz.org/alzheimers‐dementia/diagnosis/why‐get‐checkedAccessed January 3 2019
Starfield B, 1998, Primary Care: Balancing Health Needs, Services, and Technology, 10.1093/oso/9780195125429.001.0001
Robert Graham Center.The State of Primary Care in the United States: A Chartbook of Facts and Statistics Available at:https://www.graham‐center.org/content/dam/rgc/documents/publications‐reports/reports/PrimaryCareChartbook.pdfAccessed January 22 2019
Centers for Disease Control and Prevention.National Ambulatory Medical Care Survey: 2015 State and National Summary Tables Available at:https://www.cdc.gov/nchs/data/ahcd/namcs_summary/2015_namcs_web_tables.pdfAccessed January 22 2019
Centers for Disease Control and Prevention National Center for Health Statistics.Tables of Summary Health Statistics 2017 National Health Interview Survey Available at:https://www.cdc.gov/nchs/nhis/shs/tables.htmAccessed January 22 2019
Henry J. Kaiser Family Foundation.Percent of Women who Report Having No Personal Doctor/Health Care Provider by Race/Ethnicity Available at:https://www.kff.org/disparities‐policy/state‐indicator/no‐personal‐doctor/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22 %22sort%22:%22asc%22%7DAccessed January 22 2019
Henry J. Kaiser Family Foundation.Percent of Men who Report Having No Personal Doctor/Health Care Provider by Race/Ethnicity Available at:https://www.kff.org/disparities‐policy/state‐indicator/percent‐of‐men‐who‐report‐having‐no‐personal‐doctorhealth‐care‐provider‐by‐raceethnicity/Accessed January 22 2019
Urban Institute Health Policy Center Health Reform Monitoring Survey.Do Patients Trust Their Providers? Available at:http://hrms.urban.org/briefs/do‐patients‐trust‐their‐providers.html2017Accessed January 22 2019
Urban Institute Health Policy Center Health Reform Monitoring Survey.Patients Feel Comfortable Talking to Their Providers about Sensitive Issues But Providers Don't Often Ask Available at:http://hrms.urban.org/briefs/patients‐comfortable‐talking‐providers‐sensitive‐issues.html2017Accessed January 22 2019
American Society on Aging.MetLife Foundation Harris Interactive Inc. Attitudes and Awareness of Brain Health Poll Available at:http://www.paulnussbaum.com/metlifedoc.pdf2006Accessed January 22 2019
John A. Hartford Foundation.How Does It Feel?: The Older Adult Health Care Experience Available at:https://www.johnahartford.org/events/view/john‐a.‐hartford‐foundation‐public‐poll‐how‐does‐it‐feel‐the‐older‐adult‐he2012Accessed January 22 2019
U.S. Centers for Medicare & Medicaid Services Enterprise Portal.Beneficiaries Utilizing Free Preventive Services by State Available at:https://downloads.cms.gov/files/Beneficiaries%20Utilizing%20Free%20Preventive%20Services%20by%20State%20YTD%202016.pdf2016Accessed January 22 2019
U.S. Centers for Medicare & Medicaid Services Enterprise Portal.Beneficiaries Utilizing Free Preventive Services by State Available at:https://downloads.cms.gov/files/Beneficiaries%20Utilizing%20Free%20Preventive%20Services%20by%20State%20YTD%202015.pdf2015Accessed January 22 2019
U.S. Centers for Medicare & Medicaid Services.Medicare Learning Network.Annual Wellness Visit Available at:https://www.cms.gov/Outreach‐and‐Education/Medicare‐Learning‐Network‐MLN/MLNProducts/Downloads/AWV_Chart_ICN905706.pdf2018Accessed January 22 2019
National Institute on Aging.Alzheimer's and Dementia Resources for Professionals. Available at:https://www.nia.nih.gov/health/alzheimers‐dementia‐resources‐for‐professionals. Accessed January 31 2019
Alzheimer's Association.Cognitive Assessment Toolkit. Available at:https://www.alz.org/media/Documents/cognitive‐assessment‐toolkit.pdf. Accessed January 22 2019
Gerontological Society of America.KAER Toolkit: 4‐Step Process to Detecting Cognitive Impairment and Earlier Diagnosis of Dementia Available at:https://www.geron.org/programs‐services/alliances‐and‐multi‐stakeholder‐collaborations/cognitive‐impairment‐detection‐and‐earlier‐diagnosis2015Accessed January 22 2019
American Academy of Family Physicians.Cognitive Care Kit. Available at:https://www.aafp.org/patient‐care/public‐health/cognitive‐care.html. Accessed January 22 2018
Act on Alzheimer's®.Provider Practice Tools. Available at:http://actonalz.org/provider‐practice‐tools. Accessed January 31 2019
Creavin ST, 2016, Mini‐Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations, Cochrane Database Syst Rev, 1
Ranson JM, 2018, Predictors of dementia misclassification when using brief cognitive assessments, Neurol Clin Pract
Warren‐Findlow J, 2010, Primary care providers' sources and preferences for cognitive health information in the United States, Health Promot Int, 25, 464, 10.1093/heapro/daq043
Yarnall KS, 2009, Family physicians as team leaders: “Time” to share the care, Prev Chronic Dis, 6, A59
Alzheimer's Association and the Centers for Disease Control and Prevention.Healthy Brain Initiative: State and Local Public Health Partnerships to Address Dementia: The 2018‐2023 Road Map Available at:https://www.cdc.gov/aging/pdf/2018‐2023‐Road‐Map‐508.pdfAccessed January 21 2019
Pond D, 2018, Effectiveness of a peer‐mediated educational intervention in improving general practitioner diagnostic assessment and management of dementia: A cluster randomised controlled trial, BMJ Open, 8, e021125, 10.1136/bmjopen-2017-021125
National Alliance for Caregiving and AARP.Caregiving in the U.S. November2009 Available at:https://www.caregiving.org/pdf/research/FINALRegularExSum50plus.pdfAccessed January 22 2019
Amo PS, 1999, The economic value of informal caregiving, Health Aff, 18, 182, 10.1377/hlthaff.18.2.182
U.S. Department of Labor Bureau of Labor Statistics.Employment Hours and Earnings from the Current Employment Statistics Survey.Series 10‐CEU 6562160008 Home Health Care Services (NAICS code 6216) Average Hourly Earnings July2018 Available at:www.bls.gov/ces/data.htmAccessed January 3 2019
Albert SM, 2010, The MetLife Study of working caregivers and employer health care costs
U.S. Centers for Medicare & Medicaid Services.Health Expenditures by State of Residence 1991‐2014 Available at:https://www.cms.gov/Research‐Statistics‐Data‐and‐Systems/Statistics‐Trends‐and‐Reports/NationalHealthExpendData/NationalHealthAccountsStateHealthAccountsResidence.htmlAccessed December 18 2018
Shriver M, 2010, The Shriver Report: A Woman's Nation Takes on Alzheimer's