Projected Number of People Age 65 and Older (Total and by Age) in the U.S. Population with Alzheimer’s Dementia, 2020 to 2060 27 the total number of people with Alzheimer’s or other dementias in the United States and other high-income Western countries is expected to continue to increase dramatically because of the increase in the number of people at the oldest ages. It is unclear whether these encouraging trends will continue into the future given worldwide trends showing increases in diabetes and obesity — potential risk factors for Alzheimer’s dementia — which may lead to a rebound in dementia risk in coming years,107,301,303,321-323 or if these positive trends pertain to all racial and ethnic groups.241,273,300,319-320,324 Thus, while recent findings are promising, the social and economic burden of Alzheimer’s and other dementias will continue to grow. Moreover, 68% of the projected increase in the global prevalence and burden of dementia by 2050 will take place in low- and middle-income countries, where there is currently no evidence that the risk of Alzheimer’s and other dementias has been declining.325 Looking to the Future: Aging of the Baby-Boom Generation A large segment of the American population — the babyboom generation — has started reaching age 65 and older, when the risk for Alzheimer’s and other dementias is elevated. By 2030, the segment of the U.S. population age 65 and older will have grown substantially, and the projected 74 million older Americans will make up over 20% of the total population (up from 17% in 2021).213,326 As the number of older Americans grows rapidly, so too will the numbers of new and existing cases of Alzheimer’s dementia, as shown in Figure 5.A5,72 • By 2025, the number of people age 65 and older with Alzheimer’s dementia is projected to reach 7.2 million — a 16% increase from the 6.2 million age 65 and older affected in 2021.216 • By 2060, the number of people age 65 and older with Alzheimer’s dementia is projected to reach 13.8 million, barring the development of medical breakthroughs to prevent, slow or cure Alzheimer’s disease.A5,216 Growth of the Oldest-Old Population The number of Americans surviving into their 80s, 90s and beyond is expected to grow dramatically due to the aging of the large baby-boom cohort, as well as longer life expectancies due to medical advances and changes to social and environmental conditions.326 This will lead to an increase in the number and percentage of Americans who will be 85 and older, the oldest-old. Between now and 2050, the oldest-old are expected to comprise an increasing proportion of the U.S. population age 65 and older — from 17% in 2021 to 22% in 2050.326 This will result in an additional 12 million oldest-old people — individuals at the highest risk for developing Alzheimer’s dementia.326 • In 2021, about 2.3 million people who have Alzheimer’s dementia are age 85 or older, accounting for 36% of all people with Alzheimer’s dementia.216 • By 2060, 6.7 million people age 85 and older are expected to have Alzheimer’s dementia, accounting for about half (48%) of all people 65 and older with Alzheimer’s dementia.216 Prevalence Mortality and Morbidity. Each year 500,000 surgical site infections occur in the US. Surgical site infections are the second most common healthcare-associated infections resulting in readmissions, prolonged hospital stays, higher medi-cal costs, and increased morbidity and mortality. Sur-gical site infections are preventable in most cases by following evidence-based guidelines for hand hygiene, administration of prophylactic antibiotics, and periop-erative patient temperature management. As attention to issues of healthcare quality heightens, the demand for positive surgical patient outcomes are intensify-ing. The Certified Registered Nurse Anesthetist can provide transparent high-quality care by implementing evidence-based guidelines for timely and appropriate antibiotic use, maintenance of normothermia, and hand washing. The Centers for Disease Control and Prevention (CDC) es-timates that 500,000 surgical site infections (SSIs) occur an-nually and account for 3% of surgical mortality, prolonged lengths of hospital stay, and increased medical costs. The literature suggests that 60% of the SSIs are preventable.1 Performance measures aimed at prevention of SSIs have been implemented nationally to enhance quality and mini-mize complications with respect to inpatient surgery.This course describes SSIs epidemiology, risk factors, and clinical consequences. It concludes by discussing the contribution of Certified Registered Nurse Anesthetists (CRNAs) to preventing SSIs by implementing guidelines for timely and appropriate use of antibiotics, mainte-nance of normothermia, and appropriate hand hygiene techniques.Surgical site infections are the second most common healthcare-associated infection. The CDC and the National Nosocomial Infection System have established criteria for defining SSIs that are widely used by SSI-surveillance and perioperative personnel.2 An SSI is an infection related to an operative procedure that occurs at or near the surgical incision within 30 days of the proce-dure.3,4 The CDC and the National Nosocomial Infection System define SSIs by the following clinical criteria:AANA Journal Course No. 34: AANA Journal course will consist of 6 successive articles, each with an objective for the reader and sources for additional reading. This educational activity is being presented with the understanding that any conflict of interest on behalf of the planners and presenters has been reported by the author(s). Also, there is no mention of off-label use for drugs or products. Please visit AANALearn.com for the corresponding exam questions for this article. Efforts to lower the incidence of SSIs date back to the 19th century when Lister pioneered antiseptic use to prevent infection in orthopedic patients.5 It is estimated that SSIs develop in 2% to 5% of the more than 30 million patients who undergo surgical procedures, representing 14% to 16% of all hospital-acquired infections annually in the US.6 These infections account for 3% of all surgical mortality and lead to increased readmissions, increased lengths of hospital stays, and higher costs.1 Patients who develop an SSI are 5 times more likely to be readmitted to the hospital, 60% more apt to require stay in an inten-sive care unit (ICU), and twice as likely to die compared with patients who are free of infection.2 Evidence further suggests that patients who contract multidrug-resistant infections face worse outcomes.5,7 The financial burden of SSIs is sizeable. An extensive epidemiologic review of surgical patient data revealed that lengths of hospital stay postoperatively extend 7 to 10 days, while hospital charges ranged from $3,000 to $29,000 per patient with a SSI diagnosis.3,5 Annually, hospital-acquired infections (HAIs) cost the healthcare system $9.8 billion.8 Compared with all HAIs nation-wide, SSIs occur most often and contribute the most to the overall cost, at 37.7% of the total cost.8 Death in the postoperative period was directly related to SSIs in 75% of patients in whom an SSI was diagnosed.3 The infection risk associated with primary hip and knee arthroplasty is approximately 1% and increases to 2% to 5% for arthroplasty revision.7 Compared with the infection rate for colon surgery, which is 20%, SSI rates in orthopedic surgery appear quite low. However, infec-tion in the bones and joints is very difficult to treat and is associated with a lifelong recurrence risk of 10% to 20%.9 When multiresistant pathogens such as methicillin-re-sistant Staphylococcus aureus (MRSA) infect a prosthetic joint, the treatment failure rate is 20% to 40%.7 Surgical infections that occur after total hip and knee arthroplasty are very costly and devastating for patients.7 Treatment of SSIs following joint replacement often requires removal and replacement of the prosthesis, prolonged systemic antibiotic therapy, and extensive rehabilitation because of impaired mobility. A consensus distinguishes timely antibiotic prophylaxis as essential in infection prevention, suggesting 30 minutes to 1 hour before incision as the ideal window for drug administra-tion.9,20 Merollini and colleagues20 determined through structured interviews with infectious disease physicians and orthopedic surgeons that antimicrobial prophylaxis is a relevant clinical practice for SSI prevention recom-mended by all participants.