Reader TTS

But this, the authors note, isn't happening on anything like a widespread basis, at least in part because no one's taking the lead in the exam room: “More than nine out of 10

surveyed older adults thought their doctor would recommend cognitive testing, and one in seven brought the topic up on their own. However, primary care physicians are often waiting for

patients and their families to report symptoms and ask for an assessment." Lock notes that AARP, as a policy, encourages people to get cognitive assessments, and that for those over 65,

the Medicare annual wellness visit is supposed to include a cognitive evaluation. “But we know less than half of people 65 and older received an assessment, and only 16 percent are being

assessed regularly. Even for those lucky enough to be properly assessed, frequently patients are not told of their diagnosis — even if the doctor thinks they have dementia!” In practice,

Small says many factors, including simple fear, can discourage such a talk from ever happening: “Everyone's afraid of Alzheimer's and they're terrified that whenever they

forget someone's name they're on the road to ending up in a nursing home, unable to communicate and in a wheelchair.” And doctors, he adds, may be burdened by already cramming so

much into what's an average of “eight minutes per visit per patient.” The report also wades into the complicated issue of a possible screening test for dementia — a standardized memory

test or questionnaire routinely given to older people to flag those at high risk. Citing years of back and forth among medical bodies about whether this would bring more potential value than

harm to the individual, the report calls for adding more data to the debate. Specifically, it recommends developing “an evidence base to demonstrate links between cognitive screenings,

early diagnosis, and improved outcomes for people diagnosed with dementia early.” That said, some experts interviewed said that short of a blood test to identify dementia, which researchers

are pursuing, a simple screen for a complicated brain condition doesn't exist. Others say a simple questionnaire with questions such as “Is your memory worse than it was last year?”

could serve as a useful screening tool. In the meantime, Small notes that about half of those who have dementia don't know they have it. CAREGIVING The final section of the report

offers suggestions for improving dementia-related caregiving. One top recommendation involves maintaining the federally funded Geriatrics Workforce Enhancement Program, which integrates

geriatrics expertise into caring for dementia patients and also trains families, caregivers and health care practitioners on best practices for taking care of those with dementia. The Milken

Institute authors also advocate using existing Medicare payment and delivery models, among other things, to “help deliver cost-effective, coordinated, and high-quality care.” Forecasting a

need for 3.4 million caregivers by 2030, the report calls for measures to find and train dementia-care workers now, and for employers to step up with flexible work schedules, respite care,

and paid family and medical leave for employees trying to shoulder caregiving burdens. Finally, they see the need to better train family caregivers and find ways to help them reduce the

stress that comes with the role.