In our second interview ahead of next month’s International Dementia Conference and Care & Dementia Show in Birmingham, Alzheimer’s INSIGHTS dropped in on one of the leading lights in the world of Alzheimer’s in the USA. Dr Tara Cortes is the Executive Director of the Hartford Institute for Geriatric Nursing in New York City, and is looking forward to speaking at the conference on her country’s emerging National Strategy for Alzheimer’s, for which the foundations will be education, training, and collaboration.
Tara, your distinguished career in geriatric nursing has seen you involved in a number of vitally important causes, many of them involving the shifting of perceptions away from problems seen as disabilities to being health challenges that can and must be faced.
That was the main achievement of Lighthouse International, where I was privileged to be CEO for four years. We refused to recognise problems of vision impairment and loss as being part of the aging process: our challenge was in identifying the collaborations and building the training networks that could shift public perception to what was, and is, a health issue.
That must have been useful early experience ahead of what you are doing now at the Hartford Institute, with Alzheimer’s, given another widespread identification that memory loss is just a natural part of the aging process.
Absolutely. The fact that a variety of conditions correlate to some extent with old age does not mean they’re inevitable, or can’t be prevented. But preventing these health challenges from overwhelming us requires a huge effort of education, and better, far more focused training. It will happen, and it is happening. But the solution is taking longer to emerge than it needed to. After all, we have been hearing for 30 to 40 years about the approaching tsunami of our aging population. Now it’s here. In the USA, the Baby Boomer generation is turning 65 at the rate of 10,000 every day.
How is that rather startling statistic being addressed in our training of nurses and doctors of the future?
Not adequately, yet. Nursing of older people in hospital settings takes up 60% of all care time; that figure is higher in home care. But the percentage of geriatric training in nursing and medical schools is in single figures. Only about one half of undergraduate nursing programmes offer a unique course in geriatrics. Most do integrate geriatrics as a concept throughout the curriculum but medical schools often only offer an elective course in geriatrics. Less than 1% of nursing graduates are certified in geriatrics.
And outside the schools, Tara? What training can be given to caregivers?
This is vitally important in reducing what we call the “caregiver burden”. Working with the Montefiore Center for the Aging Brain, the Hartford Institute is developing a three-hour programme for educating caregivers, and we aim to build this as a combined offline/online module for rolling out nationally.
Now plans for a National Strategy for Alzheimer’s are very much at the core of what you are going to be talking about in four weeks at the International Dementia Conference. Can you give us a foretaste of what this national strategy is going to look like?
There are, broadly, four main focusing areas. Research is vital, with the primary emphasis on clinical research as we pursue the ambition to find a cure or a disease modifying treatment within 10 years. There is a lot of good work being done here already, but more funding, greater collaboration, and better communications will help. And the second focus is research into the care element to enhance the quality and efficacy of dementia services – the sort of innovations that will be profiled at the Birmingham conference – this will be vital too, especially given how much of the burden in the near future is going to land on caregivers.
Does the American strategy involve a focus on caregivers too, then?
Very much so: preventing caregiver burden is our third area of concern! Training innovations such as the one I mentioned earlier are part, but just one part, of the solution in this area. While the world of medicine has been formulating a coherent response to the challenges of dementia, millions of caregivers around the world have just had to get on with it. We have mountains of data and anecdotes about best practices and inspired thinking on how to bring the challenges of caregiving into the community mainstream, and we understand better than ever the costs of getting it wrong in supporting caregivers, and the considerable benefits of getting it right.
In addition to the financial costs, caregivers are more prone to depression.
Not only that, but neglected caregivers are more prone to the whole range of chronic illnesses. And at a time when our healthcare systems – here in the States that means our Affordable Care Act – are all about keeping people out of hospital, the last thing we need is even more people succumbing to chronic illnesses that might have been prevented with proper diagnoses made earlier, with better education, with much more active preventative measures, and with healthier lifestyles.
You mentioned a fourth area of focus in the new national strategy?
Well, that’s education. Education for everyone involved: the professional spectrum of health and service providers; the people being diagnosed or living with the challenges of illness; the caregivers; and the wider community, which can offer such powerful support for patients and caregivers. And education not just about the disease, its progression, and strategies for managing it: but also what will be vitally important is a truly person-centred Plan of Care for people getting a diagnosis, and for the people looking after them. Engaging everyone in a formal action plan for turning the tide . . .
Thank you, Tara. INSIGHTS looks forward to hearing more in Birmingham.
I’m looking forward to seeing you there!
Alzheimer’s Insights is an online newsletter created for consumers -- primarily patients and carers -- who live with the challenge of Alzheimer’s disease. Based upon intelligent search algorithms that scour the Internet for the most read, relevant and useful stories from around the world, it is curated and published each Tuesday by a team of health and publishing experts. You can subscribe for future weekly newsletters here.