By Bob DeMarco
Alzheimer's Reading Room
A special dementia care plan, involving regular assessments of patients with Alzheimer's disease in specialist memory clinics, does not slow functional decline compared with usual care, finds a study published on bmj.com.
I found the results of this study particularly interesting (see the study results below).
People are often surprised and sometimes shocked when they learn I have not taken my mother to a neurologist in several years. The only exception to this occurred when Dotty was enrolled in the Dimebon clinical trial.
I don't have anything against neurologists. Nor, am I suggesting that you do what I do.
It is my belief that the personal care physician is the key -- the point guard -- the quarterback. This is the doctor we rely on the most.
This does explain why I am so adamant that people should search high and low for the very best personal care physician in their area. By the way, in my opinion, this rule applies to everyone not just persons suffering from Alzheimer's disease.
Since I now live around a large number of older people -- over 75 years of age -- I received an excellent first hand account about how the medical care system works in the United States of America.
I can say, we have everything under the sun available to us. A good thing. I am sad to say that not all personal care physicians are equal. In fact, it is my personal opinion that only a small percentage are excellent. My rule of thumb is clear: 2 percent -- excellent; 10 percent -- good; another 20 percent adequate. The rest -- if you have a doctor in this group, good luck.
Here is an example from our personal care experience.
I was having a problem getting a call back from a personal care physician in regards to a problem with my mother. After two days, what did I do? I went over to the doctor's office and told the general manager of the practice that I wanted to speak to him in person. She told me how busy he was, I told her -- no problem. I'll just sit here as long as it takes to speak with him for five minutes.
I went in and stated my grievances. Guess what he said? He told me that we were going to get everything I wanted, and the treatment I wanted. He then said to me, "the wheel that squeaks the loudest gets the best treatment." We changed doctors.
Sad, very sad. My mother has me, but what about all the older persons that don't have someone like me to make sure they get the service and treatment they are entitled too?
In my experience, many of these personal care physicians treat patients like cattle. Time and time again someone we know has a medical issues. They tell me the problem. I suggest to them that they ask the doctor that send them to a specialist (fill in the blank).
The folks around here rarely if ever take or follow my advice. Then, months later, they end up getting the treatment and solution that I suggested they ask for at the beginning.
I am not a doctor. But if I am able to diagnose the eventual treatment months in advance, what does that tell you? It tells you that the doctor makes more money if the person keeps coming in week after week complaining with the same symptoms and problems. All those visits add up. Bunkhouse logic.
The doctor gets paid for all those visits -- typically by Medicare. The patent rarely cares because they aren't paying. Really? Did anyone notice how the co-pays for specialized treatment and medication went up this year? They wouldn't be going up if there was less "waste" in the system.
At any rate, frequent visits to memory clinics, etc. are not slowing the decline in patients with Alzheimer's.
I'll tell you what I think helps. Tender loving care, creating a safe secure environment, and learning how to become the very best caregiver you can be. Learning how to accept the common problems that most Alzheimer's caregivers experience each day is a good step in the right direction.
And, finding a wonderful, caring, personal care physician.
Special care plan does not slow decline in patients with Alzheimer's
Research: Effectiveness of a specific care plan in patients with Alzheimer's disease: Cluster randomized trial (PLASA study)
A special dementia care plan, involving regular assessments of patients with Alzheimer's disease in specialist memory clinics, does not slow functional decline compared with usual care, finds a study published on bmj.com today.
Guidelines for the care of patients with Alzheimer's disease recommend regular evaluation and follow-up. However, questions remain over the feasibility and real impact of these guidelines, and whether assessments are better carried out in primary care or specialist memory clinics.
So a team of researchers in France tested the effectiveness of a comprehensive care plan in reducing the rate of functional decline in patients with Alzheimer's disease compared with usual care.
The study was conducted over two years at 50 memory clinics in France and involved 1,131 community dwelling patients with mild to moderate Alzheimer's disease. Patients were randomised to either a comprehensive care plan (intervention group) or usual care (control group).
Patients in the intervention group received regular 6-monthly assessments, while the control group received only an annual consultation.
After two years, there was no significant difference in functional decline between the two groups. There was also no difference in the risk of being admitted to an institution or death between the two groups.
The authors say: "This finding underlines the fact that this kind of broad intervention does not convey benefit in activities of daily living and may have little public health value."
They add: "it may be that interventions must be targeted towards patients at particular risk of decline or we may need to develop a more effective intervention and ensure that it is correctly implemented in all patients."
Future research is needed to determine whether functional decline can be improved by more direct involvement of general practitioners or by using case manager programmes, they conclude.
In an accompanying editorial, Professor Lon Schneider from the University of Southern California acknowledges that care plans are not simple to implement, but says the trial "provides an important basis from which to assess the feasibility and effectiveness of care plans delivered by doctors. It also highlights the need to develop effective comprehensive care plans that can be integrated into practice."
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Original content Bob DeMarco, the Alzheimer's Reading Room