DC Brain Health Initiative: DC Health's application for BOLD public health programs aimed at addressing Alzheimer's disease and related dementias. - Alzheimer's disease and related dementias (ADRD) disproportionately affects the most vulnerable residents in our nation's capital, creating a substantial emotional, physical, and financial burden on patients, families, caregivers, and the District of Columbia (District). In 2020, ADRD ranked as the 6th leading cause of death in the District, with 13% of residents 65 and older living with the disease. The mortality rates for ADRD rose by 18% between 2010 and 2020, and this trend is continuing. Additionally, 10% of District residents aged 45 and older reported subjective cognitive decline (SCD), with 84% of those aged 65 and older with SCD also having one or more chronic health condition. Unfortunately, only 42% of those experiencing SCD have discussed their symptoms with a healthcare provider. Furthermore, nearly 14,000 unpaid caregivers in the District provide aid and support for the daily tasks of over 10,000 persons living with dementia (PLWD). Dementia caregivers are also at an increased risk of negative health consequences, including stress, depression, exhaustion, difficulty maintaining a healthy lifestyle and utilizing preventive care. In 2020, the District’s Brain Health Initiative conducted a needs assessment that identified disparities in the prevalence of dementia by race, ethnicity, and geographic location. The findings revealed that Black/African American residents had a higher prevalence of dementia than White residents, and Wards 4(16%), 5(17%), 7(15%) and 8(12%) had the highest prevalence rates among those aged 65 and older. A comprehensive analysis of the Behavioral Risk Factor Surveillance System (BRFSS), mortality rates, and needs assessment identified several priority populations. These include Black/African American and Hispanic/Latino residents, underinsured individuals, those with low educational attainment, households with incomes below $50,000, residents in Wards 4, 5, 7, and 8, and adults aged 45 and over. To address the burden of ADRD, DC Health has implemented a data-driven policy and health equity framework to promote brain health, wellness, and equity across the District. Since 2019, DC Health has established a brain health initiative, hired a dementia services coordinator, conducted a needs assessment in collaboration, formed and engaged a coalition, and is implementing a direct care worker licensing requirement and a mass-media education campaign to raise awareness and educate the public about dementia. Through the BOLD project, DC Health aims to expand the coalition to increase multisectoral partnerships, strengthen the ADRD workforce, improve organizational and individual dementia literacy, enhance data collection and surveillance, and improve community-clinical linkages. These efforts will increase access to high-quality care and services and improve health outcomes for persons living with dementia (PLWD) and their caregivers. DC Health will prioritize equitable access to ADRD services, risk reduction, early detection and diagnosis, and reduce the disease burden in vulnerable populations while creating sustainable change and impact.
