Changes in Health Indicators Among Caregivers - United States, 2015-2016 to 2021-2022.

Caregivers provide support to persons who might otherwise require placement in long-term care facilities. Approximately one in five U.S. adults provides care to family members or friends who have a chronic health condition or disability. Promoting the well-being of this large segment of the population is a public health priority as recognized by the 2022 National Strategy to Support Family Caregivers. Although negative associations between caregiving and caregiver health are known, changes in the health status of caregivers over time are not. Data from the 2015-2016 and 2021-2022 Behavioral Risk Factor Surveillance System were analyzed to compare changes in the prevalence of 19 health indicators among cross-sectional samples of caregivers and noncaregivers at different time points. Caregivers experienced improvements in prevalence of four health indicators, whereas six worsened. Some health indicators, such as cigarette smoking, improved for both caregivers and noncaregivers, although smoking prevalence remained higher for caregivers (16.6% versus 11.7%). Prevalence of lifetime depression increased for both groups and remained higher among caregivers (25.6%) than among noncaregivers (18.6%). During 2021-2022, age-adjusted estimates for caregivers were unfavorable for 13 of the 19 health indicators when compared with noncaregivers. Strategies for supporting caregivers are available, and integrating these with existing programs to address mental health and chronic diseases among this population might improve caregiver well-being. For example, many community organizations support caregivers by offering interventions designed to relieve caregiver strain, including skills training, support groups, and care coordination.

Alzheimer's disease and related dementia diagnoses among American Indian and Alaska Native adults aged ≥45 years, Indian Health Service System, 2016-2020.

BACKGROUND: Alzheimer's disease is the most common type of dementia and is responsible for up to 80% of dementia diagnoses and is the sixth leading cause of death in the United States. An estimated 38,000 American Indian/Alaska Native (AI/AN) people aged ≥65 years were living with Alzheimer's disease and related dementias (ADRD) in 2020, a number expected to double by 2030 and quadruple by 2050. Administrative healthcare data from the Indian Health Service (IHS) were used to estimate ADRD among AI/AN populations. METHODS: Administrative IHS healthcare data from federal fiscal years 2016 to 2020 from the IHS National Data Warehouse were used to calculate the count and rate per 100,000 AI/AN adults aged ≥45 years with at least one ADRD diagnosis code on their medical record. RESULTS: This study identified 12,877 AI/AN adults aged ≥45 years with an ADRD diagnosis code, with an overall rate of 514 per 100,000. Of those, 1856 people were aged 45-64. Females were 1.2 times (95% confidence interval: 1.1-1.2) more likely than males to have a medical visit with an ADRD diagnosis code. CONCLUSIONS: Many AI/AN people with ADRD rely on IHS, tribal, and urban Indian health programs. The high burden of ADRD in AI/AN populations aged 45-64 utilizing IHS health services highlights the need for implementation of ADRD risk reduction strategies and assessment and diagnosis of ADRD in younger AI/AN populations. This study provides a baseline to assess future progress for efforts addressing ADRD in AI/AN communities.

The intersection of social determinants of health and family care of people living with Alzheimer's disease and related dementias: A public health opportunity.

In this Perspective article, we highlight current research to illustrate the intersection of social determinants of health (SDOHs) and Alzheimer's disease and related dementia (ADRD) caregiving. We then outline how public health can support ADRD family caregivers in the United States. Emerging research suggests that family care for persons with ADRD is influenced by SDOHs. Public health actions that address these intersections such as improved surveillance and identification of ADRD caregivers; building and enhancing community partnerships; advancing dementia-capable health care and related payment incentives; and reducing the stigma of dementia and ADRD caregiving can potentially enhance the health and well-being of dementia caregivers. By engaging in one or all of these actions, public health practitioners could more effectively address the myriad of challenges facing ADRD caregivers most at risk for emotional, social, financial, psychological, and health disruption.

Epidemiologic and Clinical Features of Mpox in Adults Aged >50 Years - United States, May 2022-May 2023.

During May 2022-May 2023, approximately 30,000 mpox cases were reported in the United States, predominantly among young adult men. Persons aged >50 years might experience more severe mpox disease because of a higher prevalence of comorbidities. Conversely, they could have residual protection from childhood smallpox vaccination against monkeypox virus infection and severe mpox, as has been suggested by investigation of some previous mpox outbreaks. To examine the characteristics of mpox cases among adults aged >50 years, analysts compared mpox epidemiology and clinical outcomes among all adults aged ≥18 years, by age group. Further, outcomes were compared among adults aged >50 years by JYNNEOS vaccination status. During May 10, 2022-May 17, 2023, among 29,984 adults with probable or confirmed mpox reported to CDC, 2,909 (9.7%) were aged >50 years, 96.3% of whom were cisgender men. Compared with adults aged 18-50 years, adults aged >50 years had higher prevalences of immunocompromising conditions (p<0.001) and HIV infection (p<0.001). Among adults with mpox aged >50 years, 27.6% had received JYNNEOS vaccination; this group had lower prevalences of constitutional symptoms (p<0.001), pruritus (p<0.001), and hospitalization (p = 0.002) compared with those who had not received JYNNEOS vaccine. Currently recommended JYNNEOS vaccination among all adults at risk for mpox should be encouraged, irrespective of childhood smallpox vaccination status.

Racial and Ethnic Differences in Subjective Cognitive Decline - United States, 2015-2020.

Subjective cognitive decline (SCD), the self-reported experience of worsening or more frequent memory loss or confusion, might be a symptom of early-stage dementia or future serious cognitive decline such as Alzheimer disease* or a related dementia (ADRD) (1). Established modifiable risk factors for ADRD include high blood pressure, inadequate physical activity, obesity, diabetes, depression, current cigarette smoking, and hearing loss (2). An estimated 6.5 million persons aged ≥65 years in the United States live with Alzheimer disease, the most common dementia (1). This number is projected to double by 2060, with the largest increase among non-Hispanic Black or African American (Black), and Hispanic or Latino (Hispanic) adults (1,3). Using data from the Behavioral Risk Factor Surveillance System (BRFSS), CDC assessed racial and ethnic, select demographic, and geographical differences in SCD prevalence, and prevalence of health care professional conversations among those reporting SCD. The age-adjusted prevalence of SCD during 2015-2020 was 9.6% among adults aged ≥45 years (5.0% of Asian or Pacific Islander [A/PI] adults, 9.3% of non-Hispanic White [White] adults, 10.1% of Black adults, 11.4% of Hispanic adults, and 16.7% of non-Hispanic American Indian or Alaska Native [AI/AN] adults). College education was associated with a lower prevalence of SCD among all racial and ethnic groups. Only 47.3% of adults with SCD reported that they had discussed confusion or memory loss with a health care professional. Discussing changes in cognition with a physician can allow for the identification of potentially treatable conditions, early detection of dementia, promotion of dementia risk reduction behaviors, and establishing a treatment or care plan to help adults remain healthy and independent for as long as possible.

Characteristics of Asian American Family Caregivers of Older Adults Compared to Caregivers of Other Racial/Ethnic Groups: Behavioral Risk Factor Surveillance System 2015-2020.

Asian Americans (AAs) are the fastest-growing racial/ethnic minority group in the United States. While otherwise highly heterogeneous, AAs overall value filial piety and eldercare. This study compared the health and caregiving experiences of AA caregivers of older adults to AA non-caregivers and caregivers of older adults across racial/ethnic groups. We used 2015-2020 Behavioral Risk Factor Surveillance System data for 315 AA caregivers and 3822 AA non-caregivers, plus 395 American Indian/Alaska Native, 1883 Black, 1292 Hispanic, and 20,321 non-Hispanic White caregivers. Among AAs, 4.3% were caregivers, a lower proportion than in other racial/ethnic groups. Most AA caregivers were female (59%), married (71%), in excellent/very good/good health (76%), and with at least one chronic health condition (66%). Other than relationship to care recipients, caregivers' experiences were similar across racial/ethnic groups: most cared for <20 hours/week and provided household and personal care. Efforts to support AA caregivers should be attentive to cultural practices.

Promoting Healthy Aging to Reduce the Risk of Dementia: A Public Health Imperative.

Alzheimer's disease and related dementias place an enormous burden on individuals, families, health and long-term care systems, and governmental budgets. As the burden escalates with rising prevalence, attention has increasingly focused on how the risk of developing dementia can be reduced. Evidence indicates there are ways, from a population perspective, to reduce the risk of cognitive decline and possibly dementia, including through healthier lifestyles. It is imperative that the public health community lead the effort to address modifiable risk factors and social determinants of health for dementia and promote healthy aging through public health action.

Prevalence and Characteristics of Arthritis Among Caregivers - 17 States, 2017 and 2019.

Caregiving provides numerous benefits to both caregivers and care recipients; however, it can also negatively affect caregivers' mental and physical health (1-4), and caregiving tasks often require physical exertion (1). Approximately 44% of adults with arthritis report limitations attributable to arthritis, including trouble doing daily activities (5). These limitations might affect caregivers' ability to provide care, but little is known about arthritis among caregivers. To assess arthritis among caregivers of a family member or friend, CDC examined data from 17 states that administered both the arthritis and caregiving modules as part of the Behavioral Risk Factor Surveillance System (BRFSS) in either 2017 or 2019. Approximately one in five adults (20.6%) was a caregiver. Prevalence of arthritis was higher among caregivers (35.1%) than noncaregivers (24.5%). Compared with caregivers without arthritis, those with arthritis provided similar types of care and were more likely to have provided care for ≥5 years and for ≥40 hours per week. In addition, higher proportions of caregivers with arthritis reported disabilities compared with those without arthritis, including mobility issues (38.0% versus 7.3%). Arthritis among caregivers might affect their own health as well as the care they can provide. Caregivers can discuss their arthritis and related limitations with a health care professional to identify ways to increase their physical activity and participation in lifestyle management programs.* Such interventions might ease arthritis pain and related limitations and might support them in their ongoing caregiving role. Public health professionals can implement strategies to support caregivers throughout the caregiving process.†.

Modifiable Risk Factors for Alzheimer Disease and Related Dementias Among Adults Aged ≥45 Years - United States, 2019.

Alzheimer disease,* the most common cause of dementia, affects an estimated 6.5 million persons aged ≥65 years in the United States (1). A growing body of evidence has identified potential modifiable risk factors for Alzheimer disease and related dementias (ADRD) (1-3). In 2021, the National Plan to Address Alzheimer's Disease (National Plan) introduced a new goal to "accelerate action to promote healthy aging and reduce risk factors for Alzheimer's disease and related dementias" to help delay onset or slow the progression of ADRD (3). To assess the status of eight potential modifiable risk factors (i.e., high blood pressure, not meeting the aerobic physical activity guideline, obesity, diabetes, depression, current cigarette smoking, hearing loss, and binge drinking), investigators analyzed data from the cognitive decline module that was administered to adults aged ≥45 years in 31 states and the District of Columbia (DC)† in the 2019 Behavioral Risk Factor Surveillance System (BRFSS) survey. Among the risk factors, prevalence was highest for high blood pressure (49.9%) and lowest for binge drinking (10.3%) and varied by selected demographic characteristics. Adults with subjective cognitive decline (SCD),§ an early indicator of possible future ADRD (4), were more likely to report four or more risk factors than were those without SCD (34.3% versus 13.1%). Prevalence of SCD was 11.3% overall and increased from 3.9% among adults with no risk factors to 25.0% among those with four or more risk factors. Implementing evidence-based strategies to address modifiable risk factors can help achieve the National Plan's new goal to reduce risk for ADRD while promoting health aging.¶,*.

Prevalence and Characteristics of Subjective Cognitive Decline Among Unpaid Caregivers Aged ≥45 Years - 22 States, 2015-2019.

Approximately 20% of U.S. adults are unpaid caregivers (caregivers) (1) who provide support to a family member or friend with a health condition or disability. Although there are benefits to caregiving, it can negatively affect caregivers' physical and mental health (2-4). Much of the assistance caregivers provide, such as administering medications or financial management, relies on cognitive ability, but little is known about caregivers' cognitive functioning. Subjective cognitive decline (SCD), the self-reported experience of worsening or more frequent confusion or memory loss over the past year (5), could affect caregivers' risk for adverse health outcomes and affect the quality of care they provide. CDC analyzed SCD among caregivers aged ≥45 years through a cross-sectional analysis of data from 22 states in the 2015-2019 Behavioral Risk Factor Surveillance System (BRFSS). Among adults aged ≥45 years, SCD was reported by 12.6% of caregivers who provided care to a family member or friend with a health condition or disability in the past 30 days compared with 10.2% of noncaregivers (p<0.001). Caregivers with SCD were more likely to be employed, men, aged 45-64 years, and have chronic health conditions than were noncaregivers with SCD. Caregivers with SCD were more likely to report frequent mental distress, a history of depression, and frequent activity limitations than were caregivers without SCD. SCD among caregivers could adversely affect the quality of care provided to care recipients. Understanding caregivers' cognitive health and the types of care provided is critical to maintaining the health, well-being, and independence of the caregiving dyad. Health care professionals can support patients and their patients' caregivers by increasing awareness among caregivers of the need to monitor their own health. The health care team can work with caregivers to identify potential treatments and access supports that might help them in their caregiving role and compensate for SCD.

Baby Boomers Who Provide Informal Care for People Living with Dementia in the Community.

One in four Baby Boomers fills the informal caregiver role in the United States. The objectives of this study were to estimate the prevalence of Baby Boomers who are informal caregivers for people living with dementia and compare their physical and mental health status to caregivers for persons with conditions other than dementia using 2015-2018 Behavioral Risk Factor Surveillance System data (N = 10,602). We identified caregiving status (assisting a family member/friend with a long-term illness or disability in the past month, managing personal care, and not caring for a child/grandchild) and whether the care recipient's major health condition was dementia. We calculated weighted estimates and used chi-square tests and log-binomial regression for comparisons of selected characteristics. Among Baby Boomer caregivers, 15.4% were caring for someone with dementia. Dementia caregivers were more likely to be female, caring for a parent/parent-in-law, and providing care longer than caregivers for persons without dementia. After adjusting for sociodemographic and caregiving characteristics, the prevalence of fair/poor health, frequent mental distress, and chronic conditions were similar across types of caregivers. Although no differences in caregiver's physical and mental health by care recipient's dementia status were found, we should underscore the importance of maintaining Baby Boomer caregivers' health and well-being.

Subjective cognitive decline higher among sexual and gender minorities in the United States, 2015-2018.

INTRODUCTION: Subjective cognitive decline (SCD) represents self-reported problems with memory, a possible early sign of dementia. Little is known about SCD among sexual and gender minority (SGM) adults who identify as lesbian, gay, bisexual, and/or transgender or gender non-binary. METHODS: Data were weighted to represent population estimates from 25 states' 2015-2018 Behavioral Risk Factor Surveillance System to describe SCD in adults ≥45 years by SGM status. Logistic regression tested associations between demographic and health conditions. RESULTS: SCD prevalence was higher in SGM (15.7%; 95% confidence interval [CI]:13.1-18.2) than in non-SGM adults (10.5%; 95% CI:10.1-10.9; P < .0001). SGM adults with SCD were also more likely to report functional limitations due to SCD than non-SGM adults with SCD, 60.8% versus 47.8%, P = .0048. Differences in SCD by SGM status were attenuated after accounting for depression. DISCUSSION: Higher prevalence of SCD in SGM adults highlights the importance of ensuring inclusive screenings, interventions, care services, and resources for SGM adults.

Population measures of subjective cognitive decline: A means of advancing public health policy to address cognitive health.

Subjective cognitive decline (SCD) is receiving increasing attention as studies have suggested that SCD status is associated with risk of future cognitive decline and dementia. Population-based measures of SCD can be extremely useful to the public health community, health-care providers, researchers, and policymakers. A large population-based SCD measure now exists through the state-based Behavioral Risk Factor Surveillance System (BRFSS). All 50 states have included the cognitive decline module, which asks about SCD, to their BRFSS survey one or more times. Population measures of SCD can aid researchers in designing clinical studies by better estimating the populations that may be at risk for more severe cognitive decline based on their SCD status to ensure that the optimal groups are targeted. Population-level estimates of SCD can also help to inform health-care providers' decisions about initiating cognitive assessments, managing other conditions among those with memory problems, and identifying the needs of caregivers.

Unmet needs for assistance related to subjective cognitive decline among community-dwelling middle-aged and older adults in the US: prevalence and impact on health-related quality of life.

OBJECTIVES: To estimate the prevalence of unmet needs for assistance among middle-aged and older adults with subjective cognitive decline (SCD) in the US and to evaluate whether unmet needs were associated with health-related quality of life (HRQOL). DESIGN: Cross-sectional. SETTING: US - 50 states, District of Columbia, and Puerto Rico. PARTICIPANTS: Community-dwelling adults aged 45 years and older who completed the Cognitive Decline module on the 2015--2018 Behavioral Risk Factor Surveillance System reported experiencing SCD and always, usually, or sometimes needed assistance with day-to-day activities because of SCD (n = 6,568). MEASUREMENTS: We defined SCD as confusion or memory loss that was happening more often or getting worse over the past 12 months. Respondents with SCD were considered to have an unmet need for assistance if they sometimes, rarely, or never got the help they needed with day-to-day activities. We measured three domains of HRQOL: (1) mental (frequent mental distress, ≥14 days of poor mental health in the past 30 days), (2) physical (frequent physical distress, ≥14 days of poor physical health in the past 30 days), and (3) social (SCD always, usually, or sometimes interfered with the ability to work, volunteer, or engage in social activities outside the home). We used log-binomial regression models to estimate prevalence ratios (PRs). All estimates were weighted. RESULTS: In total, 40.2% of people who needed SCD-related assistance reported an unmet need. Among respondents without depression, an unmet need was associated with a higher prevalence of frequent mental distress (PR = 1.55, 95% CI: 1.12-2.13, p = 0.007). Frequent physical distress and social limitations did not differ between people with met and unmet needs. CONCLUSIONS: Middle-aged and older adults with SCD-related needs for assistance frequently did not have those needs met, which could negatively impact their mental health. Interventions to identify and meet the unmet needs among people with SCD may improve HRQOL.

County-Level Concentration of Selected Chronic Conditions Among Medicare Fee-for-Service Beneficiaries and Its Association with Medicare Spending in the United States, 2017.

Multiple chronic conditions (MCC) reduce quality of life and are associated with high per capita health care spending. One potential way to reduce Medicare spending for MCC is to identify counties whose populations have high levels of spending compared to level of disease burden. Using a nationally representative sample of Medicare Fee-for-Service beneficiaries, this paper presents a method to measure the collective burden of several chronic conditions in a population, which the authors have termed the concentration of chronic conditions (CCC). The authors observed a significantly positive linear relationship between the CCC measure and county-level per capita Medicare spending. This area-level measure can be operationalized to identify counties that might benefit from targeted efforts designed to optimally manage and prevent chronic illness.

Cross-sectional association between physical activity level and subjective cognitive decline among US adults aged ≥45 years, 2015.

Subjective cognitive decline (SCD) is the self-reported experience of worsening or more frequent confusion or memory loss within the previous 12 months and can be one of the earliest symptoms of Alzheimer's disease. Regular physical activity can contribute to the primary, secondary, and tertiary prevention of cognitive decline. At the national level, prevalence estimates of SCD by physical activity level in the United States are currently unknown. The purpose of this study is to examine the prevalence of SCD and resulting functional limitations by physical activity level among US adults aged ≥45 years. Data from 33 states and the District of Columbia participating in the 2015 Behavioral Risk Factor Surveillance System (N = 128,925) were analyzed. We estimated the prevalence of SCD (a positive response to a question about worsening or more frequent confusion or memory loss within the previous 12 months) and resulting functional limitations overall and by self-reported physical activity level based on current guidelines (i.e., active, insufficiently active, and inactive). Odds ratios were estimated using logistic regression models adjusting for respondent characteristics. Overall, 11.3% of US adults aged ≥45 years reported SCD. Prevalence of SCD increased as physical activity level decreased (active: 8.8%; insufficiently active: 11.4%; inactive: 15.7%). Among those with SCD, the prevalence of functional limitations also increased as physical activity level decreased (active: 40.5%; insufficiently active: 50.0%; inactive: 57.4%). These differences largely remained after adjusting for respondent characteristics. Findings highlight the potential public health impact nationally of efforts to promote physical activity for cognitive health.

Baby Boomers as Caregivers: Results From the Behavioral Risk Factor Surveillance System in 44 States, the District of Columbia, and Puerto Rico, 2015-2017.

INTRODUCTION: Baby boomers, people born from 1946 through 1964, represent a substantial portion of the US population. Generally, baby boomers have more chronic disease and disability than those in the previous generation. Frequently, they also provide informal care to others. The objective of our study was to estimate the prevalence of informal caregiving among baby boomers and compare the health of baby boomer caregivers and noncaregivers. METHODS: Using data from the Behavioral Risk Factor Surveillance System (2015-2017) for 44 states, the District of Columbia, and Puerto Rico, we classified 109,268 baby boomers as caregivers or noncaregivers and compared their general health (poor or fair vs good, very good, or excellent), chronic health conditions, and frequent mental distress (FMD). FMD was defined as 14 days or more of poor mental health in the past month. We used log-binomial regression to calculate prevalence ratios, adjusted for age and sex (aPRs), and to separately estimate aPRs for fair or poor health and FMD or at least one chronic health condition. RESULTS: One in 4 baby boomers (24.2%) were caregivers. In adjusted models, male caregivers had a higher prevalence of fair to poor health than noncaregivers (aPR = 1.17; 95% confidence interval [CI], 1.06-1.29; P = .001). More caregivers than noncaregivers had at least 1 chronic health condition (aPR = 1.10, 95% CI, 1.07-1.13; P < .001) and more often had FMD (aPR = 1.39; 95% CI, 1.26-1.53; P < .001). CONCLUSION: Our study showed these caregivers had more chronic health conditions and more often had FMD than noncaregivers. The health of baby boomer caregivers is a public health priority, as these caregivers might need support to maintain their own physical and mental health.

The Public Health Road Map to Respond to the Growing Dementia Crisis.

As the proportion of older adults in the United States is projected to increase dramatically in the coming decades, it is imperative that public health address and maintain the cognitive health of this growing population. More than 5 million Americans live with Alzheimer's disease and related dementias (ADRD) today, and this number is projected to more than double by 2050. The public health community must be proactive in outlining the response to this growing crisis. Promoting cognitive decline risk reduction, early detection and diagnosis, and increasing the use and availability of timely data are critical components of this response. To prepare state, local, and tribal organizations, CDC and the Alzheimer's Association have developed a series of Road Maps that chart the public health response to dementia. Since the initial Healthy Brain Initiative (HBI) Road Map release in 2007, the Road Map has undergone two new iterations, with the most recent version, The HBI's State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map, released in late 2018. Over the past several years, significant advances were made in the science of risk reduction and early detection of ADRD. As a result, the public health response requires a life-course approach that focuses on reducing risk and identifying memory issues earlier to improve health outcomes. The most recent Road Map was revised to accommodate these strides in the science and to effect change at the policy, systems, and environment levels. The 2018-2023 Road Map identifies 25 actions that state and local public health agencies and their partners can implement to promote cognitive health and address cognitive impairment and the needs of caregivers. The actions are categorized into four traditional domains of public health, and the Road Map can help public health and its partners chart a course for a dementia-prepared future.