Background: Data on the rate of dementia is essential for planning and developing appropriate services at the national level. Objective: We report the prevalence and incidence of dementia, based on electronic health records available for the whole population. Methods: This national dementia dataset was established as a part of the National Program to Address Alzheimer’s and Other Types of Dementia. Data from medical health records for all persons aged 45+ in Israel, for 2016, were extracted from the databases of the four health maintenance organizations. Dementia cases were identified based on either recorded dementia diagnosis, through International Classification of Diseases (ICD-9 and ICD-10) or dispensation of anti-dementia drugs. The date of first diagnosis was determined by the earliest recording. Results: A total of 65,951 persons with dementia, aged 45+, were identified from electronic health data. Based on both ICD codes and anti-dementia drugs, the prevalence rates of dementia among individuals aged 45+ and 65+ in 2016 were 2.5%and 6.4%, respectively, and the incidence rates were 0.49%and 1.3%, respectively. Based on ICD codes alone, the prevalence rates of dementia among individuals aged 45+ and 65+ in 2016 were 2.1%and 5.4%respectively, and the incidence rates were 0.36%and 0.96%respectively. The rates were higher among females compared to males and paradoxically lower in lower socioeconomic status compared to higher statuses. Conclusion: This data collection reflects the present access of dementia patients to medical care resources and provides the basis for service planning and future dementia policies.

The National Program to Address Alzheimer's Disease and other Dementias in Israel has been led by the Ministry of Health, Division of Geriatrics and its partners, since 2013. Among these partners are the four health funds which provide medical services, as stipulated by law, to all citizens and permanent residents of Israel including medications, and primary and specialist care. In order to plan services, national data were needed on people with dementia including prevalence, demographic and health characteristics and service use. The Geriatric Division and the Israel Center for Disease Control collaborated with the four health funds to develop a national dementia survey using electronic medical record databases. Dementia case definition was based on a dementia diagnosis or the purchase of dementia medications. The population base was all people insured by the health funds aged 45 and over at the end of 2016. The prevalence of dementia was 6.6% for people 65 and over (1.5% in 65-74, 8% in 75-84, 25% in 85+). The prevalence of dementia over age 60 standardized to the population of western Europe (6.8%) and the USA (5.7%) was lower in Israel at 4.9%. Of identified dementia cases, 36% were identified by diagnosis only, 19% by purchasing dementia medications, and 45% by both criteria, and 64% overall received dementia medications. Of identified dementia diagnoses, 57.2% were Alzheimer's, 7.5% were vascular, 20.8% were non-specific and 14.6% were other. People with a lower socioeconomic status were underrepresented in the survey compared to the national average (8.3% vs 16%) and were less likely to purchase dementia medications. This national dementia survey, including all citizens and permanent residents of Israel, demonstrated a lower standardized prevalence of dementia than many other Western countries. Possible reasons might be under-diagnosis, lack of public and professional awareness, and diagnoses being made in the private rather than public system without information transfer. Future plans are to explore health services use by cross referencing encrypted personal identifiers with other national databases. This survey will provide the basis for a national dementia database that will help shape future policy for dementia.

In 2013, Israel developed and adopted a National Strategic Plan to Address Alzheimer's and Other Types of Dementia based on the work of a multidisciplinary group of experts from the Ministries of Health, Social Affairs, Senior Citizens, and the National Insurance Institute. In addition professional societies, the Israel Alzheimer's Association (EMDA), public foundations, the health funds, and non-governmental agencies, as well as members of academia were represented. The plan has 7 objectives: raising professional and public awareness of dementia, developing health services targeting people with dementia, developing social services, family and caregiver support, improving long term care institutional services, professional training, and research. The Ministry of Health is leading the Strategic Plan through an implementation committee including representatives of all stakeholders. Major initiatives and accomplishments to date include Three media campaigns that have increased public and professional awareness of dementia A “Dementia Friends” program in partnership with local municipalities and EMDA also to increase public awareness Financial support to the health funds to develop programs of primary care team training, and case management for people with dementia. Competitive financial support for acute and chronic care hospitals to develop programs that train professional staff; and identify, treat and discharge people with dementia using innovative care pathways. A national dementia registry is being built in cooperation with the health funds to provide a tool for policy development, planning, and research. Caregiver support and education have been a major focus with funding provided for different models of group and individual programs. The Israel National Strategic Plan to Address Alzheimer's and Other Types of Dementia has led to cooperation between governmental ministries and across public and private agencies. The major initiatives described have resulted in an increased awareness of dementia, not only among professionals and the public, but also among policy makers. Our goal is to continue to promote care for people with dementia and their families as a public health priority.

The ageing population phenomenon is pushing the design of innovative solutions to provide assistance to the elderly. In this context a socially–assistive robot can act as a proactive interface in a smart-home environment, providing multimodal communication channels and generating positive feelings in users. The present paper reports results of a short term and a long term evaluation of a small socially assistive humanoid robot in a smart home environment. Eight elderly people tested an integrated smart–home robot system in five real–world scenarios. Six of the participants experienced the system in two sessions over a two week period; the other two participants had a prolonged experience of eight sessions over a three month period. Results showed that the small humanoid robot was trusted by the participants. A cross–cultural comparison showed that results were not due to the cultural background of the participants. The long term evaluation showed that the participants might engage in an emotional relationship with the robot, but that perceived enjoyment might decrease over time.

OBJECTIVES:To determine whether a designation of frailty using the Adjusted Clinical Groups-diagnoses based computerized predictive model (ACG Dx-PM) can identify an elderly population who (1) have the clinical characteristics of frailty and (2) are frail as determined by the validated Vulnerable Elders Survey (VES), and to determine the ability of these tools to predict adverse outcomes.STUDY DESIGN:Secondary analysis of administrative and survey data.METHODS:Participants over age 65 years (n = 195) in an outpatient comprehensive geriatric assessment study at an Israeli health maintenance organization (HMO) were screened for frailty using the ACG Dx-PM and VES. Administrative and demographic data were also gathered.RESULTS:Compared with ACG nonfrail patients, ACG frail patients were older and less likely to be married; had a higher rate of falls, incontinence, and need for personal care; and had a poorer quality of life consistent with a clinical picture of frailty. The ACG frailty tag identified a frail population using the VES frailty determination as the accepted standard with moderate success (area under the curve 0.62). Adjusting for sex and functional status in backward logistic regression, the ACG frailty tag predicted hospitalizations (P <.032) and the VES frailty tool predicted emergency department visits (P <.016).CONCLUSIONS:The ACG frailty tag identified an elderly population with clinical characteristics of frailty and performed with moderate success compared with the VES. Both tools predicted adverse outcomes in older HMO members. A combined screening approach for frailty using predictive modeling with a function-based survey deserves further study.

To assess factors that affect the adoption of healthy lifestyles among a variety of active Israeli seniors, a survey was conducted in 2002 at the Peiluyada, a physical activity-oriented health fair for seniors held annually in Israel from 1995 to 2002. A multi-language, self-administered questionnaire, assessing predisposing factors, barriers and health-protective behaviors, was fielded to potential participants. Response rate at the event was 51%. Hebrew and Arabic speakers generally characterized their health as good to very good, while Russian speakers’ health was rated only poor to fair. Over 80% engaged in regular physical activity, were satisfied with their diet, and conformed to international nutritional recommendations. Vaccination coverage against influenza (81%) and pneumocccocus (58%) was highest among Arabic speakers, and lowest among Russian speakers (33.5% and 12%, respectively). Higher age (≥75 years) was significantly associated with receiving a vaccination against influenza. Major barriers to exercise included low motivation and poor physical health or disability. Health-related dietary restrictions were the leading nutritional barrier. Prominent barriers to vaccination included concerns about vaccine effectiveness (39%) and side effects (29%). Leading cues to action were a recommendation from one's doctor (67%) and from a healthcare worker (51%).

BACKGROUND:Bisphosphonates are effective in the prevention and treatment of osteoporosis, yet their use is suboptimal. OBJECTIVES:To measure bisphosphonate compliance among first-time users and identify factors associated with compliance. METHODS:We conducted a prospective follow-up of all women aged 45+ in the second largest health management organization in Israel who were prescribed bisphosphonates for the first time. The 4448 women were classified by drug dosage. Persistence and adherence measures of compliance were calculated for each woman over a 1 year period. RESULTS:Mean bisphosphonate persistence over a year was 216 days, with a mean medication possession ratio of 66%. Women whose medication was changed, whether from weekly to daily or daily to weekly, always had better persistence rates than those who consistently took the original dose. Persistence rates were as follows: 264 days for women who switched back and forth between daily and weekly doses, 229 days for those who switched from daily to weekly, 222 days for those who took the dosage weekly only, 191 days for those who switched to daily dosage, and 167 days for those who took the dosage daily only (P < 0.001). Switchers were also more likely to have adequate adherence rates (MPR > or = 80%): 81.3%, 76.6%, 67.5%, 61.3% and 52.2% respectively (P < 0.001). More than 20% of women stopped taking their medication within the first month. Women with higher supplemental insurance (offering significant discounts for weekly dose medications) had better persistence rates: 221 vs. 208 days (P = 0.03). Younger women and women on national pension insurance had the lowest persistence rates: 204 and 209 days respectively. CONCLUSIONS:While weekly bisphosphonate takers had better compliance rates, persistence and adherence rates were inadequate for all groups. Changing medication to meet the needs of the patient, discounting weekly medications, and providing follow-up within the first months of prescription may promote compliance.