COGNITIVE DECLINE PUBLIC HEALTH SURVEILLANCE: EXPERT-GUIDED COLLABORATION FOR BRFSS MODULE REVISION

The Behavioral Risk Factor Surveillance System (BRFSS) Cognitive Decline Module collects population level data on subjective cognitive decline (SCD) — self-reported difficulties in thinking or memory — which can be one of the earliest warning signs of dementia. Originally devised in 2009, the module undergoes periodic revision to ensure it remains current, the data collected are actionable, and to encourage uptake of the module by state health agencies. In 2021, the Alzheimer’s Association and the Centers for Disease Control and Prevention’s Alzheimer’s Disease Program formed an expert workgroup to examine the ongoing value and relevance of the module and propose any improvements. Workgroup members included researchers, chronic disease directors, epidemiologists, survey methodologists, policy analysts, and BRFSS coordinators. Using a consensus-building process, the workgroup utilized pre-meeting worksheets to identify areas of agreement and disagreement which informed key debates during subsequent meetings. Among many factors, the workgroup assessed the existing module for accuracy and utility. Discussion centered on aligning language and concepts contained within the module’s questions with current scientific research on SCD and how to accurately and adequately assess the associated burden SCD imposes. People living with cognitive impairment were consulted during the revision process to ensure phrasing reflected their lived experience. The result was a consensus set of suggested revisions to the Cognitive Decline Module, submitted to CDC for review and approval. The robust process, involving a variety of stakeholders and perspectives, can serve as an efficient and effective model for ensuring the longevity and usefulness of population health surveillance.

TOOLS TO SUPPORT NEEDS ASSESSMENTS ON DEMENTIA, COGNITIVE HEALTH, AND CAREGIVING

Dementia, cognitive health, and caregiving are not always included in community health needs assessments, leading to their absence in public health improvement and strategic plans, and subsequent lack of action and funding to address these needs. In response, the Alzheimer’s Association and the Association of State and Territorial Health Officials published the Needs Assessment Toolkit for Dementia, Cognitive Health, and Caregiving. Designed for state, local, and territorial public health and aging officials, this toolkit helps communities identify unmet needs of older adults, scale up existing community strengths, and promote healthy aging. The toolkit embeds health equity as a cornerstone to assessing community health. It offers approaches to operationalize equity in the assessment process by including wide representation of people from different racial and ethnic backgrounds, geographic locations, and levels of socioeconomic status and educational attainment. The toolkit’s five steps are modular in design and allow jurisdictions to enter the process at any stage. It considers alignment with jurisdiction-wide plans including Alzheimer’s plans, health improvement plans, aging plans, and the Healthy Brain Initiative Road Map, helping public health agencies advance attention to Alzheimer’s through their networks. Developed through an iterative process, expert input from public health and aging practitioners guided the development and organization. Over 1,600 comments were reconciled to ensure usability among stakeholders, elevate equity to an essential component throughout the assessment process, and add value to allied strategic plans. This presentation complements Learn, Plan, Do: Public Health Planning to Address Dementia and Caregiving, abstract ID 1229181.

THE ROAD MAP STRATEGIST INITIATIVE: A NATIONWIDE EFFORT TO BUILD LOCAL PUBLIC HEALTH CAPACITY ON DEMENTIA

The Road Map Strategist Initiative is a nationwide effort to build local health department (LHD) capacity to address cognitive health and dementia. Through a collaboration between the Alzheimer’s Association and the National Association of County and City Health Officials (NACCHO), the initiative aims to make policy, systems, and environmental change, with a focus on health equity. Participating health departments receive funding, training, and technical assistance to establish a part-time Healthy Brain Initiative (HBI) Road Map Strategist, a public health professional serving as a system change agent. With support and education from the program sponsors, Road Map Strategists conduct a community health needs assessment, train LHD staff and leadership, and collaborate with community partners to implement and accelerate public health actions on dementia. Actions taken by the Road Map Strategists are informed by the Healthy Brain Initiative’s State and Local Public Health Partnerships to Address Dementia, The 2018-2023 Road Map. Presenters will share lessons learned from the first cohort of eight (8) LHDs during each stage of the initiative, with a focus on approaches used for Road Map implementation efforts in their communities. This session will share evaluation findings on successes and barriers for changing health department capacity to support local dementia efforts. Data from key indicators related to knowledge gain and capacity change will be shared, including the way LHD characteristics influenced success. The session will also cover effective approaches toward advancing health equity in dementia in local communities and plans for future iterations of the initiative.

Start at the Center: Age-Friendly Public Health Systems and Healthy Brain Initiative Frameworks

SIGNIFICANCE. Older adults can contribute wisdom, skills, and time to communities. The public health sector has unique capabilities for creating conditions that promote health, foster community connections, and quality of life. METHODS. Two frameworks provide public health (PH) with core strategies to improve outcomes for all older adults. The Framework for Creating an Age-Friendly Public Health System (AFPHS) supports the PH role, as demonstrated by 37 of Florida’s 67 county health departments that are piloting the AFPHS Framework. The Healthy Brain Initiative’s (HBI) State and Local Public Health Partnerships to Address Dementia is a framework for action used by PH to promote cognitive health, improve care for cognitive impairment, and increase caregiving supports. Both frameworks call for utilizing regional data and cross-sector partnerships. IMPLICATIONS. PH can contribute to community-wide initiatives to promote well-being and community connections for older adults. Cross-sector partnerships can start by using available tools and planning guides.

Go Local: Innovating Local Health Departments' Engagement on Alzheimer’s

The aging Baby Boom generation is a major force behind projected increases in the prevalence of Alzheimer’s, which is expected to grow from 5.8 million (2020) to 13.8 million (2050). Local health departments play a major role connecting people living with dementia (and their caregivers) to services, supports, and education, and to ensure safe, accessible environments where they can flourish. From September 2019-July 2020, two local health departments (from San Diego County and the City of Boston) participated in a yearlong collaborative pilot project with the Alzheimer’s Association to advance cognitive health, dementia, and caregiving issues in their local jurisdictions. The National Association of County and City Health Officials (NACCHO) provided expert guidance and input throughout the collaboration. As part of the project, the local health departments: scanned their current work on healthy aging, identified existing data sources, and examined how existing healthy equity initiatives can apply to cognitive health, dementia, and caregiving issues. Action plans were developed, with a focus on policy mechanisms to initiate and sustain these projects and workforce development initiatives. Plans corresponded to actions of the Healthy Brain Initiative Road Map, helping elevate recommendations to change systems, policies, and environments. In fall 2020, LHDs will be able to use best practices, case studies, and tools developed from San Diego’s and Boston’s pilots to address Alzheimer’s as a chronic condition. The tools will help them engage health officials, develop action plans, and train the public health

LISTENING AND LEARNING TO FORM THE HBI ROAD MAP FOR INDIAN COUNTRY

American Indian and Alaska Native (AI/AN) communities are establishing new paths as more older adults develop Alzheimer’s and other dementias along with other co-morbidities. To offer a flexible framework of public health strategies that proactively address the growing issue of dementia among AI/ANs, Alzheimer’s Association and Centers for Disease Control and Prevention (CDC) developed the first-ever Healthy Brain Initiative Road Map for Indian Country. Partnering with International Association for Indigenous Aging supported Road Map development through virtual listening sessions and written comments from regional Native health experts, tribal aging service leaders, and tribal government officials. Many additional discussions, engagement of a cultural guide, and an additional partnership with National Indian Health Board further informed Road Map contents, graphic design, and marketing. Presenter will describe rationale for the process, themes from the consultations, and lessons learned by the Association and CDC that can apply to similar initiatives.