Explore the vast range of titles available.

This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non‐physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID‐19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh‐leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth‐leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at$346.6 billion in 2023. Its costs, however, extend to unpaid caregivers’ increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community‐based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community‐based workers to provide dementia care. Average per‐person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long‐term care and hospice services for people age 65 and older with dementia are estimated to be $ 360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non‐physician health care professionals play in facilitating clinical care and access to community‐based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.

This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care, and the ramifications of AD for family caregivers, the dementia workforce, and society. The Special Report discusses Americans’ attitudes about early diagnosis and treatment of AD. An estimated 7.2 million Americans age 65 and older live with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 120,122 deaths from AD in 2022. Since 2020, when COVID‐19 became one of the top 10 causes of death in the United States, AD has ranked as the seventh‐leading cause of death. However, 2023 data indicate that Alzheimer's will probably become the sixth‐leading cause of death in the near future. Between 2000 and 2022, deaths from stroke, heart disease, and HIV decreased, whereas reported deaths from AD increased by more than 142%. Nearly 12 million family members and other unpaid caregivers provided an estimated 19.2 billion hours of care to people with Alzheimer's or other dementias in 2024. These figures reflect a decline in the number of caregivers compared with a decade earlier and an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at$413.5 billion in 2024. Its costs, however, extend to unpaid caregivers’ increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community‐based workforce are involved in diagnosing, treating, and caring for people with dementia. However, the United States faces growing shortages across many segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models are urgently needed to attract, better train, and effectively deploy health care and community‐based workers to provide dementia care. Average per‐person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2025 for health care, long‐term care, and hospice services for people age 65 and older with dementia are estimated to be $ 384 billion. The Special Report examines how Americans feel about new developments in diagnosing and treating AD. Based on survey results, most Americans believe early detection of Alzheimer's is important, and nearly all would want a simple diagnostic test if it were available to allow for early diagnosis and treatment. About two‐thirds of Americans are aware that new medications exist to slow the progression of AD, and most feel optimistic about the future of new Alzheimer's treatments over the next decade.

Background: Sexuality in later life and its relationship to dementia is a neglected topic: greater understanding of the area has the potential to contribute to the quality of life of people with dementia, their family members, and formal carers. We review current knowledge about sexuality, aging, and dementia. Methods: We undertook a review of the recent literature to examine of the following areas: what is known about sexuality and aging, and about attitudes to sexuality and aging; what is known about the relevance of sexuality and aging to people living with dementia and their care; and the management of sexual behaviors causing concern to others. Results: Sexual activity decreases in frequency with increasing age but many older people remain sexually active; there is no age limit to sexual responsiveness; and sexuality is becoming more important to successive cohorts of older people, including people living with dementia and gay, lesbian, bisexual, and transgendered elderly people. Attitudes and beliefs toward sexuality and aging are strongly influenced by stereotypes and myths, not only among the general public but also among those working in health and social care. Conclusions: Professional bodies should include sexuality, aging, and dementia in their training curricula. More work is needed on the impact of environmental issues, particularly in group living situations, on older adults’ sexuality, and on consent issues. Ethical decision-making frameworks can be useful in practice. Organizations should investigate how to support staff in avoiding a problem-orientated approach and focus on providing holistic person-centered care.

Abstract Background and Objectives Several systematic reviews exist that examine the efficacy of educational interventions in randomized controlled trials (RCTs) designed to improve formal caregivers’ knowledge and skills and/or the outcomes of persons living with dementia. The aim of this article is to summarize existing systematic reviews to assess the effectiveness of educational interventions tested in RCTs and directed at formal caregivers. Research Design and Methods Smith et al.’s methodology guided this systematic review of systematic reviews. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2) for quality appraisals. Reviews were included if they contained interventions with an RCT design that focused on changing staff behavior and/or practice toward persons living with dementia, in any setting and for any health care discipline. Results We identified six systematic reviews, one rated as high-quality on the AMSTAR 2. Most interventions were directed at nursing staff, in long-term care facilities, focused on agitation, and were atheoretical. There is insufficient evidence to guide implementation of currently tested interventions; however, training in communication skills, person-centered care, and dementia-care mapping with supervision show promise for improving agitation. Discussion and Implications There’s a critical need for additional research with well-designed RCTs, and clear reporting of protocols and findings to inform the field on how best to train and support the workforce. Although there is no conclusive evidence on what interventions are most effective, it could be argued that providing training using interventions with modest evidence of impact is better than no training at all until the evidence base is strengthened.

Purpose - Through consultation with people living with dementia and carers, this paper aims to identify skills that patients and carers feel need to be developed in the workforce. This work is part of a project to develop competencies for the West Midlands dementia workforce.Design methodology approach - People living with a dementia and carers were contacted through cafés, a carers' group and memory group, and two people contributed interviews to the analysis. All materials were analysed qualitatively using thematic analysis.Findings - Feedback was received from 69 individuals. In total, six major themes were identified: knowledge about dementia, person centred care, communication, relationships, support and helping people engage in activities.Originality value - It is argued that people living with dementia and carers bring unique and valuable perspectives to an analysis of the skills of the dementia workforce, which grounds the required skills in the relationship between the worker and the person and family they are working with. This different emphasis needs to be considered and addressed throughout dementia training and education.

Purpose – The purpose of this paper is to outline the first stage of an innovative developmental study addressing the educational and emotional needs of dementia care home staff using arts-based materials. Design/methodology/approach – The arts workshop was developed using a mixed methods approach. This included ethnographic observation within a dementia care home, in-depth interviews with senior care home managers, a thematic analysis of focus groups and the development of a comic. At all stages, the multi-disciplinary project team collaborated closely with the care home staff. A comprehensive literature review of the policy, practice and academic background to dementia workforce education provided a contextual framework for the study. Perspectives from the medical humanities informed the project. Findings – Despite the high prevalence of people living with dementia in care homes, there is a lack of appropriate training for the workforce that provides their care. This study found that an arts-based workshop offering an interactive mode of education was an effective way to engage this workforce. The workshop empowered participants to recognise their skills and focus on person-centred care; reflecting current recommendations for dementia care. Research limitations/implications – The workshop was delivered in a single dementia care home and therefore findings may not be generalisable. In addition, the management did not take a direct part in the delivery of the workshop and therefore their views are not included in this study. Practical implications – The arts-based approach can offer a means of engaging the dementia care workforce in education linked to their experience of caring. Originality/value – The paper identifies the gap in relevant education for the dementia care workforce and outlines one possible way of addressing this gap using the arts.

More than three million US nursing home residents were diagnosed with Alzheimers disease and related dementias (ADRD) between 2017 and 2019. This number is expected to increase as the population ages and ADRD prevalence increases. People with ADRD require specialized care from trained staff. This study addressed two questions: Are residents with ADRD concentrated in nursing homes where they are the majority? If not, what are the implications for their quality of care and life? We answered the first question by determining the ADRD census for each nursing home in the country during the period 2017-19. Using the Minimum Data Set and Medicare claims, we compared characteristics of nursing homes with high and low ADRD census along several dimensions, including staffing, resident outcomes, and resident characteristics. We found that residents with ADRD were dispersed throughout all nursing homes, with fewer than half residing in nursing homes where residents with ADRD accounted for 60-90 percent of the census. Furthermore, only facilities exceeding 90 percent of residents with ADRD seemed to offer better care. These findings raise concerns about the quality of care and life for the majority of residents with ADRD, suggesting that current National Institutes of Health dementia research initiatives and the Biden administrations policies to improve nursing home care should be coordinated.

INTRODUCTION The role of community characteristics on supporting the community residence of older adults with dementia has received little attention. This study explores the association of community resources with extending older adults’ stay in community settings and mitigating premature institutionalization and mortality. METHODS Using data from 286,940 patients with dementia in South Korea, this study used Cox proportional hazard models to analyze the relationships among community management, institutionalization, mortality rates, and the availability of long‐term care and medical resources at the municipal level, adjusting for individual factors. RESULTS Increased availability of home care nurses and physicians was significantly associated with enhanced community management, showing a noticeable decrease in mortality and institutionalization risk. Additionally, more home care social workers were associated with a reduced institutionalization risk, while an excess of medical and long‐term care facilities was linked to a heightened institutionalization risk. DISCUSSION These findings underscore the importance of health‐care resources aligning with the specific needs of patients with dementia. Highlights Local health‐care resources may affect dementia patients’ community residence. Results reveal physicians and home case nurses lower institutionalization and death. Study findings indicate home care social workers also reduce institutionalization. But, more hospital beds and long‐term care facilities increase institutionalization. This underscores the need for nuanced approaches to community‐based care.

Background Dementia is a growing challenge to health and aged care worldwide and is the leading cause of disease burden in older Australians. High-quality person-centred care of people with dementia and support for their family caregivers require a trained multidisciplinary health and aged care workforce. Compared with major cities in Australia, rural and remote areas encounter greater challenges in workforce recruitment and retention. Moreover, these areas have distinctive distance-related barriers to workforce training and a higher proportion of aged and First Nations people at elevated risk of developing dementia. We designed and distributed a survey to investigate the perspectives on training among rural and remote health and aged care workers providing dementia care in diverse occupations and settings. Methods After piloting, the online survey was promoted to rural and remote organisations and professional networks nationwide. The instrument included multiple-choice and ordered-scale items on respondents’ dementia care self-rating and appraisal of their current workplace dementia care training, as well as items categorising their demographic characteristics, main work role, main workplace setting, and geographical site. Analysis incorporated description of respondent characteristics and estimation along with graphical presentation of response proportions for ordered-scale items, with differences among key respondent subgroups (i.e., workplace setting, remoteness, and main role) investigated using crude and multivariable robust Poisson regression models. Results There were 558 respondents from residential aged care, community/primary care and hospital settings across all Australian states and territories. The majority (61.7%) were from degree-requiring health professional/management positions, and 27.4% were certificate-requiring workers (predominantly personal care assistants and enrolled nurses). A majority considered that the dementia care provided in their current workplace was inadequate overall and specifically in relation to First Nations and culturally and linguistically diverse clients. Respondents noted organisational resource limitations impeding workers’ participation in training, and insufficient opportunities for input into determining priorities for training content and delivery. Hospital/acute care-based workers had the least favourable self-ratings and represented the highest proportion of respondents reporting shortcomings of training. Conclusions Health and aged care workers in rural and remote Australia perceive substantial shortcomings in the dementia care training provided by their workplace.

Ensuring an informed and effective dementia workforce is of international concern; however, there remains limited understanding of how this can be achieved. This review aimed to identify features of effective dementia educational programs. Critical interpretive synthesis underpinned by Kirkpatrick s return on investment model was applied. One hundred and fifty-two papers of variable quality were included. Common features of more efficacious educational programs included the need for educational programs to be relevant to participants 'role and experience, involve active face-to-face participation, underpin practice-based learning with theory, be delivered by an experienced facilitator, have a total duration of at least 8 hours with individual sessions of 90 minutes or more, support application of learning in practice, and provide a structured tool or guideline to guide care practice. Further robust research is required to develop the evidence base; however, the findings of this review have relevance for all working in workforce education.