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State of Alaska

Health Indicator Report of Mental Health - Increased Confusion or Memory Loss - Adults (45+)

Worsening or more frequent confusion or memory loss (often referred to as subjective cognitive decline) is one of the earliest warning signs of Alzheimer's disease and may be a way to identify people who are at high risk of developing mild cognitive impairment, Alzheimer's, and other dementias.^3,4^ Subjective cognitive decline does not refer to occasional problems with forgetting names or keys, but rather relates to more serious problems such as trouble recalling how to do familiar tasks or not remembering things usually known. Many people who experience subjective cognitive decline develop mild cognitive impairment or Alzheimer's disease and other dementias, but others do not.^5^ Memory loss or increased confusion can affect individuals' ability to manage their chronic conditions, care for themselves, and recover from illness or injury.^6,7^ Healthy People 2020 includes the objective to "increase the proportion of persons with diagnosed Alzheimer's disease and other dementias, or their caregiver, who are aware of the diagnosis."^8^ Discussions between older adults and health care providers about changes in cognition can support identification and treatment of reversible conditions that mimic cognitive impairment and dementia, such as depression or vitamin deficiency.^9^ Early detection of potential cognitive impairment also can help health care providers provide better care for comorbidities and help people with subjective cognitive decline to build a care team and make plans for future care and finances.^10^ Early diagnosis can help individuals and families connect with appropriate services early on, which often results in people being able to live safely in their own homes for a longer time, sometimes at a lower cost, and with improved quality of life. [[br]] [[br]] ---- {{class .SmallerFont See "'Resources and References"' tab for references. }}

Data Source

Alaska Data: [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System], Alaska Department of Health and Social Services, DPH, Section of Chronic Disease Prevention and Health Promotion

Data Interpretation Issues

Data on Increased Confusion or Memory Loss (ICML) was collected using the 2015 version of the BRFSS Cognitive Decline module.^1^ ICML has also been referred to as cognitive decline or subjective cognitive decline (SCD). Beginning in 2015 the ICML question module was only asked to respondents aged 45 and up. The findings in this report are subject to at least four limitations. First, data are self-reported, not validated by any clinical measurement, and might be subject to recall bias. Second, the survey design is cross-sectional, and causality of specific diseases or conditions cannot be inferred. Third, although questions underwent multiple rounds of cognitive testing to ensure that respondents understood the questions, given misperceptions surrounding dementia, respondents might provide the most "socially acceptable" answer, which could vary by race/ethnicity or geography. Furthermore, whether increased confusion or memory loss interferes with a respondent's ability to accurately describe functional difficulties is unknown. Fourth, these results might underestimate confusion or memory loss and functional difficulties because BRFSS does not include residents of nursing homes or other facilities where a high percentage of people with cognitive impairment reside, and results were limited to telephone survey responses.^2^[[br]] [[br]] ---- {{class .SmallerFont See "'Resources and References"' tab for references. }}

Definition

Percentage of adults 45 years of age and older who responded "Yes" on the [http://dhss.alaska.gov/dph/Chronic/Pages/brfss/default.aspx Behavioral Risk Factor Surveillance System (BRFSS)] to the question: "During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse?"

Numerator

Weighted number of adults (45+) who responded "Yes" on the BRFSS to the question: "During the past 12 months, have you experienced confusion or memory loss that is happening more often or is getting worse?"

Denominator

Weighted number of adults (45+) with complete and valid responses on the BRFSS to the question on increased confusion or memory loss, excluding those with missing, "Don't know/Not sure", or "Refused" responses.

Other Objectives

Healthy Alaskans 2020 Indicator 9: Reduce the mean number of days in the past 30 days that adults (age 18 and older) report being mentally unhealthy to 2.9 days by 2020.

How Are We Doing?

The percentage of Alaska adults reporting increased confusion or memory loss is highest among those who are 65 years of age and older at 14.4%. As an age-related impairment, lower rates were reported by those 45-55 years of age (7.8%) and the prevalence of increased confusion or memory loss was highest among those 75 years of age and older at 18.4%. Among those less than 45 years of age and older, respondents with less than a high school education or those unable to work were at the highest risk for increased confusion or memory loss for those aged, 26.6% and 34.8% respectively. For both groups, increased confusion or memory loss declined for the top 2 income brackets. Rates of increased confusion or memory loss from the BRFSS are initially presented for all Alaskans and Alaska Native people for 2016. Subsequent analyses were conducted for demographic subpopulations (i.e., sex, age, race/ethnicity, marital status, education, employment status, income, and poverty status). Crosstabulations were also conducted for body mass index, current smoking, sexual orientation, disability, adverse childhood experiences, and self-report general health. Higher levels of increased confusion or memory loss were associated with obesity, current smoking, being disabled, exposure to adverse childhood experiences, and self-report of fair or poor general health. Rates of increased confusion or memory loss by regions of Alaska are presented for all Alaskans and Alaska Native people for combined years 2013 and 2016: 1) 7 Alaska Public Health Regions, 2) 5 Metropolitan and Micropolitan Statistics Areas and rural remainder, and 3) 10 behavioral health assessment regions based upon aggregations of 20,000 population. There were insufficient responses to tabulate by the 29 boroughs and census areas or the 12 tribal health organization regions. Limitations attributable to increase confusion or memory loss are displayed by all Alaskans and Alaska Native people.

How Do We Compare With the U.S.?

The Cognitive Decline (CD) module was asked in 21 states in 2016.^11^ A national baseline for comparison has not been reported.[[br]][[br]] ---- {{class .SmallerFont 11. National Center for Chronic Disease Prevention and Health Promotion. 2016 Modules by State by Data Set & Weight. https://www.cdc.gov/brfss/questionnaires/modules/state2016.htm. Accessed September 22, 2017. }}

What Is Being Done?

Reducing poor mental health in adults was identified as one of 25 leading health indicators to be addressed by Healthy Alaskans 2020.^12^ The Alaska strategies being followed are: 1. Identify adults who rate their mental health as not good and connect them to screening, treatment, and social support services without delay. 2. Identify environmental and individual strengths of Alaskans who are mentally healthy to inform health promotion strategies. 3. Create supportive environments that promote resilient, healthy, and empowered individuals, families, schools, and communities.[[br]][[br]] ---- {{class .SmallerFont 12. Alaska Department of Health and Social Services and the Alaska Native Tribal Health Consortium. Healthy Alaskans 2020. [http://hss.state.ak.us/ha2020/]. Accessed May 5, 2016. }}

Evidence-based Practices

As part of the Healthy Alaskans 2020 health improvement process, groups of Alaska subject matter experts met over a period of months in a rigorous review process to identify and prioritize strategies to address the 25 health priorities. Below are the strategies identified for enhancing adult support systems. '''Strategy 1:''' [[br]]Identify adults who are experiencing or at-risk of experiencing mentally unhealthy days and connect them to screening, treatment, and social support services immediately (indicated prevention). '''Evidence Base:''' [[br]]Individuals who receive treatment and/or behavioral interventions earlier are less likely to develop serious mental health disorders. Screening for both depression and substance abuse is indicated, as the impact of misuse and dependence on alcohol and drugs in overall mental health is substantial. The U.S. Preventive Services Task Force recommends depression screening for adults at higher risk, including those experiencing substance misuse, chronic medical diseases, unemployment, and poverty. '''Sources:''' [[br]][http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/section2a.html Depression Guide to Clinical Preventive Services] [http://beta.samhsa.gov/sites/default/files/sbirtwhitepaper_0.pdf Screening, Brief Intervention and Referral to Treatment (SBIRT) in Behavioral Healthcare] '''Strategy 2:''' [[br]]Identify the environmental and individual strengths of Alaskans reporting 0-3 mentally unhealthy days per month to inform mental health improvement strategies. '''Evidence Base:''' [[br]]Individuals have both biological and psychological characteristics that affect their vulnerability and resiliency to potential behavioral health problems. Protective factors might include positive self-image, self-control, or social competence. Understanding the specific characteristics of mentally healthy Alaskans will inform prevention and health promotion activities tailored to improve mentally healthy days. '''Source:''' [[br]]Bonanno, GA. Loss, Trauma, and Human Resilience: Have We Underestimated the Human Capacity to Thrive After Extremely Aversive Events? American Psychologist 2004;59(1):20-8. '''Strategy 3:''' Create supportive environments that promote resilient, healthy, and empowered individuals, families, schools, and communities (universal prevention). '''Evidence Base:''' The World Health Organization holds that "a supportive environment is of paramount importance for health. The two are interdependent and inseparable" (Sundsvall Statement on Supportive Environments for Health, 1991). Supportive environments can help protect people from risk factors for poor health, encourage participation in health care and health promotion, expand individuals' health competencies and self-reliance, and support person-centered health care. Stigma and attitudes about help-seeking (specifically seeking treatment or services for mental health conditions) are key barriers to promoting mental and emotional health and preventing mental illness. Creating communities that de-stigmatize depression and mental illness and encourage people to seek mental health services when needed can increase the number of people accessing services. '''Sources:''' [[br]]Segal DL, Coolidge FL, Mincic MS, O'Riley A. Beliefs about mental illness and willingness to seek help: a cross-sectional study. Aging and Mental Health 2005;9(4):363-7. Reynders A, Kerkhof AJFM, Molenberghs G, Van Audenhove C. Attitudes and stigma in relation to help-seeking intentions for psychological problems in low and high suicide rate regions. Social Psychiatry and Psychiatric Epidemiology 2014;49(2):231-9. A listing of strategies, actions, and key partners on this measure can be found at: [http://hss.state.ak.us/ha2020/assets/Actions-Partners_9_MentalHealth_Adults.pdf].

Available Services

'''Aging and Disability Resource Centers''' Alaska's [http://dhss.alaska.gov/dsds/pages/adrc/default.aspx ADRCs] connect seniors, people with disabilities, and caregivers with long-term services and supports of their choice. The ADRC network serves Alaskans statewide, regardless of age or income level, through regional sites. Office locations: ANCHORAGE Agency: Municipality of Anchorage 825 L Street, Suite 203 Anchorage, Alaska 99501 Phone: 907-343-7778 | Fax: 907-343-6320 Website: [http://www.muni.org/Departments/health/PHIP/pages/ADRC.aspx] MAT-SU Agency: LINKS Mat-Su ADRC 3161 E. Palmer-Wasilla Hwy #2 Wasilla, AK 99654 Phone: 907-373-3632 | Fax: 907-373-3620 Email: [mailto:linksinfo@linksprc.org linksinfo@linksprc.org] Website: [http://www.linksprc.org] BRISTOL BAY Agency: Bristol Bay Native Association Box 310, Dillingham, AK 99576 Phone: 907-842-4139 | Toll free: 1-800-478-4139 Fax: 907-842-4106 Website [http://www.bbna.com/website/ElderlyServ.html] KENAI PENINSULA Agency: Independent Living Center, Inc. Website: [http://www.peninsulailc.org] Homer 3953 Bartlett P.O. Box 2474 Homer, AK 99603 Phone: 907-235-7911| Fax: 907-235-6236 Central Peninsula 47255 Princeton Ave. Suite 8 Soldotna, Alaska 99669 Phone: 907-262-6333 | Fax: 907-260-4495 Seward 201 Third Ave., Suite 102 P.O. Box 3523 Seward, AK 99664 907-224-8711 | Fax: 907-224-7793 SOUTHEAST Agency: Southeast Alaska Independent Living Center Website: [http://www.sailinc.org] Haines 24 Fort Seward Drive Haines, AK 99827 Mailing address: P.O. Box 183 Haines, AK 99827 Phone: 907-766-3297 | Fax: 907-766-2753 Email: [mailto:haines@sailinc.org haines@sailinc.org] Juneau 3225 Hospital Drive, Suite 300 Juneau, AK 99801 Toll free: 1-800-478- SAIL(7245) | Fax: 907-568-4980 | TTY: 907-523-5285 Afterhours/Weekend contact Interpreter requests: 907-321-4085 Ketchikan Independent Living Specialist 602 Dock Street, Suite 107 Ketchikan, AK 99901 Toll free: 1-888-452- SAIL(7245) | Local: 907-225-4735 | Fax: 907-247-4735 Sitka 514 Lake Street, Suite C Sitka, AK 99835 Toll free: 1-888-500-7245 | local: 907-747-6859 | Fax: 907-747-6783 Email: [mailto:sitka@sailinc.org sitka@sailinc.org] A [http://dhss.alaska.gov/dsds/Pages/adrc/map.aspx Map Link] is also available or call 1-877-6AK-ADRC (1-877-625-2372) toll-free.
Page Content Updated On 09/28/2017, Published on 09/28/2017
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health (Ak-IBIS) web site (http://ibis.dhss.alaska.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Thu, 24 May 2018 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health web site: http://ibis.dhss.alaska.gov ".

Content updated: Thu, 28 Sep 2017 11:27:35 AKDT
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics AK-IBIS web site (http://ibis.dhss.alaska.gov/). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Thu, 24 May 2018 0:22:01 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Indicator-Based Information System for Public Health Web site: http://ibis.dhss.alaska.gov/ ".

Content updated: Thu, 28 Sep 2017 11:27:35 AKDT