DNP 810 Week 6 Health Issues for the Aging
Alzheimer’s disease (AD) is a neurocognitive disorder common in the elderly and is associated with aging. It is an irreversible, gradual brain disorder that affects almost 5.1 million Americans. It progressively impairs brain function, resulting in cognitive decline, which manifests with memory loss, impaired executive function, and language difficulties. Patients with AD also have behavioral and psychiatric disorders like depression, agitation, and delusions and experience deterioration in functional status (Breijyeh & Karaman, 2020). In over 90% of persons with AD, symptoms are not usually evident until after 60 years, and the incidence of the disorder increases with age. The purpose of this paper is to discuss a solution in literature, and explore how it is incorporated into policy, barriers to implementation, and funding options.
What the Literature Suggests as a Resolution to Alzheimer’s Disease
AD is associated with adverse effects on affected persons like short-term memory loss, poor judgment, language dysfunction, impaired reasoning, visuospatial dysfunction, and challenges in managing complex tasks. The available pharmacological therapies for AD act by only slowing or reversing AD progression but do not reverse the impact of cognitive decline (Breijyeh & Karaman, 2020). The therapies previously proposed for AD treatment have mostly had disappointing outcomes. As a result, literature has suggested cognitive training as a non-pharmacological intervention to improve cognition in AD patients.
Cognitive training entails a sequence of standardized tasks like memory, attention, or problem-solving and has intrinsic challenges that target particular cognitive domains. Kang et al. (2019) established that cognitive training could benefit individuals with early AD, which is associated with positive effects in mild and moderate AD. Cognitive training benefited the general cognitive functions in the early stage of AD. Butler et al. (2018) established that cognitive training in older adults with normal cognition enhances cognitive performance in the domain trained.
Attempts to Incorporate the Solution into Public Policy
There have been attempts to integrate the cognitive training solution into public policy through the National Alzheimer’s Project Act (NAPA). On January 4, 2011, President Barack Obama signed NAPA into law. NAPA calls for the Secretary of the U.S. Department of Health and Human Services (HHS) to launch the National Alzheimer’s Project to develop and sustain an integrated national plan to address AD (ASPE, 2021). The Secretary of the HHS is also required to coordinate AD research and services across all federal agencies and speed up the development of therapies that may prevent, stop, or reverse the course of AD (ASPE, 2021). The policy is expected to enhance early diagnosis and coordination of care and treatment of AD and to improve outcomes for ethnic and racial minority populations at a higher risk for AD.
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NAPA creates a vital opportunity to build upon and control HHS programs and other federal initiatives to change the course of AD. The policy requires the HHS to prioritize expanding, coordinating, and condensing programs to improve the health outcomes of AD patients and lower the financial burden of AD on patients, their families, and society (ASPE, 2021). It offers a significant opportunity to address the numerous challenges individuals with AD and their families face.
Barriers to Implementation of the Solution
The implementation of cognitive training in AD has met various barriers that have hindered attaining the desired outcome in patients with mild and moderate AD. One of the barriers is the widespread social stigma and misconceptions associated with AD. This profoundly affects the care provided to AD patients, and individuals with mild and moderate AD tend to decline in engaging in cognitive training due to stigma (van Dam et al., 2022). In addition, the lack of adequate health professionals to conduct the cognitive training hinders many individuals who are candidates for the intervention from accessing the service. Thus, more health professionals need to be trained in providing cognitive training to increase the number of people who access the training.
Limited time is a significant barrier to implementing cognitive training, which usually requires a lot of time for training and follow-up. Besides, the workloads for mental health providers hinder them from providing cognitive training. Cognitive training is increasingly being offered through computerized cognitive interventions. Although this eases access to this service, it is a barrier since most clients are 65 years and older and are not well-versed with using healthcare technology (Bodner et al., 2020). Furthermore, cognitive improvements only occur in targeted domains, which often de-motivate clients who perceive that the cognitive training will improve all cognitive domains. The lack of motivation causes many patients to drop out of cognitive training programs.
Options Being Discussed For Public or Private Funding
Building on the NAPA, the Obama Administration announced a noteworthy $156 million investment to address Alzheimer’s disease. The investment includes instantly increasing AD research funding. The National Institutes of Health (NIH) committed an extra $50 million to fund Alzheimer’s disease research (ASPE, 2021). The investment also aims at sustaining and developing the AD research investment. The President’s 2013 fiscal year budget proposed $80 million in new AD research funding. In two fiscal years, 2012 and 2013, investments totaled $130 million in new AD research funding.
In addition, the investment is aimed at supporting individuals with AD and their families and educating the public and health providers about AD. The initiative also included $26 million to support the National Plan’s goals which include: Providing education and outreach to enhance the public’s understanding of AD; Conducting outreach programs to improve the knowledge of health care providers on AD; Increasing support for individuals with AD and caregivers in the community; Enhance data collection and analysis to improve the understanding on the impact of AD on patients, their families, long-term care facilities, and the healthcare system (ASPE, 2021).
The federal government is the biggest public funder of research in AD. The National Institute of Mental Health, National Institute on Aging, National Center for Advancing Translational Science, and National Institute of General Medical Sciences fund parts of research in development of AD drugs (Cummings et al., 2018). Other funders include the Food and Drug Administration, National Science Foundation, and the Center for Medicare and Medicaid Service. Nonetheless, funding source interaction is mostly unstructured, and the available funding is inadequate to meet all demands for new AD therapies.
I would recommend that a policy be enacted requiring funding for mental health providers on cognitive training. Hospitals can be funded to facilitate training for their mental health practitioners, which would ensure there are enough providers to conduct cognitive training. This would increase the number of patients who access cognitive training in the early stages of AD, which would delay the progression of AD and improve their overall cognitive functioning. Furthermore, I would recommend that all hospitals providing Alzheimer’s care incorporate cognitive training in the care plans for patients with mild and moderate AD.
Assistant Secretary for Planning and Evaluation (ASPE). (2021). National plan to address Alzheimer’s disease: 2021 update.
Bodner, K. A., Goldberg, T. E., Devanand, D. P., & Doraiswamy, P. M. (2020). Advancing Computerized Cognitive Training for MCI and Alzheimer’s Disease in a Pandemic and Post-pandemic World. Frontiers in psychiatry, 11, 557571. https://doi.org/10.3389/fpsyt.2020.557571
Breijyeh, Z., & Karaman, R. (2020). Comprehensive Review on Alzheimer’s Disease: Causes and Treatment. Molecules (Basel, Switzerland), 25(24), 5789. https://doi.org/10.3390/molecules25245789
Butler, M., McCreedy, E., Nelson, V. A., Desai, P., Ratner, E., Fink, H. A., … & Kane, R. L. (2018). Does cognitive training prevent cognitive decline? A systematic review. Annals of internal medicine, 168(1), 63-68. https://doi.org/10.7326/M17-1531
Cummings, J., Reiber, C., & Kumar, P. (2018). The price of progress: Funding and financing Alzheimer’s disease drug development. Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 4, 330-343. https://doi.org/10.1016/j.trci.2018.04.008
Kang, M. J., Kim, S. M., Han, S. E., Bae, J. H., Yu, W. J., Park, M. Y., Ku, S., & Yang, Y. (2019). Effect of Paper-Based Cognitive Training in Early Stage of Alzheimer’s Dementia. Dementia and neurocognitive disorders, 18(2), 62–68. https://doi.org/10.12779/dnd.2019.18.2.62
van Dam, M., van Weeghel, J., Stiekema, A., Castelein, S., Pijnenborg, M., & van der Meer, L. (2022). Barriers and facilitators to implementation of cognitive adaptation training in long‐term inpatient facilities for people diagnosed with severe mental illness: A nursing perspective. Journal of Psychiatric and Mental Health Nursing. https://doi.org/10.1111/jpm.12821
Topic 6 DQ 2
Most developed nations are experiencing an increasingly aging population in some way. The rise in the aging population is attributed to an increased life expectancy due to declines in infant mortality and premature death (Williams et al., 2019). However, the aging population is often judged negatively from an economic view. On average, older age groups have significantly higher health care expenditures than younger ones, especially in developed healthcare systems. As a result, policy-makers often believe population ageing will lead to an unconstrained increase in health spending (Williams et al., 2019). Nonetheless, an aging population does not mean there will be large increases in health expenditure growth.
An aging population is also associated with wastage of healthcare resources. Cristea et al. (2020) assert that population aging brings about growing healthcare costs owing to an increase in age-related medical procedures and treatments. This pushes up costs of long-term care, which are projected to increase faster than other healthcare needs. However, these procedures and treatments are often unnecessary leading to wastage (Cristea et al., 2020). Besides, elderly patients with more than one chronic illness consult more than one specialist. The different specialists often order the same diagnostic tests resulting in wastage.
Genetics are associated with non-communicable diseases (NCDs), often diagnosed in the aging population and resulting in increased healthcare spending. For example, genetics are associated with NCDs like cancer, hypertension, heart disease, and diabetes (Melzer et al., 2020). The treatment of these diseases significantly affects the economics of the healthcare system since patients often require life-long medication and regular follow-ups. The DNP- nurse can utilize the information to assess elderly patients and their health risks and implement lifestyle interventions to lower the risk of NCDs. This can help lower the healthcare costs associated with the treatment of NCDs.
Cristea, M., Noja, G. G., Stefea, P., & Sala, A. L. (2020). The Impact of Population Aging and Public Health Support on EU Labor Markets. International journal of environmental research and public health, 17(4), 1439. https://doi.org/10.3390/ijerph17041439
Melzer, D., Pilling, L. C., & Ferrucci, L. (2020). The genetics of human ageing. Nature Reviews Genetics, 21(2), 88-101. https://doi.org/10.1038/s41576-019-0183-6
Williams, G., Cylus, J., Roubal, T., Ong, P., Barber, S., & World Health Organization. (2019). Sustainable health financing with an ageing population: will population ageing lead to uncontrolled health expenditure growth?.
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