Jun 26, 2014

UCSF to Develop Online Dementia Care Ecosystem

“Our hope is this is going to radically improve the way dementia patients are cared for.”

Alzheimer's Reading Room


UC San Francisco and the University of Nebraska Medical are creating a new web-based model of dementia care.

It will provide around the clock consultations for patients and their families, online education and, for a subset of patients, remote monitoring with smart phones and home sensors.

This is exciting and important news that is beging triggered by a $10 million grant from the Centers for Medicare & Medicaid Innovation. If this takes off nationally and worldwide it is just what caregivers need. Most importantly, it could help cut down caregiver depression which is currently estimated as high as 60 percent.

“Our hope is this is going to radically improve the way dementia patients are cared for,” said Katherine Possin, PhD, who is an assistant professor of neuropsychology at UCSF. “We hope we’ll show this works, and that it can be adopted nationwide.”

The Gist
  • Each patient will have a navigator, who will check in by telephone or with a personal visit, as well as by monitoring communication with patients and their families through an Internet dashboard.
  • Navigators will be people without a formal medical degree and will be supervised closely by nurses, social workers and pharmacists with expertise in dementia care.
  • The navigators will triage calls, making sure that patients see nurses and doctors when necessary and helping with other things that don’t require medical expertise, such as a hazardous situation in the home that could cause the patient to fall.
  • Patients and their families will be able to get training online  to help make financial plans and work through tough medical decisions before their loved ones have reached a crisis stage.
  • Researchers hope to create a virtual care system that is supportive enough to protect the mental and physical health of caregivers, who tend to neglect their own needs.
  • Nearly 60 percent of caregivers say the work was highly stressful and more than a third reported symptoms of depression.
“Our ecosystem will have wisdom and experience continuously piped in every day to caregivers who are overwhelmed,” said Bruce Miller, MD, director of the MAC, who holds the A.W. and Mary Margaret Clausen Distinguished Professorship in Neurology at UCSF. “Typically, these people have a hard time getting through to anyone in the medical system.”
  • Some patients in the study will have an added level of technology-based care. They will use smart phones and electronic wristbands to record their activity levels, count the number of steps they take and measure how far they range from home.
“If someone, instead of getting up two times a night, is getting up four or five times a night, we might send a nurse the next morning to their home to get a urine sample, and if it’s bad start the patient on antibiotics,” said Steve Bonasera, MD, PhD, an associate professor of geriatrics at UNMC, who did his fellowship at UCSF. “We’re going to be monitoring people who are a seven- or eight-hour drive from my office in Omaha.”

  • The system will also monitor the drugs that patients take and flag high risk and inappropriate medications, such as antipsychotics and benzodiazepines that can send patients with certain forms of dementia to the emergency room. It will also flag medications that should not be combined.
  • Initial projections are that the improved caregiver support, more continuous access to medical help and medication management will reduce emergency room visits by a half, cut hospitalizations by almost a third and delay the move into a nursing home for six months.
  • Researchers said that once families have easy access to educational resources, office visits will become less pressured and patients and their families will be able to take more time to absorb information and make important decisions.
“The idea of 24/7 telephone access to clinicians with expertise in dementia has really resonated with caregivers,” said Jennifer Merrilees, RN, PhD.

The Dementia Care Ecosystem will not replace clinicians, but rather bring educational resources developed over the last decade by the UCSF Memory and Aging Center (MAC) to patients and their families, while enabling clinicians to monitor their patients from afar.

Source UC SanFrancisco, http://bit.ly/1yS5X3k

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Original content Bob DeMarco, the Alzheimer's Reading Room

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