Alaska Commission on Aging 2008 Senior Data Presentation

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


• 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



• 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


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%


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%


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%


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%


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%


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


• 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


• 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.

Documents

Alaska Commission on Aging 2008 Senior Data Presentation