dr. wierman? dr. wierman: good afternoon. chairman collins, ranking member mccaskill and the distinguished members of the senate, special committee on aging. i am very appreciative of this opportunity to be here with you. i specialize in treating those with dementia and working with their caregivers. am a geriatric physician in maine with roots in oregon. clinically my work is in dementia. i evaluate individuals and work with their family at our outpatient geriatric center. i spend time in the hospital working with older adults who are hospitalized. i work the prevent delirium which is particularly devastating. it changes the trajectory of dementia that in a negative fashion. dementia really is a looming crisis for our state and the nation. maine has the oldest median age, nearly six years older than the average median age in the united states, which means we have fewer working age individuals to help care for our older adults particularly those with dementia as their disease progresses. projections for maine are that the 65

dr. wierman. dr. wierman: good afternoon, chairman collins, ranking member mccaskill and the distinguished members of the special committee on aging. i'm pleased to be here to give you my thoughts on working with people with dementia and their care givers. i'm a geriatrician in maine and clinically my work is focused on dementia. i evaluate individuals and work with their families at our outpatient geriatric center and i work with the hospital working to prevent complications for older adults that are hospitalized as the medical director for the hospital i work to prevent delirium. it changes the trajectory of their dementia in a negative fashion. dementia really is a looming crisis for our state and the nation. maine has the oldest median age, nearly six years older than the average median age in the united states, which means we have fewer working age individuals to help care for our older adults and particularly those with dementia as their disease progresses. projections for maine are that the 65 a

dr. wierman? dr. wierman: good afternoon. chairman collins, ranking member mccaskill and the distinguished members of the senate, special committee on aging. i am very appreciative of this i opportunity to be here with you. i specialize in treating those with dementia and working with their caregivers. am a geriatric physician in maine with roots in oregon. clinically my work is in dementia. i evaluate individuals and work with their family at our outpatient geriatric center. i spend time in the hospital working with older adults who are hospitalized. i work the prevent delirium which is particularly devastating. it changes the trajectory of demeant that in a negative fashion. dementia really is a looming crisis for our state and the nation. maine has the oldest median age, nearly six years older than the average median age in the united states, which means we have fewer working age individuals to help care for our older adults particularly those with dementia as their disease progresses. projections for maine are that the 65

dr. wierman. i was surprised to learn from your testimony that the diagnosis and treatment of patients with dementia is not a routine part of the clinical training for most health care providers. if you look at the trajectory of alzheimer's and other dementias and the number of people and their families that are going to be affected in the near term -- we hope we'll have a cure, a means of prevention or effective treatments for the long term -- that really -- that lack of training really surprises me. is that changing now, in your judgment? and why do you think there isn't more emphasis put on that training? heidi: there has been a lot more emphasis in the last few years as far as setting milestones for medical education all the way up through residency training. so i think we've made some headway in the medical community. i think it's incredibly variable when people go to different programs what they get. most individuals will get training in older adults but not specifically in cognitive impairm

dr. wierman. dr. weirman mentioned that you look at delirium as well. i am wondering if there is research that shows that do. in older people after surgery where a general anesthetic has been involved which i have seen cases of can be a trigger. i see dr. haut is nodding also so maybe i will start with them. is there a link? can that be a trigger about summers? -- cannot be a trigger for alzheimer's? is there a link when you see something in older people after an operation that involves a general anesthetic and dementia? dr. hodes: good point. the room can be succeeded or followed by decreasing the cognitive function and so also for general anesthesia, even if there is not delirium so that is after general anesthetics, there can be a short-term decline. most people recover fine, but the recovering quickly is also predicted of long-term. both of these insoles, whatever that means to the brain as a result of deep anesthesia or delirium, do seem to be capable of a celebrating that functional decline -- of accelerating the functional decline. madam chairman

dr. wierman: i'm pleased to be here to give you my thoughts on working with people with dementia and theire givers. i'm a geriatrician in maine and clinically my work is focused on demen shasm i evaluate individuals and work with their families at our outpatient geriatric center and i work with the hospital working to prevent complications for older adults that are hospitalized as the medical director for the hospital i work to prevent delirium. it changes the trajectory of their dementia in a negative fashion. dementia really is a looming crisis for our state and the nation. maine has the oldest median age, nearly six years older than the average median age in the united states, which means we have fewer working age individuals to help care for our older adults and particularly those with dementia as their disease progresses. projections for maine are that the 65 and older population is the only population that's going to grow in the next 10 years. our total population will remain flat at about 1.3 million, but we currently have about 37,000 individuals diagnosed with dementia and it's pr