People living with Alzheimer's face unique safety challenges in community settings. Public health must address these challenges through increasing awareness, preventing abuse and exploitation, addressing potential self-neglect and promoting care planning.

What public health can do

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

Possible risk situations include:

• Abuse and neglect.
• Wandering.
• Driving.
• Access to dangerous tools or to weapons.
• Cooking or bathing alone.

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

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

Care planning: Because Alzheimer’s complicates the management of other chronic diseases, professional care planning — particularly 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.