An Emerging Public Health Issue

Millions of older adults and people with disabilities could not maintain their independence without the help of unpaid caregivers. This care would cost nearly $470 billion a year if purchased. That’s one of the reasons that caregiving is an essential public health service and should be prioritized as an emerging public health issue [PDF – 1 MB].¹

Caregivers are family members or friends who typically provide unpaid, long-term, community-based care and assistance to older adults and people with chronic health conditions or disabilities.  Caregivers help with a variety of routine tasks such as shopping, paying bills, bathing, dressing, and managing medicines.  They are often a source of emotional support and companionship for care recipients.

Caregivers: A Snapshot

• 58% of caregivers are women.
• Almost one-third of caregivers provide care at least 20 hours a week.
• Caregivers typically learn as they go and aren’t formally trained.
• 79% of caregivers care for adults aged 50 or older, and 76% of care recipients are aged 65 years and older.² 
• One in 6 non-caregivers expects to become a caregiver within two years.

Increasing Demand for Caregivers

The need for caregivers is growing along with the aging of the US population. The number of caregivers increased from 43.5 million in 2015 to about 53 million in 2020, or more than 1 in 5 Americans.³ By 2030, an estimated 73 million people in the United States will be 65 years or older.⁴ Many will require daily assistance from at least one caregiver to maintain quality of life, independence, and physical and social well-being. More than two-thirds of the US population will likely need help with tasks at some point in their lifetime.⁵

Benefits of Caregiving for Recipients and Caregivers

Caregiving allows recipients to:

• Retain their quality of life and independence.
• Avoid living in a group setting (institutionalization).
• Have less depression.
• Self-manage their chronic conditions better.

Caregiving can also benefit caregivers by helping them:

• Increase their self-confidence and fulfillment from helping others.
• Start or add to social networks of friendships associated with caregiving.
• Feel needed and useful.
• Learn and develop new skills.

Caregiving Burdens and Stress

Caregiving is also a public health concern because it can lead to physical, emotional, psychological, and financial strain.  Providing personal care and helping with behavioral and cognitive issues can be stressful for caregivers and result in depression and anxiety. Nearly 1 in 5 caregivers reports fair or poor health.⁶ Caregivers often neglect their own health needs, increasing their risk of having multiple chronic conditions. Nearly 2 in 5 caregivers have at least two chronic diseases:

• 1 in 7 caregivers has heart disease and/or stroke.
• 1 in 5 caregivers aged 65 and older have coronary heart disease and/or stroke.

A recent study by the National Alliance for Caregiving and AARP found nearly 1 in 4 US caregivers says caregiving has made their health worse.³

Financial Strains of Caregiving

Caregiving can have a negative financial effect on caregivers. Many employed caregivers have had to leave work early or take time away from work, resulting in lost wages. Nearly 2 in 10 employed caregivers had to stop working, while 4 in 10 had to reduce their working hours to care for a loved one.⁷ Caregivers sometimes pay out-of-pocket for caregiving services, meals, medical supplies, and other expenses. Almost 80% of caregivers report paying out-of-pocket for routine expenses for care recipients. The average annual out-of-pocket cost for caregivers is $7,200, and this cost rises to nearly $9,000 per year for caregivers of someone with dementia. ⁸

How to Support Caregivers?

• Help them with errands, chores, and other tasks.
• Provide emotional and social support.
• Negotiate times to check in on them.
• Make sure they are managing their own health care needs.
• Help them create and manage a care plan for the person they care for.
• Encourage them to seek mental health services if necessary.

If you are a caregiver, read about respite care.

To learn more, please visit https://www.cdc.gov/aging/publications/features/supporting-caregivers.htm.

Keeping Engaged Socially is good for your health!

We are not talking about your marital status. We mean, do you participate in activities that connect you with other people? As people get older, their social lives oftentimes slow down for a variety of reasons. When it is unwanted, this can lead to loneliness and isolation. Research has shown that for older adults, staying engaged in enjoyable activities is associated with better physical and mental health. As we age, being involved with others is strongly associated with better brain function. So it is not only fun, it is good for you! You might not have ever imagined that while you were singing in the church choir, or meeting with your book club, or volunteering at the animal shelter that you were actually improving your brain health!

In addition, research has shown that learning a new activity for older people can provide some “insurance” against memory loss. However, it cannot prevent progressive diseases like Alzheimer’s and other dementias.

There are many ways to get involved in your local community. Some to consider include:

• Participate in sports—whether tai chi or tennis, there’s something for every interest and ability.
• Head outdoors—join a walking, hiking, or bird watching group.
• Make music—join a choir or band or take lessons.
• Get involved—participate with a church, temple, or other religious organization.
• Read, join, participate, or start a book club.
• Volunteer for a cause or group you’re passionate about.
• Take classes at a gym.
• Find (or start!) a group that fits your passion —whether it’s knitting or carpentry.
• Indulge your creativity —stage a play with friends, create a themed-dining dinner club, or take an art class.

There are national organizations that can help connect you with these kinds of activities, including:

• Websites like VolunteerMatch, Idealist, and AARP’s Create the Good help connect people and nonprofits who care about similar causes.
• AARP’s Experience Corp  is an AmeriCorps program that trains adults 50+ to tutor elementary students who aren’t reading at grade level.
• The American Volkssport Association is a national organization promoting physical fitness, with has many local clubs that sponsor walks and other fitness events.
• Meetup is a website that helps connect people with common interests of all kinds, so they can meet up and enjoy discussions and activities.
• SilverSneakers is a national network of gyms with free membership for those with participating health plans, and a community of other adults seeking to remain fit and involved.
• The Senior Theater Resource  provides information for older adults interested in performing.
• Encore.org is an online resource for those interested in utilizing their experience and knowledge to do work—paid or unpaid—with social impact, to benefit future generations.

So why not take some steps to stay connected and keep your brain healthy – through an activity you enjoy – with your community?

SHARP Program

An example of a memory prompt for walkers in the SHARP Program.

Portland, Oregon is one community where theories about the benefits of increasing social engagement and brain health are being put into action. The Sharing History through Active Reminiscence and Photo-imagery (SHARP) Program, run by the Oregon Health & Science University (OHSU), brings together small groups of older African Americans for mile-long GPS-guided walks. Historic photos of local interest, like the one above, appear on the group’s digital device at selected locations. At each of these Memory Markers, the group pauses to discuss the photograph and flex their memories. The SHARP program specifically targets African Americans, who may be less aware than white Americans of the risk of Alzheimer’s Disease, have higher rates of some possible dementia risk factors, and be slower to seek care.

OHSU runs the SHARP program as part of the Healthy Brain Research Network, a thematic network of CDC Prevention Research Centers that promotes cognitive health and supports older Americans with cognitive decline as well as their caregivers. Through a unique combination of social engagement, exercise, and memory stimulation, the SHARP program aims to promote healthy aging of mind and body, preserve neighborhood memories, and increase awareness of Alzheimer’s Disease in a local community.

To learn more, please visit https://www.cdc.gov/aging/publications/features/social-engagement-aging.html.

Updates to the Advisory Committee on Immunization Practices (ACIP) Flu Vaccine Recommendations for the 2023-2024 season

A couple of things are different for the 2023-2024 influenza (flu) season:

• The composition of flu vaccines has been updated. Flu vaccines for the U.S. 2023-2024 season will contain the following:
  Egg-based vaccines
  • an A/Victoria/4897/2022 (H1N1)pdm09-like virus; (Updated)
  • an A/Darwin/9/2021 (H3N2)-like virus;
  • a B/Austria/1359417/2021 (B/Victoria lineage)-like virus; and
  • a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.

• Cell- or recombinant-based vaccines
  • an A/Wisconsin/67/2022 (H1N1)pdm09-like virus; (Updated)
  • an A/Darwin/6/2021 (H3N2)-like virus;
  • a B/Austria/1359417/2021 (B/Victoria lineage)-like virus; and
  • a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.
  • These recommendations include one update compared to the 2022-2023 U.S. flu vaccine composition. The influenza A(H1N1)pdm09 vaccine virus component was updated for egg-based and cell- or recombinant-based flu vaccines.

• People with egg allergy may get any vaccine (egg-based or non-egg-based) that is otherwise appropriate for their age and health status. Previously, it was recommended that people with severe allergy to egg (those who have had any symptom other than hives with egg exposure) be vaccinated in an inpatient or outpatient medical setting. Beginning with the 2023-2024 season, additional safety measures are no longer recommended for flu vaccination of people with an egg allergy beyond those recommended for receipt of any vaccine, regardless of the severity of previous reaction to egg. All vaccines should be given in settings where allergic reactions can be recognized and treated quickly.

Projected U.S. Flu Vaccine Supply for the 2023-2024 Season

• Vaccine manufacturers have projected that they will supply the United States with as many as 156.2 million to 170 million doses of influenza vaccines for the 2023-2024 season. These projections may change as the season progresses.
  • All flu vaccines for the 2023-2024 season will be quadrivalent (four-component).
  • Most will be thimerosal-free or thimerosal-reduced vaccines (91%), and about 21% of flu vaccines will be egg-free.

To learn more, please visit https://www.cdc.gov/flu/season/faq-flu-season-2023-2024.htm.

Brain health and physical health are both important, especially as we age. A recent CDC study found that people with one or more chronic health conditions were more likely to report worsening or more frequent memory problems, also called subjective cognitive decline (SCD).

Chronic health conditions included in the report were diabetes, heart disease, arthritis, stroke, chronic obstructive pulmonary disease (COPD), asthma, and kidney disease. SCD was most common among adults with COPD or heart disease, or who had had a stroke.

Worsening or more frequent confusion or memory loss, combined with chronic health conditions, can make it especially hard to live independently and do everyday activities like cooking, cleaning, managing health conditions and medicines, and keeping medical appointments. This may lead to worse health, and preventable hospitalizations or more severe memory loss or confusion. In some cases, SCD may put people at greater risk for Alzheimer’s disease.

What Can People With Memory Loss and Chronic Health Conditions Do?

It’s important to talk to your healthcare provider. Researchers found that only half of adults with SCD and a chronic condition had discussed their memory loss with a health care professional. Early diagnosis of memory loss is especially important for people with chronic health conditions. Getting checked by your healthcare provider can help determine if the symptoms you are experiencing are related to dementia, including Alzheimer’s disease, or a more treatable condition such as a vitamin deficiency or medication side effects. Early diagnosis also provides an opportunity to participate in clinical trials, and more time to plan for the future.

8 Ways to Help Improve Your Brain Health

There is growing scientific evidence that healthy behaviors, which have been shown to prevent cancer, diabetes, and heart disease, also may reduce risk for SCD. Here are eight steps you can take for a healthy body and healthier brain.

1. Quit Smoking—Quitting smoking now improves your health and reduces your risk of heart disease, cancer, lung disease, and other smoking-related illnesses. Free quitline: 1-800-QUIT-NOW (1-800-784-8669).
2. Prevent and Manage High Blood Pressure—Tens of millions of adults in the United States have high blood pressure, and many do not have it under control. Learn the facts.
3. Prevent and Manage High Cholesterol—Nearly 1 in 3 American adults has high cholesterol. Learn how to manage your cholesterol levels and lower your risk.
4. Maintain a Healthy Weight—Healthy weight isn’t about short-term dietary changes. Instead, it’s about a lifestyle that includes healthy eating and regular physical activity.
5. Get Enough Sleep—A third of American adults report that they usually get less sleep than the recommended amount.
6. Stay Engaged—There are many ways for older adults to get involved in their local community. Here are some activities to consider.
7. Manage Blood Sugar—Learn how to manage your blood sugar if you have diabetes.
8. If You Drink, Do So in Moderation—Learn about alcohol use and your health.

To learn more, please visit https://www.cdc.gov/aging/publications/features/healthy-body-brain.html.

As we age, our brains change, but Alzheimer’s disease and related dementias are not an inevitable part of aging. In fact, up to 40% of dementia cases may be prevented or delayed. It helps to understand what’s normal and what’s not when it comes to brain health.

Normal brain aging may mean slower processing speeds and more trouble multitasking, but routine memory, skills, and knowledge are stable and may even improve with age. It’s normal to occasionally forget recent events such as where you put your keys or the name of the person you just met.

Symptoms of Dementia or Alzheimer’s Disease

In the United States, 6.2 million people age 65 and older have Alzheimer’s disease, the most common type of dementia. People with dementia have symptoms of cognitive decline that interfere with daily life—including disruptions in language, memory, attention, recognition, problem solving, and decision-making. Signs to watch for include:

• Not being able to complete tasks without help.
• Trouble naming items or close family members.
• Forgetting the function of items.
• Repeating questions.
• Taking much longer to complete normal tasks.
• Misplacing items often.
• Being unable to retrace steps and getting lost.

Conditions That Can Mimic Dementia

Symptoms of some vitamin deficiencies and medical conditions such as vitamin B12 deficiency, infections, hypothyroidism (underactive thyroid), or normal pressure hydrocephalus (a neurological condition caused by the build-up of fluid in the brain) can mimic dementia. Some prescription and over-the-counter medicines can cause dementia-like symptoms. If you have these symptoms, it is important to talk to your health care provider to find out if there are any underlying causes for these symptoms.

For more information, see What Is Dementia?

How is Dementia Diagnosed?

A healthcare provider can perform tests on attention, memory, problem solving and other cognitive abilities to see if there is cause for concern. A physical exam, blood tests, and brain scans like a CT or MRI can help determine an underlying cause.

What To Do If a Loved One is Showing Symptoms

Talk with your loved one about seeing a health care provider if they are experiencing symptoms of Alzheimer’s dementia to get a brain health check up.

Be Empowered to Discuss Memory Problems

More than half of people with memory loss have not talked to their healthcare provider, but that doesn’t have to be you. Get comfortable with starting a dialogue with your health care provider if you observe any changes in memory, or an increase in confusion, or just if you have any questions. You can also discuss health care planning, management of chronic conditions, and caregiving needs.

To learn more, please visit https://www.cdc.gov/aging/publications/features/dementia-not-normal-aging.html.

To learn more about the Alzheimer’s Association, please visit Alzheimer’s Association | Alzheimer’s Disease & Dementia Help

Facts About Falls

Each year, millions of older people—those 65 and older—fall. In fact, more than one out of four older people falls each year, ¹ but less than half tell their doctor.² Falling once doubles your chances of falling again.³

Falls Are Serious and Costly

• One out of five falls causes a serious injury such as broken bones or a head injury.^4,5
• Each year, 3 million older people are treated in emergency departments for fall injuries.⁶
• Over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.⁶
• Each year at least 300,000 older people are hospitalized for hip fractures.⁷
• More than 95% of hip fractures are caused by falling,⁸ usually by falling sideways.⁹
• Falls are the most common cause of traumatic brain injuries (TBI).¹⁰
• In 2015, the total medical costs for falls totaled more than $50 billion.¹¹ Medicare and Medicaid shouldered 75% of these costs.

What Can Happen After a Fall?

Many falls do not cause injuries. But one out of five falls does cause a serious injury such as a broken bone or a head injury.^4,5 These injuries can make it hard for a person to get around, do everyday activities, or live on their own.

• Falls can cause broken bones, like wrist, arm, ankle, and hip fractures.
• Falls can cause head injuries. These can be very serious, especially if the person is taking certain medicines (like blood thinners). An older person who falls and hits their head should see their doctor right away to make sure they don’t have a brain injury.
• Many people who fall, even if they’re not injured, become afraid of falling. This fear may cause a person to cut down on their everyday activities. When a person is less active, they become weaker and this increases their chances of falling.¹²

What Conditions Make You More Likely to Fall?

Research has identified many conditions that contribute to falling. These are called risk factors. Many risk factors can be changed or modified to help prevent falls. They include:

• Lower body weakness
• Vitamin D deficiency (that is, not enough vitamin D in your system)
• Difficulties with walking and balance
• Use of medicines, such as tranquilizers, sedatives, or antidepressants. Even some over-the-counter medicines can affect balance and how steady you are on your feet.
• Vision problems
• Foot pain or poor footwear
• Home hazards or dangers such as
  • broken or uneven steps, and
  • throw rugs or clutter that can be tripped over.

Most falls are caused by a combination of risk factors. The more risk factors a person has, the greater their chances of falling.

Healthcare providers can help cut down a person’s risk by reducing the fall risk factors listed above.

To learn more, please visit https://www.cdc.gov/falls/facts.html.

Boyd Nursing and Rehabilitation congratulates Carlene Perry on successfully completing rehabilitation and returning to the community!

Carlene came to Boyd Nursing and Rehabilitation in April for rehabilitation following a pelvic fracture, which limited her ability to walk and care for herself independently. We provided her with a temporary nursing retreat to facilitate the healing process and receive rehabilitation. She improved her strength, balance, and mobility through ongoing physical and occupational therapy to walk and care for herself with minimal assistance. We are pleased to announce that Carlene has returned to her home at Cross Roads of Hope! Carlene says she looks forward to seeing all her friends and going on community outings. Congratulations to Carlene and her Care Team on their success!

Facts About Older Adult Oral Health

By 2060, according to the US Census, the number of US adults aged 65 years or older is expected to reach 98 million, 24% of the overall population.¹ Older Americans with the poorest oral health tend to be those who are economically disadvantaged, lack insurance, and are members of racial and ethnic minorities. Being disabled, homebound, or institutionalized (e.g., seniors who live in nursing homes) also increases the risk of poor oral health. Adults 50 years and older who smoke are also less likely to get dental care than people who do not smoke.⁶ Many older Americans do not have dental insurance because they lost their benefits upon retirement and the federal Medicare program does not cover routine dental care.²

Oral health problems in older adults include the following:

• Untreated tooth decay. Nearly all adults (96%) aged 65 years or older have had a cavity; 1 in 5 have untreated tooth decay.³
• Gum disease. A high percentage of older adults have gum disease. About 2 in 3 (68%) adults aged 65 years or older have gum disease.⁴
• Tooth loss. Nearly 1 in 5 of adults aged 65 or older have lost all of their teeth. Complete tooth loss is twice as prevalent among adults aged 75 and older (26%) compared with adults aged 65-74 (13%).³  Having missing teeth or wearing dentures can affect nutrition, because people without teeth or with dentures often prefer soft, easily chewed foods instead of foods such as fresh fruits and vegetables.
• Oral cancer. Cancers of the mouth (oral and pharyngeal cancers) are primarily diagnosed in older adults; median age at diagnosis is 62 years.⁵
• Chronic disease. People with chronic diseases such as arthritis, diabetes, heart diseases, and chronic obstructive pulmonary disease (COPD) may be more likely to develop gum (periodontal) disease, but they are less likely to get dental care than adults without these chronic conditions.⁶ Also, most older Americans take both prescription and over-the-counter drugs; many of these medications can cause dry mouth. Reduced saliva flow increases the risk of cavities.⁷

To learn more, please visit https://www.cdc.gov/oralhealth/basics/adult-oral-health/adult_older.htm.

By 2060, almost a quarter of the U.S. population will be age 65 or older. Healthy People 2030 focuses on reducing health problems and improving quality of life for older adults.

Older adults are at higher risk for chronic health problems like diabetes, osteoporosis, and Alzheimer’s disease.

Core Objectives: Dementias Including Alzheimer’s Disease (DIA)

The Healthy People 2030 Core Objectives relate to improving the health and quality of life for people with Alzheimer’s Disease and related dementias. Measuring these objectives will provide valuable data to track progress throughout the decade.

• Increase the proportion of older adults with dementia, or their caregivers, who know they have it. Learn more
• Reduce the proportion of preventable hospitalizations in older adults with dementia.  Learn more
• Increase the proportion of adults with subjective cognitive decline (SCD) who have discussed their confusion or memory loss with a health care professional. Learn more

All Healthy People 2030 core objectives meet several criteria, including having baseline data, a direct impact on health, and an evidence base, and they address the goals related to health, function, and quality of life. The Healthy People 2030 framework sets important health priorities for the nation over the next decade and will measure progress towards meeting those objectives.

For more information and an overview of all older adult objectives, please visit https://health.gov/healthypeople/objectives-and-data/browse-objectives/older-adults.

Join a dance class to exercise your brain and body.

Exercise is not only good for your body, it’s good for your brain! Sticking to a regular workout plan can be tough, but including activity in your routine doesn’t need to be boring. Scientists have found that the areas of the brain that control memory and skills such as planning and organizing improve with exercise.^1,2 Dance has the added dimensions of rhythm, balance, music, and a social setting that enhances the benefits of simple movement – and can be fun!

The Science of Dance

At the University of Illinois at Chicago, through the CDC-funded Prevention Research Centers’ Healthy Brain Research Network, researchers designed a Latin ballroom dance program for older sedentary adults. Participants in the program, BAILAMOS©, reported improvements in memory, attention, and focus.³ In a separate ballroom dance program, older people experiencing mild cognitive impairment improved their thinking and memory after a 10-month-long ballroom dancing class.⁴

So, how can you get moving?

• Sign up for a dance class and invite your friends to join. Find classes at your local community college, YMCA, dance studio, or community center.
• Try dancing at home by following along with a DVD or videos on YouTube. Easy-to-follow, free exercise videos are available at the National Institute on Aging’s YouTube channel.
• For an extra challenge, try using small weights to build strength. Keep a 2-pound or 5-pound weight in each hand while doing your dance routine. For more ideas on strength exercises, visit the Exercise and Physical Activity page on the NIH website.

Help for Caregivers of People with Alzheimer’s – Are you a caregiver for someone with Alzheimer’s disease or a related dementia? You can help the person you care for get moving, too.⁵

• Split dance moves and exercises into small, easy-to-follow steps. Use exercise videos and follow along with the person you’re caring for.
• At first, try shorter 5- or 10-minute mini dancing sessions to slowly build endurance.
• Take breaks when needed and make sure you are both drinking plenty of water.

To learn more, please visit https://www.cdc.gov/aging/publications/features/alzheimers-and-exercise.html.