Jul 19, 2012

In Home Care Program Allows AD Dementia Patients to Stay Home Longer

Home based care including assistance from trained professionals and overseen by geriatric clinicians led to improvements in care quality, ability to remain in home, and better self-reported quality of life in persons living with dementia.

People living with dementia and at home have special needs. If left unattended and without help they are at increased risk for disability, mental health condition, illness, death, and earlier placement in memory care nursing homes.

In Home Care Program | Alzheimer's Reading Room

The study described below indicates that a standardized, in home, support program can increase the ability of patients to remain at home, increase quality of life, and provide invaluable assistance for Alzheimer's caregivers.

My own opinion is that this is the type model that needs to be developed now. It is unlikely that the government will be able to afford; or that, the private sector will be able to build and develop adequate memory care facilities for the growing number of baby boomers that are likely to suffer from Alzheimer's disease dementia (AD Dementia) in the years ahead.

The approach described below makes good sense and could prove to be the more cost effective solution to the problem.

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Care Coordination Program Improves Quality of Care and Quality of Life of People with Dementia

Previous research shows that people with Alzheimer's and other dementia disorders are at increased risk for disability, medical and mental health conditions, and placement in assisted living or nursing home settings. Similarly, their caregivers are also at increased risk for a host of medical, mental health, social and economic difficulties.

Evidence also suggests that education about and management of the disease, focused on identifying and treating symptoms and providing practical and emotional support, can provide multiple benefits for those with Alzheimer's and their loved ones by minimizing the risk of complications and improving quality of life, mood, overall health, and prolonging independence.

Quincy Miles Samus, PhD, and colleagues at the Johns Hopkins University School of Medicine tested the efficacy of a multidimensional care coordination model to improve quality of care and other outcomes for community residing people with memory disorders, known as The Maximizing Independence at Home (MIND at Home) trial.

The 18-month controlled trial included 303 people with cognitive disorders (265 with dementia; 38 with mild cognitive impairment) age 70+, living at home in 28 zip codes near Baltimore, MD.

Participants were randomized to receive the care coordination intervention (n=110) or augmented usual care (n=193). The intervention team included paraprofessionals specially trained in evidence-based dementia care, a psychiatric nurse, and a geriatric psychiatrist. 

The team implemented a standardized care coordination protocol consisting of a multidimensional needs assessment, community resource referrals, memory disorder education, counseling, and problem-solving, which were supported by a customized web-based application to monitor care progress.

Primary outcomes included unmet needs and time to transfer out of the home. Secondary outcomes were participant quality of life, neuropsychiatric symptoms, and depression.

The researchers found that study participants had a wide range of unmet needs.

Home and personal safety issues, general medical care, meaningful activities, and legal issues were the most common.

The intervention group had a greater decrease in total unmet needs from the beginning of the study to 18 months compared to the control group, with the most significant reductions in safety and legal issues.

In addition, intervention participants were less likely to permanently leave their home or die compared to controls (30.0% vs. 45.6%) and had a significant reduction in time to leaving the home for any reason.

Self-reported quality of life was better in the intervention group at 18 months. No group differences were found on proxy-rated quality of life, neuropsychiatric symptoms, or depression.

"Our study provides promising preliminary evidence that the intervention can promote the ability to age in place and improve care quality," Samus said. "We are hopeful this study will help guide how community-based dementia care can be effectively and efficiently delivered in the future." 
"Further work is needed to evaluate how beneficial this intervention would be in other communities, such as those who live in disadvantaged areas. Plus, we need to work out how it might be paid for, sustained, and made available to larger groups of people over the long term," Samus said.

Original content Bob DeMarco, the Alzheimer's Reading Room