Kathleen Louden

May 17, 2015

NATIONAL HARBOR, Maryland — A new program that gives families of patients with dementia the tools to better care for their loved ones lowered nursing home use, researchers report.

In the telephone-based assessment and care management program, trained nonphysician managers used evidence-based protocols to educate and offer support to caregivers.

Results from the randomized controlled trial were presented here at the American Geriatrics Society (AGS) 2015 Annual Scientific Meeting.

In the United States, "almost 15% of residents over age 70 have dementia," said lead investigator Joshua Chodosh, MD, from the UCLA Health System in Los Angeles. "Many primary care physicians continue to be challenged on how to manage this problem."

Still, dementia care management remains uncommon in the United States, he told Medscape Medical News.

In their study, Dr Chodosh and his team randomized 242 patient–caregiver dyads to the dementia-care management program and 256 dyads to usual care.

Care managers were trained social workers, nurses, and nurse practitioners.

Greater Caregiver Satisfaction

All caregivers were surveyed at baseline and at 9 and 18 months.

At 18 months, satisfaction with healthcare was rated higher, on a 100-point scale, by caregivers in the intervention group than in the usual care group (89.6 vs 86.3; P = .06). When caregivers rated confidence in their abilities, scores in the intervention group were 5.6 points higher than scores in the usual care group (P < .05).

The unadjusted rate of nursing home use during the intervention period, documented in patients' medical records, was lower in the intervention group than in the usual care group (7.6% vs 17.5%; P = .042).

Although dementia care management cost more than usual care overall, the difference was not significant, Dr Chodosh reported.

Improvements from baseline were seen for nearly all process measures in both group, but most between-group differences were not significant.

During the first 2 months of the study, the health plan referred 75% of members in the usual care group to geriatric care programs that included care management strategies, which were likely influenced by the intervention, Dr Chodosh reported.

"There was contamination across study arms, but better outcomes for all could be viewed as success," he explained. "The unintentional spread of dementia care management strategies, I would argue, underscores the need for this type of formative evaluation."

Most patients had moderate-severity dementia, he reported. At that stage, patients tend to need more care and are more likely to benefit from care management than those at an early stage, he told Medscape Medical News.

More Dementia Care Needed

"There is room for a lot of improvement in the way we provide care for patients with dementia," said Sharon Brangman, MD, from SUNY Upstate Medical University in Syracuse, New York. "This study provides an evidence-based care model that shouldn't be that hard to replicate," she told Medscape Medical News.

Dr Brangman, a past president of the AGS who was not involved in the study, said she is impressed that the researchers developed a dementia care model, based it on best practices, and involved the entire care team in its implementation.

She said she liked that the program included features that are not always part of dementia care, such as a nonpharmacologic management approach, a method for safe return if the patient wandered away and got lost, and the creation of an advance directive.

Although Dr Brangman said she would have liked to have seen that the care management program saved money, she pointed out that "if it gave better care and did not cost significantly more, why wouldn't you want to implement a similar program?"

This study was funded by Senior Care Action Network Foundation in Long Beach, California. Dr Chodosh is a consultant for the network. Dr Brangman has disclosed no relevant financial relationships.

American Geriatrics Society (AGS) 2015 Annual Scientific Meeting: Abstract P1. Presented May 15, 2015.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: