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    Dementia Care Infrastructure

    By Dr. Marcy Adelman–

    One of the good news stories of 2018 was the quiet passage into law of an initiative that will significantly improve infrastructure access, care and support for Alzheimer’s patients and caregivers.

    The Building Our Largest Dementia Infrastructure for Alzheimer’s Act (BOLD Act) was an ambitious initiative forwarded by the Alzheimer’s Association and co-sponsored by a group of congressional leaders including Sen. Susan Collins (R-ME), Catherine Cortez Masto (D-CA), Shelley Moore Capito (R-WV), Tim Kaine (D-VA) and Maxine Waters (D-CA). Bipartisan support for the BOLD Act, and its rapid movement from introduction into law in just one year, illustrate the widespread concern over this issue and the energy to do something about it. 

    The goals of the BOLD Act are to reduce general population risk for cognitive decline and impairment, reduce health disparities, prevent avoidable hospitalization and improve access to caregiver support. The BOLD Act authorizes The Center for Disease Control and Prevention (CDC) to establish Alzheimer’s Centers of Excellence to increase education that expands and promotes evidence-based, culturally competent interventions to improve dementia outcomes. The BOLD Act also provides funding to promote cognitive health and risk reduction, increase early detection and diagnosis, and increase support for caregivers.

    In addition to significantly expanding the national Alzheimer’s public health infrastructure, this stunning legislative win will also greatly expand efforts to reduce health disparities by encouraging and funding nonprofits to report more racially and ethnically diverse data. There is currently little Alzheimer’s research on older people of color or LGBTQ older adults, although both are at higher risk for Alzheimer’s and related dementias.  

    Nationally, African Americans and Latinos over the age of 65 are more than twice as likely to develop Alzheimer’s and vascular dementia. Minority stress and high rates of chronic illness are understood to contribute to greater risk of dementia in medically underserved communities. 

    However, very little is known about the risk of Alzheimer’s and related dementias among LGBTQ older adults. It has been well documented that LGBTQ older adults experience many health disparities that may put them at greater risk for Alzheimer’s and related dementias. For example, LGBTQ older adults report high rates of chronic diseases such as asthma and cardiovascular disease, high levels of lifelong stress, and high rates of obesity, smoking and alcohol consumption. These are all known risk factors for Alzheimer’s and other forms of dementia. 

    The BOLD Act is a bold step forward in creating a culturally competent infrastructure to respond to the needs of all Americans challenged with dementia. It could not have come a moment too soon.

    Dr. Marcy Adelman, Co-founder of the nonprofit Openhouse, oversees the Aging in Community column. She is a psychologist and LGBTQI longevity advocate and policy advisor. She serves on the California Commission on Aging, the Board of the Alzheimer’s Association of Northern California and Northern Nevada and the San Francisco Dignity Fund Oversight and Advisory Committee.