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Reducing the Prevalence of Alzheimer’s Disease among Hispanics in El Paso, Texas:
A Community Health Approach
Allison Erickson
MPH 584 – Community Health
Dr. Kimberly Brodie
April 20, 2014
Introduction
In the United States, every 70 seconds, someone develops Alzheimer’s disease. The disease affects more than 5.3 million Americans, with 5.1 million being over the age of 65. Alzheimer’s disease is the sixth leading cause of death among American adults, as well at the fifth leading cause of death in individuals over 65 years of age, according to the Centers for Disease Control and Prevention (CDC, 2011). “In 2011, total Medicare and Medicaid spending for individuals with Alzheimer’s disease [was] estimated at $130 billion” (CDC, 2011). Not only is the disease burdensome financially, Alzheimer’s impacts families emotionally and mentally, as well. One in nine older adults in America suffers from the disease (Alzheimer’s Association, 2013). One of the largest states in the United States, Texas, is expected to have a 74 percent increase in Alzheimer’s patients by year 2025 (Alzheimer’s Association, 2013). The state of Texas has both populous cities and rural areas, making Alzheimer’s treatment more challenging. Also, according to the Texas Department of State Health Services (TDSHS, 2010), “There is a growing body of research indicating that African Americans and Hispanic Americans may be at higher risk.” About 38.2 percent of Texans are Hispanic, making that ethnic community the second most populous, after non-Hispanic whites (United States Census Bureau, 2014).
The increase in Alzheimer’s patients in Texas is a public health concern. With a greater number of Alzheimer’s patients in communities across Texas, there is likely to be higher medical costs and lack of medical resources to aid the patients, creating substantial challenges for both the public health and medical communities. As aforementioned, the Hispanic communities in the state of Texas often occupy both rural and urban areas. However, medical treatment options vary widely when comparing different communities across the state. For example, in Harris County, where Houston is located, there are 1198 mental health providers with a ratio of 3430 to one individual in the county (County Health Rankings and Roadmaps, 2013). However, in El Paso County, there are 83 mental health providers, with a ratio of 9687 to one individual in the county (County Health Rankings and Roadmaps, 2013). Both counties have high populations, but both do not have equal access to mental health care. This is important when considering community health efforts to improve and reduce the prevalence of Alzheimer’s across the state.
Development of Vision, Mission, Objectives, and Strategies
Vision
In order to address and create a plan for reducing Alzheimer’s prevalence in Texas over the next five years, community health officials must set objectives and strategies to assist communities in being successful. To begin observing change in Alzheimer’s prevalence across the state of Texas, community health officials and services must choose a few cities to begin implementing partnerships and programming. The state of Texas and the community of El Paso will place high value on the importance of early Alzheimer’s prevention through education and community partnerships with medical and mental health professionals, particularly in the Hispanic population, as this population is known to have relatively low Alzheimer’s research across the nation (TDSHS, 2010).
Mission
The mission of the community health services is to equip, empower, and enlighten the path to prevention of Alzheimer’s disease in the city of El Paso, Texas through increased education and advocacy, improved quality and access to care, and increasing healthy lifestyle behaviors among the Hispanic population. This will be accomplished through community connections and collaboration from the medical community and organizational community in El Paso.
Objectives and Strategies
Healthy People 2020 include new objectives related to Alzheimer’s care and treatment. Therefore, objectives for the current project will reflect those indicated in Health People 2020. For example, one of these objectives states, “Increase the proportion of persons with diagnosed Alzheimer’s disease and other dementias, or their caregiver, who are aware of the diagnosis” (Healthy People, 2013). In the current discussion, the overall goal is to reduce prevalence, therefore, assisting in achieving this objective stated in Healthy People 2020. An additional objective determined by Healthy People (2013) includes specifics around physical activity. The Alzheimer’s Association (2013) indicates that cardiovascular disease is a risk factor for developing Alzheimer’s. Therefore, the objective stating, “Increase the proportion of adults who meet current Federal physical activity guidelines for aerobic physical activity and for muscle-strengthening activity” directly correlates to reducing the prevalence of cardiovascular disease.
The following objectives will be specific to the community of El Paso, Texas in helping to accomplish the mission and vision set prior. Objectives will reflect the objectives set by the TDSHS in A Comprehensive Plan for Addressing the Burden of Alzheimer’s Disease in Texas: 2010-2015 Texas State Plan on Alzheimer’s Disease (2010). First, by December 2016, the number of Hispanics who visit a primary care physician at least one time per year will increase by 30 percent. Stakeholders for this particular objective will include primary care physicians, the patient, and financial supporters of the effort, primarily the Texas Department of Health and CDC. Successes in reaching this objective will rely on the amount of bilingual physicians or nurse practitioners are available in the El Paso area. Citizen’s have access to medical staff that speak the primary language can greatly impact reaching a 30 percent increase. Another strategy for accomplishing the objective is to have Spanish speaking physicians available in mobile community health buses or vans that enter the communities to provide easy and inexpensive access to care. Although doing this in every community in El Paso may not be fiscally possible, creating any access is better than limited to no access, especially in communities that may only have access to emergency room care. Finally, developing mobile applications and websites where patients can have conversations with physicians or nurse practitioners can impact the number of Hispanics in El Paso that have contact with a medical professional.
Continuing, the next objective includes, by 2016, 50 percent of Hispanic communities in El Paso will have at least one new park, community wellness center, or paved paths to show an increase in physical activity and healthy living education courses. Stakeholders in this particular objective will include local government employees who monitor and approve new buildings and parks, the citizens of the communities, and the organizations or departments responsible for providing funding and other resources. To increase the number of parks and community wellness centers, the community health services and representatives must begin by involving a group of Hispanic community members to delegate tasks and engage other community members and organizations. Creating this group of community members will increase the validity and support for meeting the objective. Utilizing non-profit organizations like KaBOOM! to assist in building and funding parks is a starting place. Not only do non-profit organizations assist in providing resources, the organizations will often provide ample volunteers to build or renovate buildings and parks throughout communities. Additionally, non-profit organizations, like the RGK Foundation that provide grants and funding for health education, can assist in funding classes that Hispanic adults can attend at the wellness centers.
The final objective to be accomplished to reduce the prevalence of Alzheimer’s disease in El Paso states, by 2016, 50 percent of Hispanics older than 65 years old in El Paso, will have been educated around the serious nature of Alzheimer’s disease, as well as the signs and symptoms of developing dementia. Stakeholders for this particular objective will include community leaders, health services leadership developing the educational materials and distribution, and funding organizations in Texas and abroad. Strategies to meet this goal will include providing written and spoken educational tools offered in both English and Spanish for clear understanding. Also, physicians will be encouraged to hand out brochures and tip sheets for Alzheimer’s prevention during yearly physical exams or patient visits. The Texas branch of the Alzheimer’s Association will also be utilized to provide educational materials and resources for community organizations and members can access to improve and increase education and awareness. Communication of the materials will occur face to face, telephonically, through the postal service, and through email. Using multiple communication networks will increase the probability of reaching multiple individuals in the Hispanic community.
Review of Resources
The Alzheimer’s Disease Program, “was established by legislative mandate in 1987 to provide information and support to Alzheimer's patients, their families, and long term care providers” (TDSHS, 2013). Using statewide strategic planning, this program aims to increase awareness and address the burdens of Alzheimer’s often faced by the ill individual and family. This program also provides funding for ongoing Alzheimer’s research to improve quality of care and prevention efforts across the state of Texas. In fact, in 2005, Texas lawmakers approved a two million dollar investment for increasing and improving Alzheimer’s research across Texas (TDSHS, 2010). Moving forward, the Alzheimer’s Association has chapters across the United States, often state by state. This resource is vitally important to the success of meeting objectives and goals for reducing the prevalence of Alzheimer’s in communities across the United States, specifically in El Paso, Texas. For example, the Alzheimer’s Association (2014) offers a 24 hour per day, seven days per week support and help line for Alzheimer’s patients and families to receive information and advice. This helpline is also available in over 170 languages, making the resource valuable to the current objectives aforementioned. “As the largest non-profit funder of Alzheimer's research, the Association is committed to accelerating progress of new treatments, preventions and ultimately, a cure” (Alzheimer’s Association, 2014).
Continuing, the Texas Department of Aging and Disability Services (DADS, 2013) is a valuable resource to assist individuals and families on long-term services and support for those with cognitive or physical disabilities. DADS (2013) offers financial support for community disability resource centers, as well as creating community roundtables for leaders and community groups to collaborate and discuss ways to improve the health and wellbeing of older citizens. The Alzheimer’s Disease Center at the University of Texas Southwestern Medical Center is another useful resource. This center is, “one of 32 centers funded by the National Institute on Agingto evaluate patients and conduct scientific research into the cause(s) of Alzheimer's disease” (Southwestern Medical Center, 2014). Because of the specific form of care and research that this center provides, communities across Texas can gain educational material, physician support, and funding for equipping communities with necessary tools for reducing Alzheimer’s risk. Additionally, The Community Guide (2014) provides interventions and ideas for improving social support through physical activity. Social support interventions, like utilizing community centers for health education, increases the likelihood that physical activity will occur through the support of peers in one’s community. Thus, the objective of increasing community wellness centers in Hispanic communities will play a significant role in impacting both social and physical health, both contributors to developing Alzheimer’s. Similarly, the CDC will be an agency that will assist in finding solutions to the community health issue of increasing Alzheimer’s prevalence. A specific example of this would be the partnership project from the CDC and Partnership for Prevention guide that assists healthcare and community health workers establish programs and interventions in improving health (Partnership for Prevention, 2014). One partnership includes the CDC and the National Council for Behavioral Health. This organization believes that providing mental health first aid is just as important as physical ailment first aid. “Mental health first aid is a public education program that can help individuals across the community to understand mental illnesses, support timely intervention, and save lives” (National Council for Behavioral Health, 2013). Finally, this resource allows community leaders and members to become certified to teach mental health classes in a community or provide courses in becoming more skilled in mental health services as a medical provider.
Another resource that will assist in improving Alzheimer’s prevention, care, and advocacy in El Paso is a project developed by Cherry, Vikrey, Schwankovsky, Heck, Plauche, and Yep (2004) to improve quality of care in Alzheimer’s patients. “The goal of the Dementia Care Project was to improve the quality of care for people with dementia while increasing provider and consumer satisfaction” (Cherry et al., 2004, p. 554). The 83 study participants and caregivers ranged from ages 63 to 93 years old with a primary population of African-Americans. Study results indicated that the more education physicians had about dementia and caregiving, the more satisfied patients and caregivers were with the treatment and ongoing care. Physicians who performed mental status exams regularly also saw on increase in patients and caregivers who used treatment options more effectively and efficiently. This information impacts the current goals and objectives of reducing Alzheimer’s prevalence in El Paso, Texas because increasing physician interaction and discussion about the disease with patients is vital.
Evaluation
The framework that will be utilized to measure the impact this program has on the Hispanic communities in El Paso with be the CDC Framework for Program Evaluation (1999). First, engaging stakeholders throughout the life of the program is important to ensure the important and vital elements of the program are being addressed and evaluated. Stakeholders include those that are part of the operation of the program, those impacted by the program, and those using the program. In the case of reducing the prevalence of Alzheimer’s in El Paso communities, operators of the program will include funding agencies like the CDC and the TDSHS who have program leaders and management. Other operational personnel will be the physicians, education staff, and employees of the Alzheimer’s Association aiding in gathering important information for objective measurement. Those being impacted by the program include the communities as a whole, often represented by a select number of people, and the healthcare system that has stake in overall medical treatment costs. Families from the community who often carry the burden of disease with a loved one will also be included as stakeholders. Finally, those using the program will be the Hispanic adults ages 40 and above. By utilizing the activities and services stated in the objectives, the impact the program has will be reflected in the success of the participants. Thus, allowing a few of the participants to be on the “inner circle” of operations allows the program developers to improve challenges and remove barriers, while maximizing successes.