Cognitive Difficulty - Age 65+ in Iowa

Iowa

Cognitive impairment limits older adults' ability to age in place independently. Family, friends and other unpaid caregivers often bear the responsibility of providing daily assistance and emotional support to older adults with severe cognitive impairments such as Alzheimer's, the most common form of dementia. As the 65 and older population increases, the number of older adults living with Alzheimer’s disease in the United States is projected to reach 13.8 million by 2060.

Cognitive impairment can be caused by several conditions, including metabolic and/or endocrine dysfunction, Alzheimer’s and other dementias, and treatable health issues like medication side effects and depression. While people can experience cognitive impairment at any stage in life, age is the greatest risk factor for Alzheimer’s. 

Cognitive difficulty places a large economic burden on both individuals and health care systems:

• Older adults with cognitive impairment spend twice as many days hospitalized as other older adults.
• Medicare beneficiaries with dementia are more likely to have additional chronic diseases.
• Average annual health care costs are nearly three times higher for Medicare beneficiaries age 65 and older with dementia than for those without it.

The cost of caring for adults with severe cognitive impairment, including Alzheimer’s and other dementias, was estimated at $345 billion in 2023 and is projected to reach nearly $1 trillion by 2050.

The prevalence and risk of severe cognitive impairment are higher among:

• Women compared with men.
• American Indian/Alaska Native and Hispanic older adults compared with white older adults; the prevalence is lowest among Asian/Pacific Islander older adults.
• Older adults with less than a high school diploma compared with college graduates.
• Older adults without health insurance compared with those who are insured.
• Older adults experiencing food insecurity compared with those not experiencing food insecurity.

Modifiable risk factors for Alzheimer’s include smoking, diabetes, obesity, hypertension, high cholesterol and binge drinking, as well as physical, social and mental inactivity.

Changes in the brain often occur before symptoms of cognitive difficulty appear, suggesting that it may be possible to delay the onset of symptoms. A 2021 review of the evidence emphasized the importance of early screening and interventions to improve cognitive function among older adults, including:

• Cognitive training and memory exercises aimed at problem-solving.
• Blood pressure management among individuals with hypertension.
• Increasing physical activity.
• Increasing social engagement.

Health providers should recommend hearing aids to older adults who have hearing loss. Hearing aids and cochlear implants can help protect against severe cognitive impairment.

Racial disparities in cognitive decline may be addressed by interventions to improve educational and occupational opportunities early in life. The Centers for Disease Control and Prevention’s Healthy Brain Initiative has a guide to preventing and addressing cognitive impairment for state and local public health agencies. A free educational communications toolkit on brain health and aging is available through the Administration for Community Living.

Healthy People 2030 has several objectives related to cognitive difficulty, including:

• Increasing the proportion of adults with subjective cognitive decline who have discussed their symptoms with a provider. 
• Increasing the proportion of older adults with dementia, or their caregivers, who know they have it. 
• Reducing the proportion of preventable hospitalizations in older adults with dementia.

Alzheimer’s Association. “2023 Alzheimer’s Disease Facts and Figures.” Alzheimer’s & Dementia 19, no. 4 (April 2023): 1598–1695. https://doi.org/10.1002/alz.13016.

Alzheimer’s Association, and Centers for Disease Control and Prevention. “Healthy Brain Initiative, State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map.” Chicago, IL: Alzheimer’s Association, 2018. https://www.cdc.gov/aging/pdf/2018-2023-Road-Map-508.pdf.

Downey, Autumn, Clare Stroud, Story Landis, and Alan I. Leshner, eds. Preventing Cognitive Decline and Dementia: A Way Forward. Washington, D.C.: National Academies Press, 2017. https://www.ncbi.nlm.nih.gov/books/NBK453387/.

Kim, Boeun, Laura J. Samuel, Roland J. Thorpe, Deidra C. Crews, and Sarah L. Szanton. “Food Insecurity and Cognitive Trajectories in Community-Dwelling Medicare Beneficiaries 65 Years and Older.” JAMA Network Open 6, no. 3 (March 24, 2023): e234674. https://doi.org/10.1001/jamanetworkopen.2023.4674.

Laws, Keith R., Karen Irvine, and Tim M. Gale. “Sex Differences in Cognitive Impairment in Alzheimer’s Disease.” World Journal of Psychiatry 6, no. 1 (March 22, 2016): 54–65. https://doi.org/10.5498/wjp.v6.i1.54.

Omura, John D., Lisa C. McGuire, Roshni Patel, Matthew Baumgart, Raza Lamb, Eva M. Jeffers, Benjamin S. Olivari, Janet B. Croft, Craig W. Thomas, and Karen Hacker. “Modifiable Risk Factors for Alzheimer Disease and Related Dementias Among Adults Aged ≥45 Years — United States, 2019.” MMWR. Morbidity and Mortality Weekly Report 71, no. 20 (May 20, 2022): 680–85. https://doi.org/10.15585/mmwr.mm7120a2.

Weuve, Jennifer, Lisa L. Barnes, Carlos F. Mendes de Leon, Kumar B. Rajan, Todd Beck, Neelum T. Aggarwal, Liesi E. Hebert, David A. Bennett, Robert S. Wilson, and Denis A. Evans. “Cognitive Aging in Black and White Americans: Cognition, Cognitive Decline, and Incidence of Alzheimer Disease Dementia.” Epidemiology 29, no. 1 (January 2018): 151–59. https://doi.org/10.1097/EDE.0000000000000747.

Wooten, Karen G., Lisa C. McGuire, Benjamin S. Olivari, Eva M. J. Jackson, and Janet B. Croft. “Racial and Ethnic Differences in Subjective Cognitive Decline — United States, 2015–2020.” MMWR. Morbidity and Mortality Weekly Report 72, no. 10 (March 10, 2023): 249–55. https://doi.org/10.15585/mmwr.mm7210a1.

Yeo, Brian Sheng Yep, Harris Jun Jie Muhammad Danial Song, Emma Min Shuen Toh, Li Shia Ng, Cyrus Su Hui Ho, Roger Ho, Reshma Aziz Merchant, Benjamin Kye Jyn Tan, and Woei Shyang Loh. “Association of Hearing Aids and Cochlear Implants With Cognitive Decline and Dementia: A Systematic Review and Meta-Analysis.” JAMA Neurology 80, no. 2 (December 5, 2022): 134–41. https://doi.org/10.1001/jamaneurol.2022.4427.

Zhang, X.-X., Y. Tian, Z.-T. Wang, Y.-H. Ma, L. Tan, and J.-T. Yu. “The Epidemiology of Alzheimer’s Disease Modifiable Risk Factors and Prevention.” The Journal of Prevention of Alzheimer’s Disease 3, no. 8 (2021): 313–21. https://doi.org/10.14283/jpad.2021.15.