GEORGIA ALZHEIMER'S DISEASE & Related Dementia Report, 2016 Georgia Department of Public Health / 1 PERCEIVED COGNITIVE IMPAIRMENT (PCI) AMONG GEORGIA RESIDENTS: ANALYSIS OF THE GEORGIA BRFSS 2011-2015 GEORGIA ALZHEIMER'S DISEASE & Related Dementia Report, 2016 Perceived Cognitive Impairment (PCI) Among Georgia Residents: Analysis of the Georgia BRFSS 2011-2015 CONTENTS Executive Summary 2 .................................................................................................................................................. Background.................................................................................................................................................................................2 Benefits of a State Alzheimer's and Related Dementias Registry................................................3 Goals for the ADRD Registry in Georgia..............................................................................................................3 Sources of Data for the Registry...............................................................................................................................3 2016 Georgia Alzheimer's and Related Dementias (GARD) Highlights and Updates 4 ...................................................................................................................................... Work Group Updates...........................................................................................................................................................4 Workforce Development...................................................................................................................................................4 Service Delivery.......................................................................................................................................................................5 Public Safety..............................................................................................................................................................................5 Outreach and Partnerships............................................................................................................................................6 Policy.................................................................................................................................................................................................6 Healthcare, Research, and Data Collection...................................................................................................... 7 Prevalence of Perceived Cognitive Impairment (PCI) Among Georgia Adults 8 ......................................................................................................................................... Highlights ....................................................................................................................................................................................9 Introduction ............................................................................................................................................................................ 12 Prevalence of PCI................................................................................................................................................................ 12 Prevalence by Sex .............................................................................................................................................................. 12 Prevalence by Race/Ethnicity ................................................................................................................................. 12 Prevalence by Age ............................................................................................................................................................. 12 Prevalence by Educational Level ........................................................................................................................... 13 Prevalence by Employment Status ..................................................................................................................... 13 Prevalence by Health Insurance Status .......................................................................................................... 13 Prevalence by General Health Status ............................................................................................................... 13 Prevalence by Number of Diagnosed Chronic Conditions............................................................... 14 Prevalence by Sex and Race...................................................................................................................................... 14 Prevalence by Sex and Age......................................................................................................................................... 14 Prevalence by Race and Age...................................................................................................................................... 14 Discussed PCI with a Health Care Professional (HCP) and Received Treatment/Therapy.................................................................................................................. 16 Inability to Perform Household Activities / Chores Due to PCI................................................... 18 Social Context and PCI Prevalence...................................................................................................................... 19 Prevalence of PCI by Public Health District................................................................................................. 20 Prevalence of PCI by Georgia Area Agencies on Aging Planning and Service Areas........................................................................................................ 21 Summary....................................................................................................................................................................................22 Appendix 24 .............................................................................................................................................................................. Georgia Department of Public Health / 5 EXECUTIVE SUMMARY DPH HAS PARTNERED WITH THE DIVISION OF AGING SERVICES WITHIN THE GEORGIA DEPARTMENT OF HUMAN SERVICES AND THE ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICIALS (ASTHO) TO CONVENE STAKEHOLDER MEETINGS INCLUDING MORE THAN 40 INTERNAL AND EXTERNAL PARTNERS: Georgia Department of Human Services, Division of Aging Georgia Alzheimer's Association Georgia Hospital Association Medical Association of Georgia State Legislators Georgia Department of Community Health (Medicaid, State Health Benefit Plan) Background DURING THE 2013 GEORGIA LEGISLATIVE SESSION, the Georgia General Assembly created the Georgia Alzheimer's and Related Dementias State Plan Task Force (GARD) to meet during the following summer. The task force was charged with creating a state Alzheimer's disease plan, including recommendations to collect statewide data to inform the evaluation and care infrastructure. All four legislative healthcare committee chairs and state health agency commissioners served on the task force and chaired issue-specific subcommittees. Georgia Department of Public Health Commissioner, Brenda Fitzgerald, M.D., chaired the Healthcare Research and Data Collection Subcommittee which included clinical and state agency stakeholders. One of the goals for the subcommittee was to identify and make recommendations about using surveillance data to enhance Alzheimer's awareness and action in public health programming and state planning [1]. The subcommittee found that there was a paucity of data about Alzheimer's disease and related dementias in Georgia and that no central repository for these data existed. Furthermore, this has created a barrier to estimating accurate Alzheimer's disease and related dementias prevalence rates in Georgia to inform planning, research and reporting efforts. One key recommendation made was to establish a statewide Alzheimer's Disease and Related Dementias (ADRD) Registry that will provide accurate and current data to address these urgent needs. During the 2014 Georgia Legislative Session, legislation (HB 966) regarding the establishment of an ADRD registry within the Georgia Department of Public Health (DPH) was introduced and subsequently passed (O.C.G.A 31-2a-17) [2]. As a major proprietor of health data in Georgia, DPH is uniquely situated to house such a registry. And given its existing footprint in the areas of health policy and promotion, DPH was identified as a prime coordinator of stakeholders and partners in the registry planning and development effort. West Virginia and South Carolina Alzheimer's and Related Dementias Registry Staff Carl Vinson Institute, University of Georgia University of Georgia, College of Public Health Emory University, Rollins School of Public Health Members of the healthcare provider community 2 / GARD REPORT / Georgia 2016 Benefits of a State Alzheimer's and Related Dementias Registry - Provide legislators, state planners and administrators, and members of the private sector with accurate data that will enable informed planning for current and future healthcare and social service needs (e.g. nursing home beds, adult day care, etc.). - Provide a resource for Georgia researchers to secure National Institute of Health (NIH) funding and establish an environment that will attract clinical trial and biotechnology investments, and create new jobs. - Serve the people of the state of Georgia by guiding efforts to educate the public on ADRD and serve as an information clearing house on ADRD for patients and caregivers. - To further serve Georgians by supporting cutting edge clinical research that will offer more effective treatments for dementing diseases Goals for the ADRD Registry in Georgia - Collect and disseminate usable data to inform programs and services for the aging population. - Determine the burden of ADRD among Georgians - Identify epidemiologic trends. - Bring awareness at the state level to issues of ADRD and increase the potential for positive statewide health outcomes and influence the management of associated healthcare costs. - Inform stakeholders for planning and for future registry needs. Data Sources for the ADRD Registry Georgia DPH currently collects and consolidates data from various sources including Medicare, Medicaid, Vital Records, Hospital Discharge Records, Emergency Room Visits Records, Physicians Reporting Portal (https://sendss.state.ga.us/ sendss/!alzheim.alzheim_login), the State Health Benefits Plan, Nursing Home Data, and Georgia Regents Health Plan. The Georgia Behavioral Risk Factor Surveillance System (BRFSS) also serves as a primary source of information on the prevalence of perceived cognitive impairment (PCI), other chronic health conditions, health risk behaviors, and the use of clinical preventive services among adult Georgia residents [3]. Additionally, it provides information on the challenges facing caregivers of individuals with ADRD, and other long-term illnesses or disabilities. The analysis in this annual report is based on data collected in the Georgia BRFSS during calendar years 2011, 2012, 2013, and 2015. Georgia Department of Public Health / 3 HIGHLIGHTS & UPDATES 2016 GEORGIA ALZHEIMER'S AND RELATED DEMENTIAS (GARD) ......................................................................................................................................................................................... The Alzheimer's Disease and Related Dementias (ADRD) State Plan Coordinator began working June 1, 2016 in the Department of Human Services, Division of Aging Services on . ......................................................................................................................................................................................... July 2016 GARD Advisors and Advisory Council met and revitalized six existing work groups. ......................................................................................................................................................................................... 190 people are included in GARD email distribution and are updated on progress. ......................................................................................................................................................................................... 70 people are engaged in six active work groups. ......................................................................................................................................................................................... Over 45 June 2016 new members were added to GARD email distribution since , with many now engaged in work groups. ......................................................................................................................................................................................... 6 There are active work groups. ......................................................................................................................................................................................... GARD WORK GROUP UPDATES Workforce Development Chairs: Kathy Simpson (Alzheimer's Association, Georgia Chapter) and Dr. Jennifer Craft Morgan (Georgia State University, Gerontology Institute) Established State Plan Goals: Assess the current workforce in Georgia, improve/increase dementia capability of workforce, develop education and training curricula, and improve workforce retention. 2016 Update: Produced a one-year report about an online dementia education module for physicians, which showed that 77 healthcare professionals completed the training and that the education proves to be impactful. Participants demonstrated a strong understanding of the basics of Alzheimer's disease and the Annual Medicare Wellness Visit after completing the modules. Collaborated with the Culture Change Network of Georgia and convened a group of providers to develop standard competencies for professionals who support people living with dementia. The workgroup is comprised of three subcommittees: Healthcare Provider Education, Direct Care Worker Competencies, and Data Collection & Analysis. 4 / GARD REPORT / Georgia 2016 2017 Vision and Goals: Creation of a second web-based dementia training module for physicians Complete a dementia education competency guide for the direct care workforce Expand data collection on dementia competency and training of long-term care workforce Service Delivery Chair: Eve Anthony (Athens Community Council on Aging) Established State Plan Goals: Assess the regional capacity of our state including rural versus urban access to services, train workforce in person-centered care, promote use of person-centered care models in long-term care, improve access to services and information, improve care transitions, and ensure high-quality services and quality care measurement in dementia services. 2016 Update: Established a chairwoman, reconvened membership, and reviewed the established goals of service delivery. Communicated with work groups to determine collaboration opportunities 2017 Vision and Goals: Work toward the established goals in the state plan Collaborate with Workforce Development work group on common goals and strategies Public Safety Chair: This work group did not have a chair in 2016. Established State Plan Goals: Ensure safety of persons with dementia who are at-risk for abuse, neglect, or exploitation and reduce rates of injury among people living with dementia. 2016 Update: Reconvened and decided to continue to support the Abuse, Neglect, and Exploitation initiatives that were established. Explored the current policies in the state of Georgia around the determination of decision-making capacity in someone living with dementia. 2017 Vision and Goals: Determine next steps in the creation or revision of a decision-making capacity toolkit for professionals including physicians, mental health professionals and judges Revisit the goals established in the state plan and determine next steps Expand work group membership to include first-responders Georgia Department of Public Health / 5 HIGHLIGHTS & UPDATES Outreach and Partnerships Chairs: Natalie Zellner, JD (Emory University, Alzheimer's Disease Research Center) and Ginny Helms (Alzheimer's Association, Georgia Chapter) Established State Plan Goals: Raise public awareness about dementia, educate the public about "dementia-friendliness," expand state's capacity to address the needs of persons living with dementia through partnerships and leveraging resources. 2016 Update: Determined a plan to bring awareness of the importance of early detection and diagnosis, which includes education about using the Medicare Annual Wellness Visit as a means to conduct cognitive screenings. Focused attention on partnership and connectivity to the faith community as a way to educate people on the topic of early detection. 2017 Vision and Goals: Use media outlets to disseminate information about the importance of early detection and diagnosis to the public Attend and participate in professional conferences for healthcare professionals as a means to communicate the importance of early detection and diagnosis Collaborate with faith communities on educational programming Policy Chairs: Sheila Humberstone, Principal (Stone Bridge Consulting Group) Established State Plan Goals: The policy workgroup serves to assess the statutory, regulatory, and state funding environment as it relates to Alzheimer's disease and make necessary recommendations. The group serves to vet and move forward as appropriate any policy changes requested by other workgroups as well as independently consider policy changes which would assist individuals with dementia and their families. 2016 Update: Worked with GARD members on priorities during the 2016 Legislative Session, including: Increase in Home and Community Based Services (HCBS) funding Allocation of funding for Georgia Bureau of Investigation (GBI) to hire additional staff for abuse, neglect and exploitation of vulnerable adults. Uniform Adult Guardianship and Protective Proceedings Jurisdiction Act 2017 Vision and Goals: Work with the other GARD workgroups to develop a strong policy platform for 2018 Pursue budgetary, legislative, and regulatory actions as advised by the GARD workgroups 6 / GARD REPORT / Georgia 2016 Healthcare, Research, & Data Collection Chair: This workgroup did not have a chair in 2016. Established State Plan Goals: Ensure early and accurate diagnosis of dementia, use surveillance data to enhance awareness for state planning, recognize Alzheimer's . as chronic disease, and improve the care and healthoutcomes of people living with dementia and their families. 2016 Update: Reconvened in order to establish direction. Began work on a data set catalogue to assess existing data on dementia in the state of Georgia. Welcomed the new full-time staff person leading the ADRD registry efforts to the work group. 2017 Vision and Goals: Complete data set catalogue and determine next steps Use multiple data sets to analyze the accessibility challenges and health disparities . that exist in our state for people living with dementia Continue to support the improvement of the ADRD registry efforts of Department of Public Health Georgia Department of Public Health / 7 Prevalence Of Perceived Cognitive Impairment (PCI) Among Georgia Adults Although Alzheimer's Disease and Related Dementia is not a normal part of aging, increasing age is the greatest known risk factor. The majority of people with ADRD are 65 years and older but there are those who have early onset of ADRD, beginning as early as age 40. 8 / GARD REPORT / Georgia 2016 HIGHLIGHTS More than 2.8 million Georgia adults are 45 years and older. ......................................................................................................................................................................................... Approximately 385,500 (13 percent) self-reported PCI. The prevalence of PCI was relatively consistent among races and ethnicities. ......................................................................................................................................................................................... 75 Georgians aged years and older reported a higher prevalence of PCI (Weighted Frequency (WF)* = 61,550; 17 percent) than those less than 65 years. ......................................................................................................................................................................................... Georgians who had less than a high school education reported the highest prevalence of PCI (WF*=106,200; 22 percent) than those with higher levels of education. ......................................................................................................................................................................................... Georgians who rated their general health as Fair or Poor (WF*=211,480; 30 percent) were significantly more likely to report PCI than those who reported good or better general health (WF*=173,830; 8 percent). ......................................................................................................................................................................................... The prevalence of PCI is significantly higher among Georgians without any form of health care coverage (WF*=61,720; 17 percent) than those who have some form of coverage (WF*= 322,788; 13 percent). ......................................................................................................................................................................................... Approximately 80 percent (WF*=262,260) of Georgians who reported PCI had not discussed their condition with a health care provider (HCP), and had therefore not received any treatment 8 percent ( 24,940) or therapy. Only WF*= had discussed their condition with a HCP and received treatment. ......................................................................................................................................................................................... * The BRFSS employs a complex survey design to account for overrepresentation or underrepresentation of various population subgroups within the final sample of respondents. Responses to the survey are then weighted to adjust for the distribution of the sample data. The weighted frequency represents the estimated number of adult Georgians who responded to a particular question. Georgia Department of Public Health / 9 INTRODUCTION Like other chronic diseases, Alzheimers Disease and Related Dementia is not randomly distributed in the population. It is more common in certain demographics than others, such as older adults and women. 10 / GA R D RE P O RT / G e orgi a 20 16 More than 16 million U.S. residents are living with cognitive impairment [4]. While cognitive impairment is not an inevitable result of aging, age is the greatest risk factor. As the U.S. population continues to age and the number of people ages 65 years and older increases, the prevalence of cognitive impairment WHAT IS COGNITIVE I M PA I R M E N T ? also is expected to increase. The number of Americans ages 65 years or older who are living with Alzheimer's disease is projected to increase from 5.1 million in 2000, to about 13.2 million in 2050 [5]. Cognitive decline may also be the result of other reversible conditions/diseases (e.g., depression, infections, medication side effects or nutritional deficiencies), which can be serious and should be treated by a health care provider as soon as possible [6]. Perceived cognitive impairment (PCI) is the self- perceived impression of declining cognitive function that is not readily identifiable through neuropsychological testing, but which may be the first preclinical sign of Alzheimer's disease and other dementias . [7,8] Studies show that older adults with memory complaints have a greater risk than those without memory complaints for developing mild cognitive impairment (a potential precursor to Alzheimer's disease) [9]. While having cognitive decline and impairment does not necessarily mean a person will develop future dementia, current estimates indicate that 32 percent to 53 percent of individuals with mild cognitive impairment Cognitive impairment is when a person has trouble remembering, concentrating, learning new things, or making decisions that affect their everyday life. Cognitive impairment ranges from mild to severe. With mild impairment, people may begin to notice changes in cognitive function, but may still be able to do their daily activities. Severe levels of impairment can lead to the inability to understand the meaning or importance of something and the ability to talk or write, resulting in the inability to live independently. Cognitive impairment may be the result of causes or diseases other than Alzheimer's disease . [10] will experience some form of dementia later in life [10-12]. Geo rgia Depa rtmen t of Pu blic H ea lth / 11 PREVALENCE Prevalence of PCI Approximately 13% (385,500) of Georgians aged 45 years or older reported they had experienced PCI that was happening more often or was getting worse during the past 12 months. Prevalence by Sex Fourteen percent (14%; 177,500) of males and 13% (208,000) of females reported experiencing PCI over the past 12 months. PERCENTAGE Prevalence of PCI among Adults Aged 45 Years or Older, Georgia, 2011-2013, 2015 13 YES NO 87 Prevalence of PCI among Adults Aged 45 Years Or Older, By Sex, Georgia, 2011-2013, 2015 50 40 30 20 14 13 10 0 MALE FEMALE Prevalence by Race/Ethnicity Approximately 13% (251,500) of Non-Hispanic Whites, 13% (96,600) of Non-Hispanic Blacks, and 15% (13,900) of Hispanics reported experiencing PCI over the past 12 months. PERCENTAGE Prevalence of PCI among Adults Aged 45 years or Older, by Race/Ethnicity, Georgia, 2011-2013, 2015 50 40 30 20 13 13 15 10 0 NH WHITE NH BLACK HISPANIC Prevalence by Age Nearly 17% (61,550) of Georgians 75 years and older reported experiencing PCI that was happening more often or getting worse over the past 12 months. This was significantly higher than the prevalence among 45-54 and 65-74 year olds (12% each). 12 / GA R D R E P O RT / G e orgi a 20 16 PERCENTAGE Prevalence of PCI among Adults Aged 45 years or Older, by Age Group, Georgia, 2011-2013, 2015 50 40 30 20 12 14 12 17 10 0 45-54 55-64 65-74 75+ AGE (YEARS) PERCENTAGE Prevalence of PCI among Adults Aged 45 years or Older, by Education Level, Georgia, 2011-2013, 2015 50 40 30 20 10 0 < HS HS GRAD SOME COLLEGE EDUCATION LEVEL COLLEGE GRAD Prevalence by Education Level A significantly higher percentage of Georgians 45 years and older with less than a high school education (22%; 106,200) reported having PCI than those with higher levels of education. Conversely, Georgians with at least a college degree had significantly lower PCI (8%; 57,800) than those with all other education levels. PERCENTAGE Prevalence of PCI among Adults Aged 45 years or Older, by Employment Status, Georgia, 2011-2013, 2015 50 40 30 20 10 0 EMPLOYED/ OUT OF WORK/UNABLE TO WORK RETIRED HOMEMAKER STUDENT EMPLOYMENT STATUS Prevalence by Employment Status The prevalence of PCI was higher among Georgians who were either out of work or unable to work (31%; 159,920) than those who were employed/homemakers/ students (7%; 107,370), or retired (13%; 117,420). PERCENTAGE Prevalence of PCI among Adults 45 years or older, by Health Insurance Status, Georgia, 2011-2013, 2015 50 40 30 20 10 0 HAS INSURANCE NO INSURANCE HEALTH INSURANCE STATUS Prevalence by Health Insurance Status The prevalence of PCI was significantly higher among Georgians who did not have any form of health care coverage (17%; 61,720) than those who had some form of coverage (13%; 322,790). Prevalence of PCI among Adults 45 years or Older, by General 50 Health Status, Georgia, 2011-2013, 2015 40 PERCENTAGE 30 20 10 0 EXCELLENT/VERY GOOD/GOOD FAIR/POOR HEALTH STATUS Prevalence by General Health Status The prevalence of PCI was significantly higher among Georgians who described their general health as fair/poor (30%; 211,480) than those who rated themselves as having at least good general health (8%; 178,830). Geo rgia Depa rtmen t of Pu blic H ea lth / 13 PREVALENCE Prevalence by Number of Diagnosed Chronic Conditions The prevalence of PCI significantly increased with every increase in the number of diagnosed comorbid chronic conditions from none (5%; 58,030), to one (11%; 93,700), two (21%; 84,570), and three or more (37%; 119,350). Prevalence by Sex and Race The prevalence of PCI was 14%, 13%, and 15% among Non-Hispanic White, Non-Hispanic Black, and Hispanic males, respectively (Table 1, Appendix). Similarly, the prevalence of PCI was 13%, 13%, and 14% among Non-Hispanic, Non-Hispanic Black, and Hispanic females, respectively (Table 1, Appendix). Prevalence of PCI among Adults 45 years or Older, by Number of Comorbid Conditions, Georgia, 2011-2013, 2015 50 40 37 PERCENTAGE 30 20 10 5 21 11 0 NONE 1 2 3 or MORE NUMBER OF DIAGNOSED DISEASES PERCENTAGE Prevalence of PCI among Adults 45 years or older, by Sex and Race, Georgia, 2011-2013, 2015 50 40 MALE FEMALE 30 20 14 13 10 13 13 15 14 0 NH WHITE NH BLACK HISPANIC Prevalence by Sex and Age The prevalence of PCI was highest among males and females 75 years or older (18% and 16% respectively). However, the differences between sex-age groups were not significant. (Table 1, Appendix). PERCENTAGE Prevalence of PCI among Adults 45 years or older, by Sex and Age, Georgia, 2011-2013, 2015 50 40 MALE FEMALE 30 20 12 12 10 15 14 12 12 18 16 0 45-54 75+ AGE (YEARS) Prevalence by Race and Age Among Non-Hispanic Blacks, a significantly higher percentage of Georgians 75 years or older (22%) reported PCI than those aged less than 65 years. (Table 1, Appendix). 14 / GA R D R E P O RT / G e orgi a 20 16 PERCENTAGE Prevalence of PCI among Adults 45 years or older, by Race and Age, Georgia, 2011-2013, 2015 50 NH WHITE NH BLACK HISPANIC 40 30 20 12 11 14 10 18 15 12 12 13 8 22 15 0 45-54 55-64 65-74 75+ AGE (YEARS) The prevalence of Perceived Cognitive Impairment was significantly higher among Georgians who described their general health as fair/poor than those who rated themselves as having at least good general health. Geo rgia Depa rtmen t of Pu blic H ea lth / 15 DISCUSSING MEMORY ISSUES Discussed PCI with a Health Care Professional (HCP) and Received Treatment/Therapy Approximately 80% of Georgians with PCI had not discussed their memory issues with an HCP, and therefore had not received any form of treatment or therapy. Only 8% of Georgians with PCI had discussed their condition with a HCP and received some form of treatment or therapy. Percentage of Adults Aged 45 Years or Older with PCI Who Have Discussed Condition with HCP and Received Treatment, Georgia, 2011-2013, 2015 8% 13% 80% DID NOT DISCUSS CONDITION DISCUSSED CONDITION, RECEIVED TREATMENT DISCUSSED CONDITION, DID NOT RECEIVE TREATMENT A similar proportion of males (7%) and females (8%) with PCI reported that they had discussed their condition with an HCP and had received some form of treatment or therapy. PERCENTAGE Percentage of Adults Aged 45 Years or Older with PCI Who Have Discussed Condition with HCP and Received Treatment, By Sex, Georgia, 2011-2013, 2015 100 80 80 DISCUSSED CONDITION, RECEIVED TREATMENT 80 DISCUSSED CONDITION, DID NOT RECEIVE TREATMENT 60 DID NOT DISCUSS CONDITION 40 20 13 7 0 MALE 13 8 FEMALE Approximately 78% of Non-Hispanic Whites, and 84% of Non-Hispanic Blacks with PCI had not discussed their condition with an HCP, and had therefore not received any treatment. 16 / GA R D R E P O RT / G e orgi a 20 16 Percentage of Adults with PCI Who Have Discussed Condition with HCP and Received Treatment, By Race/Ethnicity, Georgia, 2011-2013, 2015 100 DISCUSSED CONDITION, 84 80 75 RECEIVED TREATMENT DISCUSSED CONDITION, DID NOT RECEIVE TREATMENT 60 DID NOT DISCUSS CONDITION 40 PERCENTAGE 20 16 9 7 9 0 MALE FEMALE RACE/ETHNICITY Approximately 80% of Georgians with Perceived Cognitive Impairment had not discussed their memory issues with a health care provider, and therefore had not received any form of treatment or therapy. Among Georgians 65 years and older, a higher percentage had not discussed their PCI with an HCP, and therefore had not received any treatment, than those less than 65 years. However, the differences were not significant. PERCENTAGE Percentage of Adults with PCI Who Have Discussed Condition with HCP and Received Treatment, By Age, Georgia, 2011-2013, 2015 DISCUSSED CONDITION, 100 RECEIVED TREATMENT 80 75 DISCUSSED CONDITION, DID NOT RECEIVE TREATMENT 78 DID NOT DISCUSS CONDITION 85 86 60 40 20 16 9 45-54 10 13 55-64 11 4 AGE (YEARS) 65-74 9 5 75+ Geo rgia Depa rtmen t of Pu blic H ea lth / 17 ACTIVITY & ABILITY Inability to Perform Household Activities /Chores Due to PCI Approximately 38% of Georgia adults with PCI reported that they sometimes, usually, or always gave up on performing household chores or activities during the past 12 months because their confusion or memory loss was happening more often or was getting worse. Percentage of Adults Aged 45 Years or Older With PCI who Reported Difficulty in Performing Household Activities, Georgia, 2011-2013, 2015 38% 62% RARELY OR NEVER SOMETIMES, USUALLY OR NEVER A similar proportion of males (39%) and females (36%) with PCI reported that they sometimes, usually, or always gave up on performing household chores or activities during the past 12 months due to their worsening condition. Percentage of Adults Aged 45 Years or Older with PCI who Reported Difficulty in Performing Household Activities, By Sex, Georgia, 2011-2013, 2015 PERCENTAGE 100 80 60 39 40 20 0 MALE 36 FEMALE A significantly lower percentage of Non-Hispanic Whites (33%) than Non-Hispanic Blacks (46%) with PCI reported that they sometimes, usually, or always gave up on performing household chores or activities during the past 12 months due to their worsening condition. 18 / GA R D R E P O RT / G e orgi a 20 16 PERCENTAGE Percentage of Adults Aged 45 years or Older with PCI Who Reported Difficulty in Performing Household Activities, by Race/Ethnicity, Georgia, 2011-2013, 2015 100 80 60 40 33 20 0 MALE 46 FEMALE PERCENTAGE Percentage of Adults Aged 45 years or Older with PCI Who Reported Difficulty 100 in Performing Household Activities, by Age, Georgia, 2011-2013, 2015 80 60 45 40 40 29 25 20 0 45-54 55-64 65-74 75+ AGE (YEARS) The percentage of Georgians with PCI who reported that they sometimes, usually, or always gave up on performing household chores or activities decreased with increasing age. Percentage of Adults Aged 45 years or older with PCI, By Self Reported Difficulty in Buying Food or Paying for Rent, Georgia, 2011-2013, 2015 100 80 PERCENTAGE 60 40 22 20 0 SOMETIMES, USUALLY, ALWAYS 8 RARELY, NEVER 29 SOMETIMES, USUALLY, ALWAYS 8 RARELY, NEVER ABILITY TO PAY RENT ABILITY TO BUY FOOD Social Context and PCI Prevalence A higher percentage of Georgia adults who sometimes, usually, or always had difficulty paying rent (22%; 106,030), or buying food (29%; 104,090) reported PCI than those who rarely or never had difficulty paying rent (8%; 80,620) or buying food (8%; 96,800). Geo rgia Depa rtmen t of Pu blic H ea lth / 19 Prevalence of PCI by Public Health District Southeast, South, Northwest, North Central, and North Health Districts had the highest prevalence of PCI, but none was significantly higher than the state average (Appendix, Table 2). PUBLIC HEALTH DISTRICTS 1-1 Northwest (Rome) 1-2 North Georgia (Dalton) PCI PREVALENCE BY PH DISTRICT DADE (1-1) CATOOSA (1-1) WALKER (1-1) WHITFIELD (1-2) FANNIN (1-2) MURRAY 1-2 (1-2) GILMER (1-2) CHATTOOGA (1-1) FLOYD (1-1) GORDON (1-1) 1-1 BARTOW (1-1) PICKENS (1-2) CHEROKEE (1-2) UNION (2) LUMPKIN (2) DAWSON (2) FORSYTH (2) TOWNS (2) RABUN (2) WHITE (2) 2 HALL (2) HABERSHAM (2) STEPHENS (2) BANKS (2) FRANKLIN (2) HART (2) JACKSON (10) MADISON (10) ELBERT (10) 8% <12% 12% <14% 14% 17% 2 North (Gainesville) 3-1 Cobb-Douglas 3-2 Fulton 3-3 Clayton (Jonesboro) 3-4 GNR (Lawrenceville) 3-5 DeKalb 4 District 4 5-1 South Central (Dublin) 5-2 North Central (Macon) 6 East Central (Augusta) POLK (1-1) HARALSON (1-1) CARROLL (4) HEARD (4) COBB (3-1) GWINNETT BARROW (10) PAULDING (3-4) (1-1) 3-1 3-5 3-4 WALTON (10) DOUGLAS (3-1) FULTON (3-2) DEKALB (3-5) ROCKDALE 3-2 CLAYTON (3-3) (3-4) NEWTON 3-3 HENRY (3-4) FAYETTE (4) COWETA (4) (4) SPALDING (4) BUTTS (4) JASPER (5-2) CLARKE (10) OCONEE (10) 10 MORGAN (10) PUTNAM (5-2) OGELTHORPE (10) WILKES (6) LINCOLN (6) GREENE (10) TALIAFERRO (6) McDUFFIE (6) WARREN (6) COLUMBIA (6) RICHMOND (6) HANCOCK (5-2) GLASCOCK 6 (6) 7 West Central (Columbus) 8-1 South (Valdosta) 8-2 Southwest (Albany) 9-1 Coastal (Savannah) 9-2 Southeast (Waycross) 10 Northeast (Athens) TROUP (4) 4 MERIWETHER (4) PIKE LAMAR (4) (4) UPSON (4) MONROE (5-2) HARRIS (7) TALBOT (7) CRAWFORD (5-2) JONES (5-2) BALDWIN (5-2) BIBB (5-2) 5-2 WILKINSON (5-2) TWIGGS (5-2) WASHINGTON (5-2) JEFFERSON (6) JOHNSON (5-1) EMANUEL (6) BURKE (6) JENKINS (6) SCREVEN (6) MUSCOGEE (7) CHATTAHOOCHIE (7) TAYLOR (7) MARION (7) 7 SCHLEY (7) MACON (7) STEWART (7) WEBSTER (7) SUMTER (7) PEACH (5-2) HOUSTON (5-2) BLECHLEY (5-1) LAURENS (5-1) TREUTLEN (5-1) 5-1 DOOLEY (7) PULASKI (5-1) DODGE (5-1) MONTGOMERY (5-1) WHEELER (5-1) TOOMBS (9-2) CRISP (7) WILCOX (5-1) TELFAIR (5-1) CANDLER (9-2) BULLOCH (9-2) EVANS (9-2) TATTNAIL (9-2) EFFINGHAM (9-1) BRYAN (9-1) LIBERTY (9-1) CHATHAM (9-1) QUITMAN (7) RANDOLPH (7) TERRELL (8-2) LEE (8-2) CLAY (7) CALHOUN (8-2) DOUGHERTY (8-2) EARLY (8-2) MILLER (8-2) BAKER (8-2) 8-2 MITCHELL (8-2) SEMINOLE (8-2) DECATUR (8-2) GRADY (8-2) TURNER (8-1) WORTH (8-2) TIFT (8-1) COLQUIT (8-2) COOK (8-1) THOMAS (8-2) BROOKS (8-1) BEN HILL (8-1) IRWIN (8-1) JEFF DAVIS (9-2) COFFEE (9-2) BERRIEN (8-1) ATKINSON (9-2) LANIER (8-1) 8-1 LOWNDES (8-1) CLINCH (9-2) APPLING (9-2) BACON (9-2) WAYNE (9-2) 9-2 PIERCE (9-2) WARE (9-2) BRANTLEY (9-2) CHARLETON (9-2) LONG (9-1) 9-1 McINTOSH (9-1) GLYNN (9-1) CAMDEN (9-1) ECHOLS (8-1) 20 / GA R D R E P O RT / G e orgi a 20 16 Prevalence of PCI by Georgia Area Agencies on Aging (AAA) Planning and Service Areas (PSAs) Middle Georgia, Heart of Georgia Altamaha, and Southeast Georgia PSAs had the highest prevalence of PCI, but none was significantly higher than the state average (Appendix, Table 2). PCI PREVALENCE BY AAA PSA AAA PSA 1 Northwest Georgia 2 Georgia Mountains 3 Atlanta Region DADE (1) CATOOSA (1) WALKER (1) WHITFIELD (1) MURRAY (1) CHATTOOGA (1-1) FLOYD (1) GORDON (1) 1 BARTOW (1) FANNIN (1) GILMER (1) PICKENS (1) CHEROKEE (3) UNION (2) LUMPKIN (2) DAWSON (2) FORSYTH (2) TOWNS (2) RABUN (2) 11% <13% 13% <15% WHITE (2) 2 HALL (2) HABERSHAM (2) STEPHENS (2) BANKS (2) FRANKLIN (2) HART (2) 15%17% JACKSON (5) MADISON (5) ELBERT (5) POLK (1) HARALSON (1) CARROLL (4) HEARD (4) PAULDING (1) DOUGLAS (3) COWETA (4) COBB (3) GWINNETT (3) BARROW (5) 3 FULTON (3) DEKALB (3) CLAYTON (3) WALTON (5) ROCKDALE (3) NEWTON (5) FAYETTE (3) HENRY (3) SPALDING (4) BUTTS (4) JASPER (5) CLARKE (5) OCONEE (5) 5 MORGAN (5) PUTNAM (7) OGELTHORPE (5) WILKES (8) LINCOLN (8) GREENE (5) TALIAFERRO (8) McDUFFIE (8) WARREN (8) COLUMBIA (8) RICHMOND (8) HANCOCK (8) GLASCOCK 8 (8) TROUP (4) 4 MERIWETHER (4) PIKE LAMAR (4) (4) UPSON (4) MONROE (7) HARRIS (6) TALBOT (6) CRAWFORD (7) JONES (7) BALDWIN (7) 7 BIBB (7) WILKINSON (7) TWIGGS (7) WASHINGTON (8) JEFFERSON (8) JOHNSON (9) EMANUEL (9) BURKE (8) JENKINS (8) MUSCOGEE (6) TAYLOR (6) PEACH (7) HOUSTON (7) BLECHLEY (9) LAURENS (9) TREUTLEN (9) CANDLER (9) 4 Southern Crescent 5 Northeast Georgia 6 Lower Chattachoochee 7 Middle Georgia 8 Central Savannah River 9 Heart of Georgia Altamaha 10 Southwest Georgia 11 Southeast Georgia 12 Coastal Georgia SCREVEN (8) BULLOCH (12) EFFINGHAM (12) CHATTAHOOCHIE (6) 6 MARION (6) SCHLEY (6) MACON (6) STEWART (6) WEBSTER (6) SUMTER (6) DOOLEY (6) CRISP (6) PULASKI (7) WILCOX (9) 9 DODGE (9) MONTGOMERY (9) WHEELER (9) TOOMBS (9) TELFAIR (9) EVANS (9) TATTNAIL (9) 12 BRYAN (12) LIBERTY (12) QUITMAN (6) RANDOLPH (6) TERRELL (10) LEE (10) CLAY (6) CALHOUN (10) DOUGHERTY (10) TURNER (11) WORTH (10) TIFT (11) BEN HILL (11) IRWIN (11) JEFF DAVIS (9) COFFEE (11) EARLY (10) BAKER 10 (10) BERRIEN (11) ATKINSON (11) MILLER (10) SEMINOLE (10) DECATUR (10) MITCHELL (10) COLQUIT (10) COOK (11) LANIER (11) GRADY (10) THOMAS (10) BROOKS (11) LOWNDES (11) 11 CLINCH (11) APPLING (9) BACON (11) LONG (12) WAYNE (9) WARE (11) PIERCE (11) BRANTLEY (11) McINTOSH (12) GLYNN (12) CHARLETON (11) CAMDEN (12) CHATHAM (12) ECHOLS (11) Geo rgia Depa rtmen t of Pu blic H ea lth / 21 SUMMARY Approximately 92,000 (6.4 percent) of Medicare beneficiaries in Georgia were living with Alzheimer's disease and related dementias (ADRD) in 2013 . [14] Our analysis showed that approximately 80 percent of Georgians who perceived themselves as having some form of cognitive impairment have not discussed their condition with their health care provider (HCP) and therefore have not received treatment. Additionally, a significant percentage of Georgians who discussed their condition with their HCP do not receive any treatment or therapy for their complaint. Considering that individuals with PCI may have a greater risk for developing cognitive impairment later in life, equitable access to care and early diagnosis are critical not only for maintaining quality of life and independence, but are important steps in reducing the potential economic burdens of cognitive impairment. There is the need for an education campaign to encourage Georgians who experience persistent confusion or memory loss to consult with their health care providers. Efforts should also be made to integrate memory screening into regular checkups for elderly Georgians who may be more at risk of developing ADRD. While there is currently no established treatment for mild cognitive impairment, consultation with an HCP will help identify and treat any contributing medical conditions such as depression, ADRD, and blood clots or tumors in the brain . [15] Increased physical activity, spending time with family and friends, and learning new skills have also been shown to help improve memory . [15] 22 / GA R D R E P O RT / G e orgi a 20 16 As the Georgia population continues to age, the proportion of the population diagnosed with ADRD is projected to increase significantly. By analyzing data from the various data sources, the GA ADRD Registry provides a clearer picture of the burden of ADRD in Georgia. Plans for 2017 include merging data from the various resources available to the registry to produce a complete analytical dataset, and getting more physicians to sign on and submit information in the Physicians Reporting Portal (available at https://sendss.state.ga.us/ sendss/!alzheim.alzheim_login). Ongoing analysis of the Georgia BRFSS will also serve as a valuable surveillance tool for monitoring the prevalence of PCI and the challenges faced by caregivers of ADRD-affected Georgians. Geo rgia Depa rtmen t of Pu blic H ea lth / 23 APPENDIX TABLE 1. Characteristics of Georgia Adults 45 Years and Older Who Reported Perceived Cognitive Impairment (PCI), Georgia BRFSS, 2011-2013, 2015 WEIGHTED FREQUENCY* N (%) GENERAL SAMPLE 385492 2079 (13.44) SEX Male 177470 733 (13.53) Female 208022 1346 (13.36) RACE/ETHNICITY Non-Hispanic White 251449 1449 (13.27) Non-Hispanic Black 96628 466 (12.91) Hispanic 13914 35 (14.62) EDUCATION Less than HS 106175 428 (21.88) HS Grad 119895 673 (13.96) Some College 100338 526 (12.55) College Grad 57802 445 (8.04) AGE GROUP (YEARS) 45 - 54 126714 463 (12.26) 55 - 64 126803 665 (14.41) 65 - 74 70429 484 (12.09) 75+ 61546 467 (16.51) EMPLOYMENT STATUS Employed / Homemaker / Student 107368 512 (7.4) Out Of Work / Unable To Work 159918 745 (30.97) Retired 117421 816 (13.17) HEALTH COVERAGE STATUS Has Insurance 322,788 1816 (12.88) No Insurance 61722 256 (17.24) HEALTH STATUS Excellent / Very Good / Good 173826 957 (8.08) Fair / Poor 211476 1121 (29.76) HAD ANNUAL DR. VISIT WITHIN PAST 12 MONTHS Yes 299418 1677 (13.09) No 76558 347 (14.36) BMI Underweight / Normal 106544 592 (13.09) Overweight 123726 683 (11.84) Obese 142835 744 (15.84) 24 / GA R D R E P O RT / G e orgi a 20 16 95% CI 12.70 - 14.21 12.34 - 14.82 12.46 - 14.31 12.41 - 14.17 11.46 - 14.53 9.57 - 21.69 19.39 - 24.60 12.65 - 15.40 11.24 - 13.99 7.16 - 9.01 10.91 - 13.75 13.10 - 15.83 10.79 - 13.53 14.72 - 18.47 6.62 - 8.26 28.37 - 33.69 12.07 - 14.35 12.12 - 13.67 14.71 - 20.11 7.43 - 8.78 27.72 - 31.89 12.29 - 13.94 12.51 - 16.44 11.76 - 14.54 10.71 - 13.07 14.44 - 17.33 TABLE 1. (continued) Characteristics of Georgia Adults 45 Years and Older Who Reported Perceived Cognitive Impairment (PCI), Georgia BRFSS, 2011-2013, 2015 NUMBER OF CHRONIC DISEASES None 1 2 3 or more STRESSED ABOUT BEING ABLE TO PAY RENT Sometimes, Usually, Always Rarely, Never STRESSED ABOUT BEING ABLE TO BUY FOOD Sometimes, Usually, Always Rarely, Never RACE/ETHNICITY AND SEX Male Non-Hispanic White Non-Hispanic Black Hispanic Female Non-Hispanic White Non-Hispanic Black Hispanic SEX AND AGE GROUP (YEARS) Male 45 - 54 55 - 64 65 - 74 75+ Female 45 - 54 55 - 64 65 - 74 75+ RACE/ETHNICITY, AND AGE GROUP (YEARS) Non-Hispanic White 45 - 54 55 - 64 65 - 74 75+ 58031 93701 84571 119345 106026 80617 104086 96800 118740 40163 7255 132708 427946 6658 59237 61385 31592 25256 67477 65418 38837 36290 74179 83641 48312 45317 307 (4.79) 494 (11.3) 460 (20.55) 667 (37.18) 481 (22.32) 412 (7.81) 480 (29.16) 506 (7.95) 4.15 - 5.52 10.04 - 12.71 18.25 - 23.06 34.19 - 40.27 19.96 - 24.88 6.89 - 8.84 26.16 - 32.36 7.12 - 8.87 532 (13.62) 136 (12.54) 13 (15.18) 917 (12.97) 330 (13.19) 22 (14.05) 12.22 - 15.13 10.17 - 15.36 8.38 - 25.93 11.96 - 14.06 11.45 - 15.16 7.57 - 24.59 162 (12.20) 250 (14.64) 172 (11.93) 149 (17.81) 301 (12.31) 415 (14.19) 312 (12.23) 318 (15.71) 10.07 - 14.71 12.62 - 16.93 9.93 - 14.27 14.65 - 21.48 10.69 - 14.14 12.56 - 16.01 10.59 - 14.09 13.66 - 18.02 293 (11.87) 444 (14.55) 352 (12.05) 360 (15.38) 10.26 - 13.69 12.99 - 16.27 10.58 - 13.70 13.53 - 17.44 Geo rgia Depa rtmen t of Pu blic H ea lth / 25 TABLE 1. (continued) Characteristics of Georgia Adults 45 Years and Older Who Reported Perceived Cognitive Impairment (PCI), Georgia BRFSS, 2011-2013, 2015 RACE/ETHNICITY, AND AGE GROUP (YEARS) Continued Non-Hispanic Black 45 - 54 32977 55 - 64 32709 65 - 74 18391 75+ 12553 Hispanic 45 - 54 7266 55 - 64 4390 65 - 74 888 75+ a TALKED TO A HEALTH CARE PROVIDER ABOUT PCI Yes 117753 No 262262 HAVE NOT DISCUSSED PCI WITH A HEALTH CARE PROVIDER (HCP) By Age 45 - 54 83085 55 - 64 81103 65 - 74 50701 75+ 47373 By Sex Male 118598 Female 143664 By Race Non-Hispanic White 166386 Non-Hispanic Black 70557 Hispanic a 114 (10.99) 175 (12.31) 98 (12.95) 79 (21.55) 10 (13.96) 14 (18.02) 7 (7.51) 555 (30.8) 1490 (69.2) 302 (66.89) 443 (64.58) 371 (72.85) 374 (79.45) 512 (68.2) 978 (70.04) 1038 (67.44) 347 (74.04) 8.74 - 13.74 10.84 - 15.98 9.99 - 16.62 16.21 - 28.05 7.00 - 25.91b 9.74 - 30.92 b 3.01 - 17.51 27.98 - 33.78 66.22 - 72.02 60.84 - 72.43 59.34 - 69.49b 66.73 - 78.22 73.44 - 84.39 63.22 - 72.80 66.45 - 73.40 63.85 70.83 67.87 79.39 26 / GA R D R E P O RT / G e orgi a 20 16 TABLE 1. (continued) Characteristics of Georgia Adults 45 Years and Older Who Reported Perceived Cognitive Impairment (PCI), Georgia BRFSS, 2011-2013, 2015 RECEIVED TREATMENT AMONG GEORGIANS WHO DISCUSSED PCI WITH HCP Yes 24938 168 (37.17) No 42153 221 (62.83) HAVE NOT RECEIVED TREATMENT AMONG GEORGIANS WHO DISCUSSED PCI WITH HCP By Age Group (Years) 45 - 54 17752 76 (64.49) 55 - 64 13037 73 (56.31) 65 - 74 6430 42 (72.38) 75+ 4933 30 (65.54) By Sex Male 19113 81 (63.27) Female 23039 140 (62.47) By Race Non-Hispanic White 29362 158 (63.61) Non-Hispanic Black 7746 40 (56.54) Hispanic a a Not available if the unweighted sample size for the denominator is less than 50 b Estimates with 95% Confidence Intervals greater than 20 are unreliable 31.19 - 56.43b 56.43 - 68.81 53.69 - 74.00b 45.07 - 66.93b 57.49 - 83.54b 49.16 - 78.90b 52.64 - 72.75b 54.58 - 69.75 56.09 70.53 41.63 70.36b * The BRFSS employs a complex survey design to account for overrepresentation or underrepresentation of various population subgroups within the final sample of respondents. Responses to the survey are then weighted to adjust for the distribution of the sample data. The weighted frequency represents the estimated number of adult Georgians who responded to a particular question. Geo rgia Depa rtmen t of Pu blic H ea lth / 27 TABLE 2. Prevalence of PCI among Adults Aged 45 years or more, by Health District, and Area Agencies of Aging (AAA) Planning and Service Areas (PSAs). Georgia BRFSS, 2011-2013, 2015 WEIGHTED FREQUENCY* N (%) 95% CI BY HEALTH DISTRICT Northwest (Rome) 31314 136 (16.07) 13.19 - 19.44 North Georgia (Dalton) 18213 103 (12.88) 9.95 - 16.52 North (Gainesville) 31427 133 (15.25) 12.36 - 18.67 Cobb-Douglas 21449 89 (11.73) 9.08 - 15.02 Fulton 22823 91 (11.17) 8.71 - 14.23 Clayton (Jonesboro) 3661 52 (8.05) 5.70 - 11.26 East Metro (Lawrenceville) 25147 87 (10.17) 7.80 - 13.15 DeKalb 20871 96 (12.56) 9.54 - 16.38 District 4 (LaGrange) 33087 136 (13.65) 11.09 - 16.69 South Central (Dublin) 8150 129 (14.82) 11.26 - 19.25 North Central (Macon) 27281 132 (15.61) 12.74 - 18.99 East Central (Augusta) 23201 115 (13.62) 10.71 - 17.17 West Central (Columbus) 15977 135 (14.05) 11.31 - 17.33 South (Valdosta) 14403 120 (16.22) 12.00 - 21.55 Southwest (Albany) 19274 123 (13.82) 10.89 - 17.39 Coastal (Savannah) 19099 94 (11.38) 8.80 - 14.60 Southeast (Waycross) 22387 151 (16.89) 13.84 - 20.46 Northeast (Athens) 20866 114 (14.35) 11.41 - 17.89 BY AREA AGENCIES OF AGING (AAA) PLANNING AND SERVICE AREAS (PSA) Northwest Georgia 422250 198 (14.89) 12.60 17.52 Georgia Mountains 206090 133 (15.25) 12.36 18.67 Atlanta Region 107519 491 (11.29) 10.05 12.66 Southern Crescent 24140 91 (15.79) 12.26 20.10 Northeast Georgia 24780 130 (13.32) 10.74 16.42 Lower Chattahoochee 15980 135 (14.05) 11.31 17.33 Middle Georgia 25210 129 (16.21) 13.15 19.82 Central Savannah River 23220 113 (12.87) 10.12 16.22 Heart of Georgia Altamaha 18680 190 (16.88) 13.64 20.71 Southwest Georgia 19270 123 (13.82) 10.89 17.89 Southeast Georgia 23960 188 (16.15) 13.05 19.82 Coastal Georgia 22220 115 (11.70) 9.26 14.68 * The BRFSS employs a complex survey design to account for overrepresentation or underrepresentation of various population subgroups within the final sample of respondents. Responses to the survey are then weighted to adjust for the distribution of the sample data. The weighted frequency represents the estimated number of adult Georgians who responded to a particular question. 28 / GA R D R E P O RT / G e orgi a 20 16 Table 3. Percentage of Adults with PCI Stratified by Discussion with HCP and Treatment Status, Georgia BRFSS, 2011- 2013, 2015 DISCUSSED CONDITION, RECEIVED TREATMENT DISCUSSED CONDITION, DID NOT RECEIVE TREATMENT DID NOT DISCUSS CONDITION OR RECEIVE TREATMENT N % 95% CI N % 95% CI N % 95% CI GENERAL SAMPLE 168 7.57 6.21 - 9.20 221 12.80 10.85 - 15.03 1490 79.63 77.07 - 81.97 BY AGE GROUP (YEARS) 45 - 54 48 8.84 6.18 - 12.47 76 16.05 12.37 - 20.57 302 16.05 12.37 - 20.57 55 - 64 70 9.70 7.19 - 12.98 73 12.51 9.14 - 16.87 443 77.79 72.96 - 81.97 65 - 74 25 4.12 2.48 - 6.77 42 10.79 7.21 - 15.84 371 85.09 79.88 - 89.14 75+ 25 4.73 2.89 - 7.62 30 8.99 5.74 - 13.80 374 86.29 81.23 - 90.15 BY SEX Male 62 7.46 5.39 - 10.24 81 12.84 9.76 - 16.72 512 79.70 75.38 - 83.43 Female 106 7.67 6.01 - 9.74 140 12.76 10.44 - 15.51 978 79.57 79.41 - 82.40 BY RACE Non-Hispanic White 111 7.90 6.25 - 9.95 158 13.81 11.43 - 16.60 1038 78.28 75.13 - 81.14 Non-Hispanic Black 38 7.07 4.52 - 10.87 40 9.19 6.24 - 13.34 347 83.74 78.72 - 87.76 Hispanic a BY NUMBER OF DIAGNOSED CHRONIC CONDITIONS None 9 2.96 1.30 - 6.58 35 11.07 7.63 - 15.80 246 85.97 80.70 - 89.97 One 25 5.30 3.15 - 8.80 42 10.33 6.94 - 15.10 397 84.37 79.09 - 88.51 Two 48 9.53 6.49 - 13.79 43 9.93 6.79 - 14.30 324 80.54 75.07 - 85.05 Three or More 74 11.16 8.37 - 14.72 81 16.26 12.36 - 21.09 417 72.58 67.33 - 77.27 a Not available if the unweighted sample size for the denominator is less than 50 b Estimates with 95% Confidence Intervals greater than 20 are unreliable Geo rgia Depa rtmen t of Pu blic H ea lth / 29 TABLE 4. Percentage of Adults with PCI Who Had Given Up On Household Activities/Chores, Georgia BRFSS, 2011-2013, 2015 SOMETIMES, USUALLY, ALWAYS N % 95% CI General Sample 701 37.51 34.53 - 40.59 BY AGE GROUP (YEARS) 45 - 54 198 45.23 39.09 - 51.51 55 - 64 255 40.25 35.19 - 45.51 65 - 74 137 29.23 23.78 - 35.34 75+ 111 25.47 20.53 - 31.13 By Sex Male 249 39.12 34.28 - 44.19 Female 452 36.14 32.54 - 39.90 By Race Non-Hispanic White 426 33.34 29.94 - 36.64 Non-Hispanic Black 202 45.50 39.26 - 51.89 Hispanic a a Not available if the unweighted sample size for the denominator is less than 50 b Estimates with 95% Confidence Intervals greater than 20 are unreliable N 1345 260 397 342 346 473 872 1003 256 RARELY, NEVER % 95% CI 62.49 59.41 - 65.47 54.77 59.75 70.77 74.53 48.49 - 60.91 54.49 - 64.81b 64.66 - 76.22 68.87 - 79.47 60.88 63.86 55.81 - 65.72 60.10 - 67.46 66.66 54.50 63.08 - 70.06 48.11 - 60.74 30 / GA R D R E P O RT / G e orgi a 20 16 REFERENCES 1. 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