Cognitive Difficulty - Age 65+ in Pennsylvania

Pennsylvania

Cognitive impairment limits older adults' ability to age in place independently. Family, friends and other unpaid caregivers often bear the responsibility of providing daily assistance and emotional support to older adults with severe cognitive impairments such as Alzheimer's, the most common form of dementia. As the 65 and older population increases, the number of older adults living with Alzheimer’s disease in the United States is projected to reach 13.8 million by 2060.

Several conditions contribute to cognitive impairment, including metabolic and/or endocrine dysfunction, Alzheimer’s and other dementias, and treatable health issues like medication side effects and depression. While people can experience cognitive impairment at any stage in life, age is the greatest risk factor for Alzheimer’s. 

Cognitive difficulty places a large economic burden on both individuals and health care systems:

• Older adults with Alzheimer's or other dementias spend twice as many days hospitalized as other older adults.
• Medicare beneficiaries with dementia are more likely to have additional chronic diseases.
• Average annual health care costs are nearly three times higher for Medicare beneficiaries age 65 and older with dementia than for those without it.

The cost of caring for adults with severe cognitive impairment, including Alzheimer’s and other dementias, was estimated at $360 billion in 2024 and is projected to reach nearly $1 trillion by 2050.

The prevalence and risk of severe cognitive impairment are higher among:

• Women compared with men, although much of this difference is due to women’s longer life expectancy, as age is the greatest risk factor for Alzheimer’s and other dementias.
• American Indian/Alaska Native and Hispanic older adults compared with white older adults; the prevalence is lowest among Asian/Pacific Islander older adults.
• Older adults with less than a high school education compared with college graduates.
• Older adults without health insurance compared with those who are insured.
• Older adults experiencing food insecurity compared with those not experiencing food insecurity.

Changes in the brain often occur before symptoms of cognitive difficulty appear, suggesting that it may be possible to delay the onset of symptoms. Many factors contribute to cognitive health, such as genetic, environmental and lifestyle factors. While older adults cannot control all of these factors, there are ways to reduce risk, including the following: 

• Taking care of one’s physical health by getting recommended screenings, talking with a provider about medications and their effects on memory, limiting alcohol use and quitting smoking.
• Managing high blood pressure as it increases the risk of cognitive decline.
• Eating a healthy diet full of fruits and vegetables, whole grains and lean protein while limiting solid fats, salt and sugar.
• Engaging in regular physical activity.
• Staying mentally engaged. Cognitive training has a positive impact on memory retention. 
• Staying connected with family and friends.

Additionally, health providers should recommend hearing aids to older adults who have hearing loss. Hearing aids and cochlear implants can help protect against severe cognitive impairment.

The Centers for Disease Control and Prevention’s Healthy Brain Initiative has a guide for state and local public health agencies to prevent and address cognitive impairments. A free educational communications toolkit on brain health and aging is also available through the Administration for Community Living.

Healthy People 2030 has several objectives related to cognitive difficulty, including:

• Increasing the proportion of adults with subjective cognitive decline who have discussed their symptoms with a provider. 
• Increasing the proportion of older adults with dementia, or their caregivers, who know they have it. 
• Reducing the proportion of preventable hospitalizations in older adults with dementia.

Alzheimer’s Association. “2024 Alzheimer’s Disease Facts and Figures.” Alzheimer’s & Dementia 20, no. 5 (May 2024): 3708–3821. https://doi.org/10.1002/alz.13809.

Kim, Boeun, Laura J. Samuel, Roland J. Thorpe, Deidra C. Crews, and Sarah L. Szanton. “Food Insecurity and Cognitive Trajectories in Community-Dwelling Medicare Beneficiaries 65 Years and Older.” JAMA Network Open 6, no. 3 (March 24, 2023): e234674. https://doi.org/10.1001/jamanetworkopen.2023.4674.

Wooten, Karen G., Lisa C. McGuire, Benjamin S. Olivari, Eva M. J. Jackson, and Janet B. Croft. “Racial and Ethnic Differences in Subjective Cognitive Decline — United States, 2015–2020.” MMWR. Morbidity and Mortality Weekly Report 72, no. 10 (March 10, 2023): 249–55. https://doi.org/10.15585/mmwr.mm7210a1.

Yeo, Brian Sheng Yep, Harris Jun Jie Muhammad Danial Song, Emma Min Shuen Toh, Li Shia Ng, Cyrus Su Hui Ho, Roger Ho, Reshma Aziz Merchant, Benjamin Kye Jyn Tan, and Woei Shyang Loh. “Association of Hearing Aids and Cochlear Implants With Cognitive Decline and Dementia: A Systematic Review and Meta-Analysis.” JAMA Neurology 80, no. 2 (December 5, 2022): 134–41. https://doi.org/10.1001/jamaneurol.2022.4427.