Alzheimer’s, dementia and other cognitive impairment pose unique challenges to maintaining a safe and stable home environment as well as reducing the risk of injury to self or others. People living with cognitive impairment may be at additional risk of injury to themselves or others. For instance, as cognitive function deteriorates, an individual may have difficulty remembering home addresses or become disoriented, even in familiar places. This increases the risk of wandering. In fact, three in five people with Alzheimer’s will wander at some point. When creating safe communities across a population, public health must address unique challenges faced by people with dementia, especially with regards to:

Primed for implementation: HBI Road Map

Action P-6 — Assure public health plans that guide emergency preparedness and response address the needs of people with dementia and their caregivers, support access to critical health information during crises, and prepare emergency professionals for situations involving people with dementia.

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  • Wandering and other risks to personal safety such as driving or cooking.
  • Abuse, neglect and exploitation.
  • Disaster and emergency preparedness.

Public health practitioners can increase public awareness about situations that may be dangerous to people with severe cognitive impairment including wandering, driving and cooking alone. Better public awareness can help families recognize warning signs and develop safety plans to minimize these risks.

Educating the public is also a needed component of preventing abuse, neglect and exploitation (including financial exploitation) of people living with dementia. As cognitive impairment worsens, people can become increasingly vulnerable to falling victim to elder mistreatment. A person living with dementia may not recognize actions that could be harmful and have difficulty protecting themselves. Or, they may have difficulty recognizing suspicious or criminal activity. People living with dementia may experience problems communicating that hinder reporting or seeking help.

Cognitive impairment may also increase the risk of self-neglect for people living alone with dementia, especially as ability to perform activities of daily living gradually declines. The public health community can actively strive to prevent abuse, neglect and exploitation through partnerships with adult protective services, law enforcement, aging network service providers and other community-based organizations.

In many localities, public health is charged with leading the community’s disaster and emergency preparedness plans. This may include natural disasters such as hurricanes and tornadoes or emergency response plans such as evacuation and contamination. To help ensure that local and state preparedness plans consider the particular vulnerabilities of people living with dementia, public health agencies must elicit insights from people living with dementia, caregivers, and experts on cognitive impairment. Further, emergency responders and shelter staff benefit from specific training about the signs and symptoms of dementia and other cognitive impairments.

Care and advance planning

An early and accurate diagnosis of dementia allows individuals and their families to better prepare for the future by documenting wishes for care, planning finances and arranging legal matters. Advance care plans should designate a care team, power of attorney and guardianship when warranted. The sooner planning starts, the more the individual with dementia can participate and express preferences. Knowing the individual’s wishes helps eliminate guesswork for families and caregivers and allows the individual with dementia to designate a surrogate decision-maker when necessary.

Care planning for cognitive impairment

Clinicians can be reimbursed for providing comprehensive care planning services to individuals with cognitive impairment — including cognitive and safety evaluations, caregiver interview, and planning for palliative care needs.

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Because Alzheimer’s dementia complicates the management of chronic diseases, professional care planning — particularly when it is done by interdisciplinary teams — is key to coordinating and managing care. Care planning allows people with dementia diagnoses and their caregivers to:

  • Receive a comprehensive assessment.
  • Learn about medical and non-medical treatments.
  • Secure relevant services in the community that can support a higher quality of life.
People receiving care planning specifically geared toward dementia have fewer hospitalizations, fewer emergency room visits and better medication management.


One way the public health community can help promote care planning for people with cognitive impairment is to educate health care professionals about offering reimbursable care planning services. CPT billing code 99483 allows clinicians to be reimbursed for providing a comprehensive set of care planning services to people with cognitive impairment and their caregivers.  

Learn more: Care Planning for Cognitive Impairment

State-specific action you can take

Communities are taking public health action against Alzheimer’s and other dementias. Find out how the disease impacts your state and what you can do to make Alzheimer's the next public health success story.

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Featured Resources

Centers for Disease Control and Prevention Elder Abuse and Violence Prevention Center
Health Resources and Services Administration Training Curriculum: Alzheimer’s Disease and Related Dementias
National Center on Elder Abuse National Center on Elder Abuse Resource Center

 
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CA City of San Francisco Northern California and Northern Nevada Chapter of the Alzheimer’s Association convened a summit for emergency department physicians on detection and diagnosis.
LA Louisiana Department of Health Assessed the awareness, experiences and training needs of Baton Rouge Police Department staff with respect to Alzheimer’s and other dementias, especially in regards to wandering behaviors; the assessment also included an educational component.
MD Maryland Department of Health Facilitated the integration of cognition and cognitive health concerns into public health programming, including older driver safety and education of public health professionals.
MN Dakota County Public Health Department Dakota County Public Health Department is enhancing evidence-based falls prevention programs to encourage early identification of people with dementia and to better serve this population.
MN Department of Human Services Minnesota Department of Human Services established a common point of entry for reporting abuse, neglect, and exploitation of vulnerable adults statewide, including those with dementia.
MO Missouri Department of Health and Senior Services With the Missouri Department of Health and Senior Services, the Saint Louis University's College for Public Health and Social Justice conducted two webinar trainings for professionals employed with local public health agencies, adult protective services, and Veterans Administration. The first webinar covered Alzheimer’s basics and the other addressed cognitive assessment tools. Participants were offered continuing education units.
WI Department of Health Services With legislative support, the Wisconsin Department of Health Services will award grants to counties for their mobile crisis teams to obtain training on recognizing and serving individuals with dementia.