David B Reuben, Zaldy S Tan, Tahmineh Romero, Neil S Wenger, Emmett Keeler, Lee A Jennings
BACKGROUND/OBJECTIVES: Persons with Alzheimer disease and related dementias (ADRDs) require comprehensive care that spans health systems and community-based organizations. This study examined the clinical outcomes of a comprehensive dementia care program and identified subgroups who were more likely to benefit.
DESIGN: Observational, baseline and 1 year after intervention.
SETTING: Urban, academic medical center.
PARTICIPANTS: A total of 554 persons with dementia and their caregivers who had 1-year follow-up evaluations and data on clinical outcomes.
INTERVENTION: Health system-based comprehensive dementia care management program using nurse practitioner dementia care managers.
MEASUREMENTS: Patient measures included the Mini-Mental State Examination (MMSE), the Functional Activities Questionnaire, Basic and Instrumental Activities of Daily Living scales, the Cornell Scale for depression in dementia, and the Neuropsychiatric Inventory Questionnaire (NPI-Q) Severity. Caregiver measures included the Modified Caregiver Strain Index, the Patient Health Questionnaire-9, NPI-Q Distress, and the dementia Burden Scale-Caregiver). We used established minimal clinically important differences and lowest tertiles of baseline symptoms to define improving symptoms and maintaining low symptoms as clinical benefit for patients and caregivers.
RESULTS: At year 1, persons with ADRD improved on all scales, except MMSE and functional status measures; caregivers improved on all scales. Using validated instruments, 314/543 (58%) of patients, 282/447 (63%) of caregivers, and 376/501 (75%) of patients or caregivers demonstrated clinical benefit. In adjusted multivariate models, at year 1, more behavioral symptoms and fewer depression symptoms at baseline were associated with Patient improvement; and fewer baseline depression symptoms were associated with maintaining low behavioral symptoms. Male caregiver sex, higher baseline caregiver burden, and caring for patients with fewer baseline depression symptoms were associated with caregiver improvement. Male caregiver sex and patients with fewer depression symptoms, fewer behavioral symptoms, and more functional impairment at baseline were associated with caregivers maintaining low burden at 1 year.
CONCLUSIONS: Health system-based comprehensive dementia care management is a promising approach to improving clinical outcomes, with benefits for both patients and caregivers. J Am Geriatr Soc 67:2267-2273, 2019.
Activities of Daily Living
Adaptation, Psychological
Adult
Aged
Aged, 80 and over
Alzheimer Disease
Caregivers
Comprehensive Health Care
Dementia
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neuropsychological Tests
Psychiatric Status Rating Scales
Retrospective Studies
Severity of Illness Index
