Wellness Wednesday: Living with Alzheimer’s Disease

Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear in their mid-60s.

Senior woman with prescription medicine

The number of Americans living with Alzheimer’s disease is growing—and growing fast. Estimates vary, but experts suggest that more than 5.5 million Americans of all ages have Alzheimer’s disease.

Alzheimer’s disease is currently ranked as the sixth-leading cause of death in the United States. It is the fifth-leading cause of death among those age 65 and older and a leading cause of disability and poor health. As the U.S. population ages, Alzheimer’s is becoming a more common cause of death. It is the only top 10 cause of death that cannot be prevented, cured or even slowed.

Between 2000 and 2014, deaths from Alzheimer’s disease as recorded on death certificates increased 89 percent, while deaths from the number one cause of death (heart disease) decreased 14 percent.


Today, someone in the U.S. develops Alzheimer’s every 66 seconds. By mid-century, that is poised to become one every 33 seconds.


Alzheimer’s is the most common cause of dementia among older adults.

Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities to such an extent that it interferes with a person’s daily life and activities.

Dementia is not a specific disease. It’s an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities. Alzheimer’s disease accounts for 60 to 80 percent of cases. Vascular dementia, which occurs after a stroke, is the second most common dementia type.

Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living.

10warningsigns-2Alzheimer’s Symptoms

Just like the rest of our bodies, our brains change as we age. Most of us eventually notice some slowed thinking and occasional problems with remembering certain things. However, serious memory loss, confusion and other major changes in the way our minds work may be a sign that brain cells are failing.

The most common early symptom of Alzheimer’s is difficulty remembering newly learned information.

Alzheimer’s changes typically begin in the part of the brain that affects learning. As Alzheimer’s advances through the brain it leads to increasingly severe symptoms, including disorientation, mood and behavior changes; deepening confusion about events, time and place; unfounded suspicions about family, friends and professional caregivers; more serious memory loss and behavior changes; and difficulty speaking, swallowing and walking.

People with memory loss or other possible signs of Alzheimer’s may find it hard to recognize they have a problem. Signs of dementia may be more obvious to family members or friends. Anyone experiencing dementia-like symptoms should see a doctor as soon as possible.

People with memory and thinking concerns should talk to their doctor to find out whether their symptoms are due to Alzheimer’s or another cause, such as stroke, tumor, Parkinson’s disease, sleep disturbances, side effects of medication, an infection, or a non-Alzheimer’s dementia. Some of these conditions may be treatable and possibly reversible.

Prevalence

An estimated 5.5 million Americans of all ages have Alzheimer’s disease.

alz-risks

  • Of the estimated 5.5 million Americans living with Alzheimer’s dementia in 2017, an estimated 5.3 million are age 65 and older and approximately 200,000 individuals are under age 65 and have younger-onset Alzheimer’s.
  • Almost two-thirds of Americans with Alzheimer’s are women.

The number of Americans with Alzheimer’s disease and other dementias will grow each year as the size and proportion of the U.S. population age 65 and older continue to increase. By 2050, the number of Americans living with Alzheimer’s disease may reach 16 million, barring the development of medical breakthroughs to prevent or cure the disease.

In 2017, an estimated 700,000 people in the U.S. age 65 and older will die with Alzheimer’s.

As the population of the U.S. ages, Alzheimer’s is becoming a more common cause of death. Although deaths from other major causes have decreased significantly, official records indicate that deaths from Alzheimer’s disease have increased significantly. Between 2000 and 2013, deaths attributed to Alzheimer’s disease increased 71 percent.

Cost of Alzheimer’s

Let me help you out of the carIn 2016, 15.9 million family and friends provided 18.2 billion hours of unpaid assistance to those with Alzheimer’s and other dementias, a contribution to the nation valued at $230.1 billion.

  • Approximately two-thirds of caregivers are women, and 34 percent are age 65 or older.
  • 41 percent of caregivers have a household income of $50,000 or less.
  • Approximately one quarter of dementia caregivers are “sandwich generation” caregivers—meaning that they care not only for an aging parent, but also for children under age 18.

Alzheimer’s takes a devastating toll on caregivers. Nearly 60 percent of Alzheimer’s and dementia caregivers rate the emotional stress of caregiving as high or very high; about 40 percent suffer from depression.

Alzheimer’s disease is one of the costliest chronic diseases to society.

  • Total payments in 2017 for all individuals with Alzheimer’s or other dementias are estimated at $259 billion.
  • Average per-person Medicare spending for people age 65 or older with Alzheimer’s and other dementias is three times higher than for seniors without dementia.
  • Total annual payments for health care, long-term care and hospice care for people with Alzheimer’s or other dementias are projected to increase from $259 billion in 2017 to more than $1.1 trillion in 2050.

Sources:
NIH National Institute on Aging
Alzheimer’s Association


More Information:

Alzheimer’s Association Fact Sheet

Alzheimer’s Association Pennsylvania Statistics

NIH Institute on Aging Alzheimer’s Fact Sheet

NIH Alzheimers Disease Basics

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Wellness Wednesday: Living Well as You Age

May is Older Americans Month. People in the U.S. are living longer than ever before. Many older adults live active and healthy lives. But there’s no getting around one thing: as we age, our bodies and minds change.

Logos2Though there are things you can do to stay healthy and active as you age, it is important to understand what to expect. Some changes may just be part of normal aging, while others may be a warning sign of a medical problem. It is important to know the difference, and to let your healthcare provider know if you have any concerns.

As you age, your heart rate becomes slightly slower, and your heart might become bigger. Your blood vessels and your arteries also become stiffer, causing your heart to work harder to pump blood through them. This can lead to high blood pressure and other cardiovascular problems.

Two senior women having fun painting in art classEngaging in social and productive activities you enjoy, like taking an art class or becoming a volunteer in your community or at your place of worship, may help to maintain your well-being.

Research tells us that older people with an active lifestyle:

  • Are less likely to develop certain diseases. Participating in hobbies and other social and leisure pursuits may lower risk for developing some health problems, including dementia.
  • Are more happy and less depressed. Studies suggest that older adults who participate in what they believe are meaningful activities, like volunteering in their communities, say they feel happier and more healthy.
  • Are better prepared to cope with loss. Studies suggest that volunteering can help with stress and depression from the death of a spouse. Among people who experienced a loss, those who took part in volunteer activities felt more positive about their own abilities.
  • May be able to improve their thinking abilities. Another line of research is exploring how participating in creative arts might help people age well. Other studies are providing new information about ways that creative activities like music or dance can help older adults.

For more information about healthy aging, visit these websites:

http://nihseniorhealth.gov/category/healthyaging.html
https://go4life.nia.nih.gov/
https://www.choosemyplate.gov/older-adults
https://www.ncoa.org/healthy-aging/
https://www.cdc.gov/aging/index.html
https://www.nlm.nih.gov/medlineplus/seniorshealth.html

Sources: Mayo Clinic and the National Institutes of Health and the Administration on Aging

Wellness Wednesday: Fighting Alzheimer’s Disease

One in nine people age 65 and older has Alzheimer’s disease. And almost two-thirds of them are women. It is estimated that a total of 5.4 million Americans are living with Alzheimer’s disease today.

Home healthcare nurse giving medications to senior adult woman.These numbers are predicted to escalate rapidly as the baby boom generation reaches age 65 and beyond. By 2050, the number of people age 65 and older with Alzheimer’s disease may nearly triple, from 5.2 million to a projected 13.8 million, barring the development of medical breakthroughs to prevent or cure the disease. Previous estimates based on high range projections of population growth provided by the U.S. Census suggest that this number may be as high as 16 million.

What is Alzheimer’s?

Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear in their mid-60s.

Alzheimer’s disease is currently ranked as the sixth leading cause of death in the U.S., but recent estimates indicate that the disorder may rank third, just behind heart disease and cancer, as a cause of death for older people.

Alzheimer’s is the most common cause of dementia among older adults.

What is Dementia?

Dementia is the loss of cognitive functioning—thinking, remembering and reasoning—and behavioral abilities to such an extent that it interferes with a person’s daily life and activities.

Dementia is not a specific disease. It’s an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities. Alzheimer’s disease accounts for 60 to 80 percent of cases. Vascular dementia, which occurs after a stroke, is the second most common dementia type.

Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living.

Alzheimer’s Symptoms

Just like the rest of our bodies, our brains change as we age. Most of us eventually notice some slowed thinking and occasional problems with remembering certain things. However, serious memory loss, confusion and other major changes in the way our minds work may be a sign that brain cells are failing.

The most common early symptom of Alzheimer’s is difficulty remembering newly learned information.

Alzheimer’s changes typically begin in the part of the brain that affects learning. As Alzheimer’s advances through the brain it leads to increasingly severe symptoms, including disorientation, mood and behavior changes; deepening confusion about events, time and place; unfounded suspicions about family, friends and professional caregivers; more serious memory loss and behavior changes; and difficulty speaking, swallowing and walking.

People with memory loss or other possible signs of Alzheimer’s may find it hard to recognize they have a problem. Signs of dementia may be more obvious to family members or friends. Anyone experiencing dementia-like symptoms should see a doctor as soon as possible.

People with memory and thinking concerns should talk to their doctor to find out whether their symptoms are due to Alzheimer’s or another cause, such as stroke, tumor, Parkinson’s disease, sleep disturbances, side effects of medication, an infection, or a non-Alzheimer’s dementia. Some of these conditions may be treatable and possibly reversible.

Prevalence

An estimated 5.4 million Americans of all ages have Alzheimer’s disease in 2016.

  • alz-risksAn estimated 5.2 million are age 65 and older, and approximately 200,000 individuals are under age 65 (younger-onset Alzheimer’s).
  • Almost two-thirds of Americans with Alzheimer’s are women. Of the 5.4 million people age 65 and older with Alzheimer’s in the U.S., 3.3 million are women and 1.9 million are men.

The number of Americans with Alzheimer’s disease and other dementias grow each year as the size and proportion of the U.S. population age 65 and older continue to increase. By 2050, the number of people age 65 and older with Alzheimer’s disease may nearly triple, from 5.2 million to a projected 13.8 million, barring the development of medical breakthroughs to prevent or cure the disease.

61 percent of those with Alzheimer’s are expected to die before age 80 compared with 30 percent of those without Alzheimer’s.

As the population of the U.S. ages, Alzheimer’s is becoming a more common cause of death. Although deaths from other major causes have decreased significantly, official records indicate that deaths from Alzheimer’s disease have increased significantly. Between 2000 and 2013, deaths attributed to Alzheimer’s disease increased 71 percent.


Alzheimer’s is the only disease among the top 10 causes of death in America that cannot be prevented, cured or even slowed.


Cost of Alzheimer’s

In 2015, caregivers of people with Alzheimer’s and other dementias provided an estimated 18.1 billion hours of unpaid assistance, a contribution to the nation valued at $221.3 billion.

  • About one in three caregivers is age 65 or older.
  • Approximately two-thirds of caregivers are women. More specifically, over one-third of dementia caregivers are daughters.
  • Forty-one percent of caregivers have a household income of $50,000 or less.
  • Over half of primary caregivers of people with dementia take care of parents.
  • It is estimated that 250,000 children and young adults between ages 8 and 18 provide help to someone with Alzheimer’s disease or another dementia.

Alzheimer’s takes a devastating toll on caregivers. Nearly 60 percent of Alzheimer’s and dementia caregivers rate the emotional stress of caregiving as high or very high; about 40 percent suffer from depression. The physical and emotional impact of dementia caregiving is estimated to have resulted in $10.2 billion in health care costs in the United States in 2015.

Alzheimer’s disease is one of the costliest chronic diseases to society.

  • Total payments for health care, long-term care and hospice are estimated to be $236 billion in 2016 for people with Alzheimer’s disease and other dementias.
  • Medicare and Medicaid are expected to cover only 68 percent of the total health care and long-term care payments for people with Alzheimer’s disease and other dementias.
  • Nearly one in every five Medicare dollars is spent on people with Alzheimer’s and other dementias. In 2050, it will be one in every three dollars.

Unless something is done, in 2050, Alzheimer’s is projected to cost over $1.1 trillion (in 2016 dollars).

Sources: NIH National Institute on Aging, Alzheimer’s Association


More Information:

Alzheimer’s Association

Alzheimers Warning Signs

Alzheimer’s Disease Facts & Figures Infographic

2016 Alzheimer’s Disease Facts and Figures

NIH Alzheimer’s Fact Sheet

Wellness Wednesday: Alzheimer’s and Brain Awareness Month

iStock_000069596201_FullWe’ve all forgotten something at one time or another. Where did I put my keys? What did I need to get at the store? Did I remember to lock the door? Why did I come into this room?

For most of us, the fast pace of life and how quick thoughts might go in and out of our heads is the likely culprit. If we slow down and try to remember the last time we had our keys, or retrace our steps from the room back to where we were, we can usually jog our memory (most of the time).

As we age, we find that some of these moments happen with a little more frequency. But what happens when it’s not just a routine bout of forgetfulness? And how can you tell if it’s something more serious?

Dementia vs. Alzheimer’s Disease

Many of us probably know someone who has/had Alzheimer’s disease or who has been a caregiver for someone with Alzheimer’s disease. We’ve all heard the term. Most of us know that it is generally an older person who has trouble with short-term memory loss.

But what really is Alzheimer’s? Is it the same as dementia?

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. It is an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities. Memory loss is one symptom of dementia.

There are several different types of dementia. Each can be caused by different factors, such as stroke or thyroid issues. So, it is important to visit an expert to be sure you’re following the best treatment pathway.

The most common type of dementia is Alzheimer’s disease, accounting for 60-80% of all dementia cases. However, the following conditions can also cause dementia: Parkinson’s diseaseCreutzfeldt-Jakob disease, Huntington’s disease and Wernicke-Korsakoff Syndrome. Vascular dementia can also be brought on after suffering a stroke.

Symptoms of Alzheimer’s Disease

Alz-risksAlzheimer’s disease is a slow, progressive brain disease that currently has no cure. It can be treated with medications which may temporarily slow the worsening of symptoms for some.

The most common and obvious symptoms of Alzheimer’s is difficulty remembering newly learned information, such as recent conversations, names or events; apathy and depression are also often early symptoms. Later symptoms include impaired communication, poor judgment, disorientation, confusion, behavior changes and difficulty speaking, swallowing and walking.

For many loved ones, the behavior caused by Alzheimer’s is the most challenging and distressing effect of the disease. Persons with Alzheimer’s have been known to ‘wander’ out of the house at all times of the day or night. They become confused or agitated easily and are more prone to outbursts. They may experience restlessness, and  you might find that their behavior becomes more repetitive, with them pacing and/or shredding paper or napkins with their hands. The chief cause of these behavioral symptoms is the progressive deterioration of brain cells.

Stages of Alzheimer’s Disease

10warningsigns-2Alzheimer’s symptoms are separated into stages; early-stage, middle-stage and late-stage. The duration of each stage is different for each individual and can last for years.

Read about each Stage here.

Early-Stage (Mild) Alzheimer’s

Many times, some of the early-stage symptoms go unnoticed, because the individual is still able to function independently. Few difficulties and behaviors may be noticed by some who close to the person, but might be shrugged off as part of normal aging.

Common difficulties include:

  • Problems coming up with the right word or name
  • Trouble remembering names when introduced to new people
  • Having greater difficulty performing tasks in social or work settings
  • Forgetting material that one has just read
  • Losing or misplacing a valuable object
  • Increasing trouble with planning or organizing

Middle-Stage (Moderate) Alzheimer’s

The middle-stage is typically the longest stage and can last for many years. A person with middle-stage Alzheimer’s may begin confusing words and become frustrated, even combatant, and acting in unexpected or inappropriate ways.

At this point, symptoms will be noticeable to others and may include:

  • Forgetfulness of events or about one’s own personal history
  • Feeling moody or withdrawn, especially in socially or mentally challenging situations
  • Confusion about where they are or what day it is
  • The need for help choosing proper clothing for the season or the occasion
  • Trouble controlling bladder and bowels in some individuals
  • An increased risk of wandering and becoming lost
  • Personality and behavioral changes, including compulsive, repetitive behavior like hand-wringing or tissue shredding

Late-Stage (Severe) Alzheimer’s

In late-stage Alzheimer’s, individuals lose the ability to respond to their environment, to carry on a conversation and, eventually, to control movement. They may need extensive help with daily activities, and have trouble communicating needs or pain.

At this stage, individuals may:

  • Require full-time, around-the-clock assistance with daily personal care
  • Lose awareness of recent experiences as well as of their surroundings
  • Require high levels of assistance with daily activities and personal care
  • Experience changes in physical abilities, including the ability to walk, sit and, eventually, swallow
  • Have increasing difficulty communicating
  • Become vulnerable to infections, especially pneumonia

Caregivers and Loved Ones

Often, the responsibilities and decision-making are placed on the closest loved ones. A spouse, who may be dealing with his or her own aging difficulties, and adult children of Alzheimer’s patients are often left to deal with a lot of information, appointments, stress, healthcare decisions and more. Caregivers may feel like they are alone. They may feel guilty for a variety of reasons including asking for help, needing a break, losing their temper or not being able to ‘do it all’.

No one can do it all alone. Caregivers need a strong support system. Caregivers have access to respite care, in-home care, adult day centers and more. There are also support groups for caregivers to get together with people who are in the same situation.

Alzheimers

Advance Directives

One way for caregivers to ensure that they know the wishes of their loved ones is to talk about and complete advance directives before they are thrust into a situation where the person is no longer able to make decisions for themselves. Whether it’s Alzheimer’s, another form of dementia, or any other condition that could potentially leave a person unable to express his/her wishes, having an advance directive, which includes a living will and durable power of attorney (POA) for healthcare is an important part of your medical file.

Without these documents, a loved one will not know what types of treatment or interventions you want. And if you are unmarried, no one is legally able to make those decisions if you have not declared a healthcare POA ahead of time.

What to Do?

If you suspect a loved one has Alzheimer’s disease or another form of dementia, your first step should be to visit his/her family doctor. He or she can direct you to a specialist who will look at the person’s full medical history, conduct tests and determine the best treatment options for your loved one. Complete this checklist and bring it with you to the doctor’s visit.

For additional information and caregiver support information, visit the Alzheimer’s Association website at www.alz.org.

For information about early onset (under 65) Alzheimer’s disease, visit http://www.alz.org/alzheimers_disease_early_onset.asp


Source: Alzheimer’s Association

 

Wellness Wednesday: What is Alzheimer’s?

What is Alzheimer’s?

Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear in their mid-60s. Estimates vary, but experts suggest that more than 5 million Americans may have Alzheimer’s.

Alzheimer’s disease is currently ranked as the sixth leading cause of death in the U.S., but recent estimates indicate that the disorder may rank third, just behind heart disease and cancer, as a cause of death for older people.

Alzheimer’s is the most common cause of dementia among older adults.

Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities to such an extent that it interferes with a person’s daily life and activities.

Dementia is not a specific disease. It’s an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities. Alzheimer’s disease accounts for 60 to 80 percent of cases. Vascular dementia, which occurs after a stroke, is the second most common dementia type.

Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living.

Alzheimer’s Symptoms

10warningsigns-2Just like the rest of our bodies, our brains change as we age. Most of us eventually notice some slowed thinking and occasional problems with remembering certain things. However, serious memory loss, confusion and other major changes in the way our minds work may be a sign that brain cells are failing.

The most common early symptom of Alzheimer’s is difficulty remembering newly learned information.

Alzheimer’s changes typically begin in the part of the brain that affects learning. As Alzheimer’s advances through the brain it leads to increasingly severe symptoms, including disorientation, mood and behavior changes; deepening confusion about events, time and place; unfounded suspicions about family, friends and professional caregivers; more serious memory loss and behavior changes; and difficulty speaking, swallowing and walking.

People with memory loss or other possible signs of Alzheimer’s may find it hard to recognize they have a problem. Signs of dementia may be more obvious to family members or friends. Anyone experiencing dementia-like symptoms should see a doctor as soon as possible.

People with memory and thinking concerns should talk to their doctor to find out whether their symptoms are due to Alzheimer’s or another cause, such as stroke, tumor, Parkinson’s disease, sleep disturbances, side effects of medication, an infection, or a non-Alzheimer’s dementia. Some of these conditions may be treatable and possibly reversible.

Prevalence

An estimated 5.3 million Americans of all ages have Alzheimer’s disease in 2015.

Alz-risks

  • An estimated 5.1 million are age 65 and older, and approximately 200,000 individuals are under age 65 (younger-onset Alzheimer’s).
  • Almost two-thirds of Americans with Alzheimer’s are women. Of the 5.1 million people age 65 and older with Alzheimer’s in the U.S., 3.2 million are women and 1.9 million are men.

The number of Americans with Alzheimer’s disease and other dementias will grow each year as the size and proportion of the U.S. population age 65 and older continue to increase. By 2025, the number of people age 65 and older with Alzheimer’s disease is estimated to reach 7.1 million—a 40 percent increase from 2015. By 2050, the number of people age 65 and older with Alzheimer’s disease may nearly triple, from 5.1 million to a projected 13.8 million, barring the development of medical breakthroughs to prevent or cure the disease.

In 2015, an estimated 700,000 people in the U.S. age 65 and older will die with Alzheimer’s.

As the population of the U.S. ages, Alzheimer’s is becoming a more common cause of death. Although deaths from other major causes have decreased significantly, official records indicate that deaths from Alzheimer’s disease have increased significantly. Between 2000 and 2013, deaths attributed to Alzheimer’s disease increased 71 percent.


Alzheimer’s is the only disease among the top 10 causes of death in America that cannot be prevented, cured or even slowed.


Cost of Alzheimer’s

In 2014, friends and family of people with Alzheimer’s and other dementias provided an estimated 17.9 billion hours of unpaid care.

  • Approximately two-thirds of caregivers are women and 34 percent are age 65 or older.
  • Forty-one percent of caregivers have a household income of $50,000 or less.
  • Over half of primary caregivers of people with dementia take care of parents.
  • It is estimated that 250,000 children and young adults between ages 8 and 18 provide help to someone with Alzheimer’s disease or another dementia.

Alzheimer’s takes a devastating toll on caregivers. Nearly 60 percent of Alzheimer’s and dementia caregivers rate the emotional stress of caregiving as high or very high; about 40 percent suffer from depression. Due to the physical and emotional toll of caregiving, Alzheimer’s and dementia caregivers had $9.7 billion in additional health care costs of their own in 2014.

Alzheimer’s disease is one of the costliest chronic diseases to society.

  • In 2015, the direct costs of caring for those with Alzheimer’s will total an estimated $226 billion, with half of the costs borne by Medicare.
  • Average per-person Medicare spending for people age 65 or older with Alzheimer’s and other dementias is three times higher than for seniors without dementia.
  • Nearly one in every five Medicare dollars is spent on people with Alzheimer’s and other dementias. In 2050, it will be one in every three dollars.

Unless something is done, in 2050, Alzheimer’s is projected to cost over $1.1 trillion (in 2015 dollars).

Sources:
NIH National Institute on Aging
Alzheimer’s Association


More Information:

Alzheimer’s Association Fact Sheet

Alzheimer’s Association Pennsylvania Statistics

NIH Institute on Aging Alzheimer’s Fact Sheet