Racial and ethnic disparities in health care are known to reflect access to care and other issues that arise from differing socioeconomic conditions. There is, however, increasing evidence that even after such differences are accounted for, race and ethnicity remain significant predictors of the quality of health care received. In Unequal Treatment, a panel of experts documents this evidence and explores how persons of color experience the health care environment. The book examines how disparities in treatment may arise in health care systems and looks at aspects of the clinical encounter that may contribute to such disparities. Patients' and providers' attitudes, expectations, and behavior are analyzed. How to intervene? Unequal Treatment offers recommendations for improvements in medical care financing, allocation of care, availability of language translation, community-based care, and other arenas. The committee highlights the potential of cross-cultural education to improve provider-patient communication and offers a detailed look at how to integrate cross-cultural learning within the health professions. The book concludes with recommendations for data collection and research initiatives. Unequal Treatment will be vitally important to health care policymakers, administrators, providers, educators, and students as well as advocates for people of color.
As the largest generation in U.S. history - the population born in the two decades immediately following World War II - enters the age of risk for cognitive impairment, growing numbers of people will experience dementia (including Alzheimer's disease and related dementias). By one estimate, nearly 14 million people in the United States will be living with dementia by 2060. Like other hardships, the experience of living with dementia can bring unexpected moments of intimacy, growth, and compassion, but these diseases also affect people's capacity to work and carry out other activities and alter their relationships with loved ones, friends, and coworkers. Those who live with and care for individuals experiencing these diseases face challenges that include physical and emotional stress, difficult changes and losses in their relationships with life partners, loss of income, and interrupted connections to other activities and friends. From a societal perspective, these diseases place substantial demands on communities and on the institutions and government entities that support people living with dementia and their families, including the health care system, the providers of direct care, and others. Nevertheless, research in the social and behavioral sciences points to possibilities for preventing or slowing the development of dementia and for substantially reducing its social and economic impacts. At the request of the National Institute on Aging of the U.S. Department of Health and Human Services, Reducing the Impact of Dementia in America assesses the contributions of research in the social and behavioral sciences and identifies a research agenda for the coming decade. This report offers a blueprint for the next decade of behavioral and social science research to reduce the negative impact of dementia for America's diverse population. Reducing the Impact of Dementia in America calls for research that addresses the causes and solutions for disparities in both developing dementia and receiving adequate treatment and support. It calls for research that sets goals meaningful not just for scientists but for people living with dementia and those who support them as well. By 2030, an estimated 8.5 million Americans will have Alzheimer's disease and many more will have other forms of dementia. Through identifying priorities social and behavioral science research and recommending ways in which they can be pursued in a coordinated fashion, Reducing the Impact of Dementia in America will help produce research that improves the lives of all those affected by dementia.
In their later years, Americans of different racial and ethnic backgrounds are not in equally good-or equally poor-health. There is wide variation, but on average older Whites are healthier than older Blacks and tend to outlive them. But Whites tend to be in poorer health than Hispanics and Asian Americans. This volume documents the differentials and considers possible explanations. Selection processes play a role: selective migration, for instance, or selective survival to advanced ages. Health differentials originate early in life, possibly even before birth, and are affected by events and experiences throughout the life course. Differences in socioeconomic status, risk behavior, social relations, and health care all play a role. Separate chapters consider the contribution of such factors and the biopsychosocial mechanisms that link them to health. This volume provides the empirical evidence for the research agenda provided in the separate report of the Panel on Race, Ethnicity, and Health in Later Life.
For most Americans, staying "mentally sharp" as they age is a very high priority. Declines in memory and decision-making abilities may trigger fears of Alzheimer's disease or other neurodegenerative diseases. However, cognitive aging is a natural process that can have both positive and negative effects on cognitive function in older adults - effects that vary widely among individuals. At this point in time, when the older population is rapidly growing in the United States and across the globe, it is important to examine what is known about cognitive aging and to identify and promote actions that individuals, organizations, communities, and society can take to help older adults maintain and improve their cognitive health. Cognitive Aging assesses the public health dimensions of cognitive aging with an emphasis on definitions and terminology, epidemiology and surveillance, prevention and intervention, education of health professionals, and public awareness and education. This report makes specific recommendations for individuals to reduce the risks of cognitive decline with aging. Aging is inevitable, but there are actions that can be taken by individuals, families, communities, and society that may help to prevent or ameliorate the impact of aging on the brain, understand more about its impact, and help older adults live more fully and independent lives. Cognitive aging is not just an individual or a family or a health care system challenge. It is an issue that affects the fabric of society and requires actions by many and varied stakeholders. Cognitive Aging offers clear steps that individuals, families, communities, health care providers and systems, financial organizations, community groups, public health agencies, and others can take to promote cognitive health and to help older adults live fuller and more independent lives. Ultimately, this report calls for a societal commitment to cognitive aging as a public health issue that requires prompt action across many sectors.
Almost 25 years have passed since the Demography of Aging (1994) was published by the National Research Council. Future Directions for the Demography of Aging is, in many ways, the successor to that original volume. The Division of Behavioral and Social Research at the National Institute on Aging (NIA) asked the National Academies of Sciences, Engineering, and Medicine to produce an authoritative guide to new directions in demography of aging. The papers published in this report were originally presented and discussed at a public workshop held in Washington, D.C., August 17-18, 2017. The workshop discussion made evident that major new advances had been made in the last two decades, but also that new trends and research directions have emerged that call for innovative conceptual, design, and measurement approaches. The report reviews these recent trends and also discusses future directions for research on a range of topics that are central to current research in the demography of aging. Looking back over the past two decades of demography of aging research shows remarkable advances in our understanding of the health and well-being of the older population. Equally exciting is that this report sets the stage for the next two decades of innovative researchâ€"a period of rapid growth in the older American population.
This book focuses on the public policy and political dimensions of Alzheimer’s Disease and other dementias (AD/D) in the United States, with coverage of the global dimensions and relevant examples from other countries. Starting off with a discussion on the characteristics of AD/D and competing theories of their causes, their human and financial costs, and the increasing burden they place on all societies as populations age, the book examines in detail the range of policy issues they raise. These include funding policies, payment policy and regulatory functions, long-term services and support (LTCS), public health and prevention policies. The book analyses the big business surrounding AD/D and shows that the strong public fear of developing dementia heightens the likelihood of exploitation of vulnerable people looking for a technological fix. It examines both informal and formal caregivers and the heavy burden placed on families, primarily women, and recent policy attempts to strengthen LTCS. It also examines the latest evidence of potential risk-reduction and prevention strategies and the difficult issues surrounding advance directives, assisted suicide, and definitions of death that increasingly face policy makers. It concludes by analyzing the policy implications on possible technological scenarios.
Societies around the world are concerned about dementia and the other forms of cognitive impairment that affect many older adults. We now know that brain changes typically begin years before people show symptoms, which suggests a window of opportunity to prevent or delay the onset of these conditions. Emerging evidence that the prevalence of dementia is declining in high-income countries offers hope that public health interventions will be effective in preventing or delaying cognitive impairments. Until recently, the research and clinical communities have focused primarily on understanding and treating these conditions after they have developed. Thus, the evidence base on how to prevent or delay these conditions has been limited at best, despite the many claims of success made in popular media and advertising. Today, however, a growing body of prevention research is emerging. Preventing Cognitive Decline and Dementia: A Way Forward assesses the current state of knowledge on interventions to prevent cognitive decline and dementia, and informs future research in this area. This report provides recommendations of appropriate content for inclusion in public health messages from the National Institute on Aging.
Sex and Gender Differences in Alzheimer's Disease: The Women's Brain Project offers for the first time a critical overview of the evidence documenting sex and gender differences in Alzheimer's disease neurobiology, biomarkers, clinical presentation, treatment, clinical trials and their outcomes, and socioeconomic impact on both patients and caregivers. This knowledge is crucial for clinical development, digital health solutions, as well as social and psychological support to Alzheimer's disease families, in the frame of a precision medicine approach to Alzheimer's disease.This book brings together up-to-date findings from a variety of experts, covering basic neuroscience, epidemiology, diagnosis, treatment, clinical trials development, socioeconomic factors, and psychosocial support. Alzheimer's disease, the most common form of dementia, remains an unmet medical need for the planet. Wide interpersonal variability in disease onset, presentation, and biomarker profile make Alzheimer's a clinical challenge to neuroscientists, clinicians, and drug developers alike, resulting in huge management costs for health systems and society. Not only do women represent the majority of Alzheimer's disease patients, but they also represent two-thirds of caregivers. Understanding sex and gender differences in Alzheimer's disease will lead to novel insights into disease mechanisms, and will be crucial for personalized disease management strategies and solutions, involving both the patient and their family. Endorsements/Reviews: "There is a clear sex and gender gap in outcomes for brain health disorders like Alzheimer's disease, with strikingly negative outcomes for women. This understanding calls for a more systematic way of approaching this issue of inequality. This book effectively highlights and frames inequalities in all areas across the translational spectrum from bench-to-bedside and from boardroom-to-policy and economics. Closing the Brain Health Gap will help economies create recovery and prepare our systems for future global shocks." Harris A. Eyre MBBS, PhD, co-lead, Neuroscience-inspired Policy Initiative, OECD and PRODEO Institute. Instructor in Brain Health Diplomacy, Global Brain Health Institute, UCSF and TCD. "Sex and Gender Differences in Alzheimer's disease is the most important title to emerge on Alzheimer's disease in recent years.This comprehensive, multidisciplinary book is a must read for anyone with a serious interest in dementia prevention, diagnosis, treatment, care, cure and research. Precision medicine is the future of healthcare and this book represents an incredible and necessary resource to guide practice, policy and research in light of the fact that Alzheimer's disease disproportionately affects women. The combination of contributions from the most eminent experts and the most up-to-date research makes this an invaluable resource for clinicians, care providers, academics, researchers and policy makers. Given the complex nature of dementia and the multiple factors that influence risk and disease trajectory the scope of the book is both impressive and important covering sex differences in neurobiological processes, sex and gender differences in clinical aspects and gender differences linked to socioeconomic factors relevant to Alzheimer's disease. If you work in Alzheimer's disease, or indeed other dementias, then Sex and Gender Differences in Alzheimer's disease is a must have for your bookshelf." -- Sabina Brennan, PhD., C.Psychol.,PsSI., National representative for Ireland on Alzheimer Disease International's Medical and Scientific Advisory Panel
