Public Health Research

Development of Culturally-Sensitive Messaging related to Cognition and Cognitive Impairment 
SIP 14-003

A major focus of CDC’s efforts to support the proposed actions of The Healthy Brain Initiative: The Public Health Road Map for State and National Partnerships, 2013–2018 [PDF-2.2M] and the nation’s Healthy People 2020 objectives related to older adults is to “educate and empower the nation.” To meet that challenge, CDC is supporting efforts to develop and disseminate science-based, culturally-relevant messages and strategies that promote awareness about cognition and cognitive impairment that will lead to increased detection of cognitive impairment, including Alzheimer’s disease.

In fiscal year 2014, CDC’s Healthy Aging Program initiated support to the University of Pennsylvania Prevention Research Center to assess perceptions about cognitive health and impairment among non-Hispanic white and African-American adults aged 50 or older living in the Philadelphia area. This work will help lead to the development, pilot-testing, and dissemination of timely public health messages for this population and examine the potential scaling of these findings to other populations. The messages will be aligned with the current state of the science, selected based on those most likely to resonate with the populations of interest, and be distributed through the most appropriate communication channels.

Older Adults with Dementia: Common Combinations and Impact of Co-occurring Chronic Illnesses 
SIP 14-004

In fiscal year 2014, CDC’s Healthy Brain Initiative continued to support work to examine how the patterns of co-occurring chronic conditions vary across the spectrum of cognitive impairment and how these variations are related to overall and all-cause mortality. CDC investigators at Case Western Reserve Prevention Research Center are conducting secondary data analyses to help further understand cognitive impairment and major “clusters” of conditions that combine major co-occurring chronic conditions, functional limitations, and geriatric syndromes. Using data from the Health and Retirement Study (HRS) linked to Medicare enrollment/claims files and the National Death Index (NDI), the aims of this study are to: 

• compare the most common combinations or clusters of chronic conditions (i.e., co-occurring chronic conditions, functional limitations, and geriatric syndromes) across individuals with no, mild and moderate/severe cognitive impairment; 
• identify the leading causes of death associated with each cluster of chronic conditions; and 
• examine the occurrence of hospitalizations across the cognitive impairment spectrum as a proxy for inadequate attention to cognitive impairment in chronic disease management. 

In collaboration with CDC colleagues, the research team will conduct a review of literature examining use of cognitive assessment tools in ambulatory healthcare settings to help promote chronic disease support and management.

Economic Cost

Evaluating Cost Information about Alzheimer’s Disease and Dementia 
SIP 14-005

In fiscal year 2014, CDC’s Healthy Aging Program is supporting the University of Washington to examine different methods and measures for estimating direct and indirect costs associated with Alzheimer’s disease and dementia treatment. Alzheimer’s disease is currently the 6th leading cause of death in the US, and even more deaths due to Alzheimer’s are anticipated as the population continues to age. Since it currently cannot be prevented and there is no known cure for the disease, the costs of caring lie mainly in the area of long-term care services, both formal and informal. Additionally, there are societal costs associated with losses of productivity and quality of life by patients as well as their families and communities. Quantifying these costs will improve states’ ability to plan for service provision. The University of Washington is addressing this issue by: 

• conducting a systematic review of the literature to identify gaps in understanding costs based on definition of disease onset, type of Medicare service (Health Maintenance Organization versus Fee for Service), and labor costs for informal care; 
• quantifying the cost difference in direct and indirect costs of dementia care by different definitions of disease onset, health system (HMO versus Fee for Service), and dynamic labor cost models to estimate lost wages; 
• highlighting opportunities for data improvement to allow states and localities to better forecast dementia care costs, and, 
• using their findings in the development of the Washington State Alzheimer’s Plan, and to promote the inclusion of cognitive impairment costs into state and local health burden reports.

Attitude Questions and Measures

Attitudes Toward Cognitive Health, Cognitive Impairment, and Caregiving: Identifying Attitude Questions and Measures for Public Health Practice 
SIP 13-071

CDC’s Healthy Aging Program is supporting the New York University School of Medicine and City University of New York School of Public Health: NYU Prevention Research Center to conduct a review of the existing literature to identify measures of the public’s attitudes and perceptions about cognitive health, cognitive impairment, and caregiving. Researchers convened an expert work group to provide guidance on the review and insight on critical gaps and differential issues for vulnerable and disparate older populations. Public health surveillance systems and datasets will be used to identify questions and measures from the compendium that could potentially be added. The review process will consist of: 

• defining a comprehensive set of keywords and phrases for searches of electronic databases that index biomedical and social science literature; 
• selecting eligible projects/studies and abstracting questions or measures; and, 
• summarizing and reporting results. 

The findings from this study will strengthen efforts to respond to the recent calls for action to address and improve the rapidly escalating crisis of cognitive impairment. Results will also be used to form a strategic public health agenda focused on increasing knowledge and decreasing negative attitudes about cognitive impairment. Findings from the review will be disseminated to the public health research and practice community through conference presentations, publications, and the electronic media.

Compendium of Measures and Questions to Assess Mobility

Developing a Compendium of Measures and Questions to Assess Mobility: A Focus on the Older Adult Population 
SIP 12-59

The Healthy Aging Program funded Boston University to develop a compendium of measures of mobility to support public health research among community-dwelling older adults with cognitive impairment or physical disabilities. Selecting measures for programs that aim to enhance or assess mobility is complex because mobility encompasses a wide variety of tasks and activities, and its measurement has been carried out by a variety of disciplines, each with its own distinct approach. Inclusion of measures was guided by the World Health Organization’s definition of mobility as well as guidance from subject matter experts. The compendium provides public health researchers with a wide range of reliable and valid tests at the self-report, performance-based, and instrumented (technology-assisted) levels. In addition, other relevant information for each measure, including descriptions of populations in which each measure has been used, the time it takes to administer each measure, and the level of involvement needed by the participant for each measure, is provided.

Caregiving Strategies

Identifying system-level caregiving strategies.
CDC’s Healthy Aging Program is supporting a project through the Association of State and Territorial Health Officials (ASTHO) to conduct an international review of the literature to identify system-level caregiving strategies, such as care coordination, to promote health and quality of life and related outcomes of care recipients. The review will be consistent with The Guide to Community Prevention Services methodologies.

Improve Emotional Health

Community-based Interventions to Improve Emotional Health in Older Adults (SIP 2007–2010).

CDC’s Healthy Aging Program supported a project to systematically evaluate existing evidence-based literature to identify community-based interventions to improve emotional health in older adults. The methods were informed by The Community Guide and the NIH Cognitive and Emotional Health (CEH) project. This project developed a strategy for: defining emotional health, identifying the set of interventions most relevant to the public health of older adults, developing a strategy for searching the peer-reviewed literature including defining article inclusion and exclusion criteria, and evaluating the strength of evidence for the identified interventions. The findings from this review are expected to be published next year (see citation below).

Reference: Publication: Snowden, M.B., Steinman, L., Carlson, W.L., Mochan, K.N., Abraido-Lanza, A.F., Bryant, L.L., Duffy, M., Knight, B.G., Jeste, D.V., Leith, K.H., Lenze,E.J., Logsdon, R.G., Satariano , W.A., Zweiback, D.J., Anderson, L.A. (In Press). Effect of physical activity, social support, and skills training on late-life emotional health: a systematic literature review and implications for public health research. Frontiers in Public Health.

Perceptions about Cognitive Health and Alzheimer’s Disease

Public’s Perceptions about Cognitive Health and Alzheimer’s Disease.

CDC’s Healthy Aging Research Network, in collaboration with CDC’s Healthy Aging Program, reviewed the literature examining the public’s perceptions about cognitive health and Alzheimer’s disease among adults. The findings will assist CDC’s Healthy Aging Program to develop targeted and effective messages about cognitive impairment and health.

Reference: Friedman, D.B., Becofsky, K., Anderson, L.A., Bryant, L.L., Hunter, R.H., Ivey, S.L., Belza, B., Logsdon, R.G., Brannon, S., Vandenberg, A.E., & Lin, S.Y. (2015). Public perceptions about risk and protective factors for cognitive health and impairment: A review of the literature. International Psychogeriatrics, 27(8), 1263-1275 (DOI: http://dx.doi.org/10.1017/S1041610214002877).

Reference: Anderson LA, Day KL, Beard RL, Reed PS, Wu B. (2009). The public’s perceptions about cognitive health and Alzheimer’s disease among the U.S. population: A national review. The Gerontologist, 49(S1):S3-S11.

Examining the Impact of Cognitive Impairment on Co-occurring Chronic Conditions (2010–2012)

CDC’s Healthy Aging Program funded the University of Washington, a member of the CDC Healthy Aging Research Network, to gather information and resources that can assist public health practitioners at the national, state, and local levels to articulate the effects of cognitive impairment on public health strategies and policies, in particular the design and delivery of evidence-based health promotion and chronic disease self-management programs. The findings will be published and a database of resources will be made available.

Reference: Bella, J.F., Fitzpatrick, A.L., Copeland, C., Chic, G., Steinman, L., Whitney R.L., Atkins, D.C., Bryant, L.L., Grodstein, F., Larson, E., Logsdon, R., Snowden, M.  (2015)Existing data sets to support studies of dementia or significant cognitive impairment and comorbid chronic conditions Alzheimer’s & Dementia. 2015; 11(6): 622–638.