South Florida beckons those in their golden years with its warm and welcoming culture, scenery and weather.
What comes with having one of the largest elderly populations in the United States? The strongest prevalence of memory diseases like Alzheimer's.
Almost 16% of people over the age of 45 have some form of cognitive decline in Florida, according to the Alzheimer’s Association. Nearly 600,000 people aged 65 and older are living with Alzheimer's in the Sunshine State.
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Dr. Marc Agronin is the chief medical officer of the Frank C. and Lynn Scaduto MIND Institute at Miami Jewish Health and says that Miami is situated to be at the forefront of memory disease and Alzheimer’s research and care, but the resources aren’t there.
“In the next 25 years, the number of individuals with Alzheimer's disease is going to double from roughly 7 million to close to 15 million individuals,” Agronin said. “We absolutely need to do better in terms of providing education, support and treatment.”
The Alzheimer’s Association reports that $30 billion worth of unpaid care is provided in Florida. $3.9 billion is dedicated to Alzheimer’s in the state’s Medicaid program. Agronin says that even though there have been advancements in detecting Alzheimer’s early, access and the cost of care is still a large barrier to treatment.
“So many people are in the middle that they just don't have the resources and the finances to manage this as best as they can, especially over the long run,” he says. “Many people, even if they planned very well for retirement, they certainly didn't plan to need that amount of care.”
As the world’s population continues to live longer and longer, Agronin wants people to start focusing more on their memory health just as they should focus on physical health. The MIND Institute is one of Florida's 17 memory disorder centers. It provides treatment for those with neurocognitive disorders and researches Alzheimer's disease.
Today is World Brain Day so WLRN producer Sofia Zarran spoke with Dr. Agronin about some common misconceptions when it comes to memory health, the true burden of finding care for those with Alzheimer's and ways that people can find the care and assistance they need.
The interview has been edited for brevity and clarity.
WLRN: In Miami-Dade County, we are among the top three locations in the US when it comes to Alzheimer's prevalence. Why do you think that in South Florida there's so many cases?
AGRONIN: So the statistics are really alarming when you consider the fact that Miami-Dade is the epicenter of Alzheimer's disease, certainly in our country, probably in the world.
We have the highest percentage of individuals 65 and above with Alzheimer's disease. I think in general it has to do with the fact that aging is the number one risk factor for Alzheimer's disease, and Florida has a much older demographic. We should realize that we are able to be on the vanguard of recognizing this and providing services for people because our society's aging in general, and what we see here in Miami-Dade we are seeing unfold across the entire country.
In the next 25 years, the number of individuals with Alzheimer's disease is going to double from roughly 7 million to close to 15 million individuals. So this is a countrywide epidemic and we absolutely need to do better in terms of providing education, support, and treatment.
I read that older Black and Latino people are more susceptible to developing Alzheimer's. Are there any other factors that you're aware of that make Miami-Dade kind of unique.
The wonderful thing about South Florida in general is we have such an incredibly diverse community and without question we know that lots of different communities, in particular the African American communities and Latino communities, face higher rates of Alzheimer's disease; in part linked to higher rates of cardiovascular disease, which can translate into cerebrovascular disease.
So there's risk factors both in terms of medical care. We know that access needs to be better across communities, and that's one thing that we [MIND Institute] really pride ourselves with is the outreach we do into the communities, especially in underserved communities in Miami-Dade. A lot of this is done through what we have at Miami Jewish Health.
It's called our PACE program. It stands for “Program for All-Inclusive Care of the Elderly,” and we provide complete wraparound medical services and mental health services for people throughout the entire Dade and now into Broward Counties as well.
The changes associated with Alzheimer's can begin years, even decades before symptoms become obvious. So how are doctors able to detect those changes earlier than before?
Some of the most important progress we've had in the past 20 years in understanding Alzheimer's disease is we recognize two of what we believe are the central causes [of Alzheimers]: the buildup of the toxic proteins beta amyloid and tau in the brain begin not years, but likely decades before people get symptoms.
Knowing that and now having ways to begin to detect the presence of these proteins in the brain years before people get symptoms allow us to identify people, at least biologically, who are at much higher risk for Alzheimer's disease. It doesn't mean that everyone who has these, what we call biomarkers, will necessarily get Alzheimer's disease, but certainly they're gonna be at a higher risk.
So to me, that's one of the most exciting developments in terms of our approach to Alzheimer's disease and it promises a future where we can actually stop it in its tracks before people even begin to develop symptoms. That would be an absolute game changer for this, and I do think we're gonna get there, and that's exactly what we're focused on right now.
People often assume that memory loss is just a normal part of getting older. So how do you know when forgetfulness is something that you should talk to a doctor about?
One of the main goals I have when someone comes into the office is to determine what's normal and what's not when they're concerned about their memory.
In very, very early stages, it can sometimes be challenging to know what's going on, which is why we provide a really comprehensive assessment. So we look at different types of cognitive testing. We do blood tests. We can do brain scans to determine if there is something biologically going on in their brain that is either leading to or may be causing symptoms.
We know that with aging, certain cognitive abilities tend to slow down. If you look at processing speed, how quickly we can recall things, come up with words, we know that those things do slow down. On the flip side, aging also brings a lot of strengths. We tend to have more knowledge, experience, wisdom, which is a conglomeration of all those skills, and that can offset some of these changes.
We use the testing to determine if this is an abnormal process. Are we seeing something that has gone awry?
Many South Florida families are considered ALICE households, which means they earn too much to qualify for most assistance programs, but they still struggle to afford necessities. So how does the financial reality affect access to Alzheimer's diagnosis, treatment, and caregiving?
It's a really important, serious issue that so many people are in the middle that they just don't have the resources and the finances to manage this as best as they can, especially over the long run. The average course here can be 8, 10, 15 years. And many people, even if they planned very well for retirement, they certainly didn't plan to need that amount of care.
I can say that working with a memory disorder center in particular can optimize at least the time and the education and support that's hard to get elsewhere, and that can help people strategize and at least find the resources that they need. If someone's on Medicare, the GUIDE program has been developed to try to plug some of those gaps.
In general, it's a challenge over time. There's no denying that. There's not adequate funding for the number of people who have Alzheimer's disease. It just doesn't exist. In all of Miami-Dade County, there's only three official memory disorder centers. There's many physicians who focus on this as well, but it's certainly not something on every block.
Individuals who have both Medicare and Medicaid can be eligible for the PACE program, potentially, which covers all their health costs. The Alzheimer's Association, the Area Agency on Aging, often have different programs that can provide free services for people. So it's out there. I think the challenge is that an individual, as a caregiver, is already overwhelmed trying to find these things.
So, to me, all roads lead to a memory disorder center, someone who can help provide those services.
What is one thing you wish that everyone could understand about protecting brain health as they age?
We are focused so much on keeping our bodies healthy. We need to look at our brains in the same way.
And brain-healthy lifestyles do not have to be something exotic or expensive. It's really about making sure that we're keeping our bodies healthy, we're exercising, having a generally healthy diet. We're keeping ourselves mentally, physically, and socially active. That makes a big difference.
And there are things that people don't think about. Having a positive attitude towards aging, having a sense of purpose are both worth their weight in gold in terms of brain health.
Is there anything that you do personally to protect your brain health and your memory health?
So I think one of the best factors for brain health is giving to other people, having a sense of purpose.
When you work with other people, when you give to other people, when you have that sense of purpose, it is great for your brain. It gives you a more positive attitude towards aging and recent studies have shown that on average, a more positive attitude towards aging confers about seven extra years of life and reduces the risk of dementia by around 30%.
So I'll take both of those. For me, the work I do is really just a labor of love. I've been here for almost 30 years and hope to continue for many, many more years with this. So obviously, diet, exercise, those things are important, and I focus on those. But at the end of the day, I think there's nothing more satisfying and nothing more healthy than having a deep sense of purpose, and part of that is working with others.
