Specialized Adult Day Programs and Family Resources

1. Specialized Adult Day Programs and Family Resources Supportive Social Stimulating Safe

2. Ray Valle PhD Mario Garrett PhD Anette Asher Dawn CarnerieDeStefani, BSW Diversity in dementia

3. MetLife Foundation 2010 • 2011 in Alzheimer's & Dementia: National Institute on Aging + Alzheimer's Association • International studies • Caregivers • Local Context

4. Ethnic Composition in San Diego • Realities of Cultural Diversity • Sweeps of Cultural Immigrants Demographics

5. San Diego County population growth California receives ~ 38% of all Immigrants to the USA http://sandiegohealth.org/sandag/publicationid_1232_5564.pdf

6. San Diego County http://csii.usc.edu/documents/SANDIEGO_web.pdf

7. San Diego County http://csii.usc.edu/documents/SANDIEGO_web.pdf

8. Largest Hispanic Origin Group by State 2010

14. Population by Nativity, and Hispanic: 200760.2% latinos Born in US Elizabeth M. Grieco. Race and Hispanic Origin of the Foreign-Born Population in the United States: 2007. American Community Survey Reports. 2010 U.S. Department of Commerce. Economics and Statistics Administration. U.S. CENSUS BUREAU

15. 698,000 immigrants • 23% of the total population • 76% since 1980 • 24% in last 10 yrs • From Mexico = 47% • From Philippines = 13% San Diego County http://csii.usc.edu/documents/SANDIEGO_web.pdf

16. National Studies • Local Studies • Quandary: Services are Local Prevalence Rates are National Latino dementia prevalence

17. Projections: Developing an Algorithm • Demography of Aging in Place • Projections of Dementia Developing Dementia Prevalence Rates Among Latinos: A Locally-Attuned, Data-Based, Service Planning Tool Ramón Valle, PhD Mario Garrett, PhD Roberto Velasquez, MSG

18. The Algorithm Population projections were obtained from the State of California, Department of Finance’s (CDF),population projections for counties for 2000-2050 Haan, M. N., Mungas, D. M., Gonzalez, H. M, Ortiz, T. A., Acharya, A., & Jagust W. J. (2003). From Prevalence of Dementia in Older Latinos: The Influence of Type 2 Diabetes Mellitus, Stroke and Genetic Factors. Journal of the American Geriatric Society 51:169–177 ADAD Prevalence RatesMalesFemales` 60-69 1.31% 60-69 0.61% 70-79 4.66% 70-79 4.71% 80-84 10.00% 80- 9.46% 85+ 23.33% 85+ 17.65 % ALL 4.05% ALL 3.76% County Male Female Age 1 year Latino vs White 2000, 2010, 2030, 2050

19. The Algorithm D.A. Evans et al, “Estimated Prevalence of Alzheimer’s Disease in the United States” The Milbank Quarterly 68:2 (1990) 267-289 Evan’s Combined & Haan Comparative Latino ADAD Prevalence Rates Evans Haan’sMale/Female Male/Female 65-74 3.9% 65-74 2.4% 75-84 16.4% 75-84 6.4% 85 + 47.55% 85+ 19.5% All 11.3% All 5.0%

20. San Diego Latino 60+ Aging-in-Place Estimates 2000-2050 Table 1a: Percentage difference from 2000 Year Latino 60 + Anglo 60+Latino 60 + Anglo 60+ 200048,299 306,947------- ------- 2010 80,180 348,24366% 13% 2030 214,426 618,244 344% 101% 2050 363,372 636,145 652% 107%

21. Source: agingstats.gov

22. Percentage San Diego Latino 60+ Aging-in-Place Estimates 2000-2050

23. Latino Age 60+ San Diego ADAD Prevalence Projections 2000-2050 Table 1c Percentage difference from 2000 Year Latino 60 + Anglo 60+ Latino 60 + Anglo 60+ 2000 1,889 16,592 --------- -------- 2010 3,267 18,025 73% 9% 2030 8,815 29,019 367% 74% 2050 23,289 48,152 1,133% 190%

24. Percentage Latino Age 60+ San Diego ADAD Prevalence Projections 2000-2050

26. Latino 60+ IN San Diego ADAD Prevalence + Caregivers 2000-2050

27. Focus Groups • Service Organizations Reality on the ground

28. Understanding depression & other mental systems Dementia • Developing culturally specific treatments • Ways to engage communities • Resources & access to patients Learning Objectives

29. Understanding Dementia is to see how in-discriminate it is. Every patient presents symptoms uniquely. • Degenerative, terminal • Beta Amyloid protein (the goop), tau and tangles Reality on the ground

30. Brain MRI with AD Reality on the ground

31. Dementia and Depression • Service Organizations • Adult Day Care • Programs: brain fitness, support groups, caregiver training Reality on the ground

32. History • Demographics: Diversity is here • Approach: How and what we do serves as outreach in community Glenner memory Care center

33. Glenner memory Care center- Demographics

34. Approach: How and what we do serves outreach in community • Day Care • Support Groups • In-Service training • New Programs: Oak Tree Brain Fitness Club, Train the Trainer Glenner memory Care center

35. Learn early signs of dementia/non-amnestic mild cognitive impairment. • Work closely with special interest groups or associations. • National Association of Hispanic Nurses http://nahnnet.organd in SD http://www.sdnahn.org • San Diego Black Nurses Association http://www.sdblacknurses.org • The Philippine Nurses Assoc. of San Diego County www.pnasd.org What we all can do in the community

36. Runkeeper (free iPhone app) • Anti-aging games (fun internet site) • The Glenner Memory Care Centers new iPad App. To be launched in January. (working on a app name… Memory Maker, Memory Finder… Techy tools for you and clients

37. Techy tools for you and clients Go to Apple’s App Store

42. FREE App due to release in January 2012. Drop off your business card at the Glenner exhibit table or contact us to get on mailing list for the Announcement www.Glenner.org 619-543-4700

43. The Latino culture respects their elderly and usually accompanies an expectation that the family will provide all care needs for their loved ones. There is usually reluctance and distrust of community options such as day care and nursing home placement. Few services have successfully provided a culturally correct and competent model that includes the proper language, sights, sounds and rapport. Latino caregivers

44. Latino caregivers express many of the same concerns as other ethnicities: denial, stress, resistance but one area that separates them is their concerns with doctors in the U.S. Many continue to travel to Mexico as they feel their doctors are more patient and less rushed. Voices of Latino Caregiving, Latino Alzheimer’s Community Forum June 19, 2010 Latino Caregivers

45. Latino caregivers often resist outside support and therefore carry high amounts of stress and a higher risk of depression. There are a limited amount of physicians and professionals that are bilingual to obtain a proper diagnosis and treatment plan for the caregiver and their loved one. Caregiver stress and depression

46. Center is located in a primarily Latino neighborhood. Enrollment of 80% Spanish Speaking participants. Staff are bilingual, activities and meals are geared to represent the participants. Professional staff also speak Spanish to provide support and resources. Ample time is given to build rapport with home visits and assessments. Have used Latino caregivers in a volunteer capacity to market in the community. Glenner Southbay ADHC/CBAS

47. Multi-cultural events

48. Apply Algorithm to other Ethnic Groups • Develop Protocol for addressing Diversity in Dementia • Final Remarks Future and recommendations