DHA 731 Week 5 Projecting Population Health Needs Example

Planning for 2040: Projecting Dementia and Diabetes Needs in Four Aging Rural North Carolina Counties

[Student Name]

University of Phoenix

DHA/731: Population Health and Epidemiology

Week 5 Assignment

[Instructor Name]

[Date]

The health network, its planning team, local population projections and service estimates are composites written for a model paper. The current diabetes count comes from real CDC PLACES 2025 tract estimates; national projections and research findings come from the sources cited.

The board of one of the region's rural hospitals was considering converting an underused inpatient wing into a memory care unit. A trustee asked whether there would be enough patients in fifteen years to justify the investment, and whether diabetes, already common, would grow as well. The vice president gave the planning team a deadline of six weeks to produce projections to 2040 for the four counties the hospitals serve. This paper presents those projections and their implications.

The National Picture

The United States is aging quickly. Census Bureau projections show adults 65 and older outnumbering children under 18 by 2034 for the first time in the nation's history, and about one in four Americans being 65 or older by 2060 (Vespa et al., 2020). Aging will drive growth in chronic conditions and dementia even if age-specific rates stay the same. This distinction matters for planning: a condition can become more common in a population simply because more people reach the ages at which it occurs, without any change in the risk faced by a person of a given age.

The Local Picture

Rural counties age faster than the nation. The four counties, home to about 100,000 people, are expected by the state's demographic projections to lose population by 2040 while the share of residents 65 and older rises from about 22% to about 26%. The number of older adults would grow from about 22,000 to about 25,000, even as the total population falls, and the number of residents 85 and older would grow faster still. Younger adults continue to leave for jobs in larger cities, while retirees stay and some return. The working-age population that provides caregiving, both paid and family, is projected to shrink, which will make each case of dementia harder to support at home.

Projecting Dementia: The Rates

National prevalence estimates provide the starting point. Rajan and colleagues estimated that in 2020 the census-adjusted prevalence of clinical Alzheimer's disease among adults 65 and older was 11.3%, with 10.0% among non-Hispanic White, 14.0% among Hispanic and 18.6% among non-Hispanic Black adults, and projected that the number of Americans with clinical Alzheimer's disease would rise from 6.07 million in 2020 to 13.85 million in 2060 (Rajan et al., 2021).

Adjusting for the Local Population

National averages do not fit these counties, whose populations differ from the nation in age and race. About half or more of their older residents are Black, a group with higher prevalence in the national estimates. Applying race-specific rates to the local older population gives a combined prevalence of about 14.7%, higher than the national figure.

Projecting Dementia: The Numbers

Applying 14.7% to about 22,000 older adults gives roughly 3,200 people with clinical Alzheimer's disease today. Applying it to 25,000 in 2040 gives about 3,700, and because the oldest group, which has the highest prevalence, will grow fastest, the team's middle estimate is about 4,000, a rise of about 25%. Including other dementias would raise both figures. Mild cognitive impairment, which Rajan and colleagues also estimated, affects even more older adults and often precedes dementia, so primary care will see a larger group of patients needing cognitive assessment and follow-up. The counties will have fewer people in 2040, but more of them will need memory care.

Projecting Diabetes: The Starting Point

Diabetes begins from a high base. Current tract estimates indicate about 16,600 adults with diagnosed diabetes in the four counties, about 19.4% of adults (Centers for Disease Control and Prevention, 2025).

Projecting Diabetes: Scenarios

National modeling shows the range of possible futures. Boyle and colleagues projected that diagnosed diabetes incidence would rise from about 8 to 15 new cases per 1,000 adults a year by 2050 and that total prevalence, diagnosed and undiagnosed, would rise from 14% in 2010 to between 21% and 33% by 2050, depending on incidence and mortality, with a middle scenario of 25% to 28%; increases were attributed largely to aging, growth in higher-risk groups and longer survival (Boyle et al., 2010).

Diabetes Scenarios for the Region

Applying the direction of those scenarios to the region's shrinking adult population gives three estimates for 2040. In a low scenario, with successful prevention and stable prevalence, diagnosed cases would stay near 16,000 as the population falls. In a middle scenario, prevalence would rise to about 22%, or about 18,500 adults. In a high scenario, prevalence would reach about 25%, or about 21,000 adults.

Translating Cases Into Service Needs: Dementia

About 4,000 people with Alzheimer's disease in 2040 would need primary care visits for cognitive care, caregiver support and, for a share with advanced disease, residential care. If about 15% need memory care beds, as the team assumed from current use, the counties would need about 600 beds, far more than the 180 now available, most of them in nursing homes outside the area.

Translating Cases Into Service Needs: Diabetes

In the middle scenario, 18,500 adults with diabetes would need about 37,000 primary care visits a year, at two visits each, and about 1,900 more diabetes education contacts than today. Complications such as kidney failure would rise, increasing demand for dialysis in counties that already send patients long distances three times a week.

Assumptions and Limits

The projections assume that age- and race-specific rates stay constant for dementia, that national diabetes trends apply locally and that migration follows recent patterns. Each assumption could be wrong. New treatments, prevention programs or economic change could alter the numbers. Dementia rates by age have declined in some studies of recent cohorts, possibly because of better education and blood pressure control, which would lower the projection. Diagnosed diabetes could rise simply because screening finds more cases. The local population figures come from state projections, which are themselves uncertain for small counties.

Recommendations

The vice president recommended proceeding with a smaller memory care unit of 24 beds, expandable to 36, combined with a caregiver support program and dementia training for primary care teams. Most people with dementia will continue to live at home, so support for family caregivers will reach far more people than any unit. For diabetes, the region should expand prevention programs now, since the difference between low and high scenarios is about 5,000 adults.

Updating the Projections

The team will update the projections every two years with new census estimates, PLACES releases and local data on memory care use and diabetes registries. The memory care unit's expansion to 36 beds will be triggered only if the unit stays above 90% occupancy for a year, tying investment to observed demand rather than projections alone.

Conclusion

The four counties will shrink but age, and dementia cases are projected to rise about 25% by 2040. Diabetes could remain level or rise by several thousand cases, depending on prevention. Adjusting national rates for the local population and presenting ranges give the board a sound basis for a modest memory care investment and stronger prevention now.

References

Boyle, J. P., Thompson, T. J., Gregg, E. W., Barker, L. E., & Williamson, D. F. (2010). Projection of the year 2050 burden of diabetes in the US adult population: Dynamic modeling of incidence, mortality, and prediabetes prevalence. Population Health Metrics, 8, Article 29. https://doi.org/10.1186/1478-7954-8-29

Centers for Disease Control and Prevention. (2025). PLACES: Local data for better health, census tract data, 2025 release [Data set]. data.cdc.gov. https://data.cdc.gov/d/cwsq-ngmh

Rajan, K. B., Weuve, J., Barnes, L. L., McAninch, E. A., Wilson, R. S., & Evans, D. A. (2021). Population estimate of people with clinical Alzheimer's disease and mild cognitive impairment in the United States (2020-2060). Alzheimer's & Dementia, 17(12), 1966-1975. https://doi.org/10.1002/alz.12362

Vespa, J., Medina, L., & Armstrong, D. M. (2020). Demographic turning points for the United States: Population projections for 2020 to 2060 (Current Population Reports P25-1144). U.S. Census Bureau. https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1144.pdf