Coordinated-Care Program for Older Adults with Dementia Improves Outcomes and Eases Burdens for Family Caregivers
More than 5 million older adults in the United States have Alzheimer’s disease, and at least another million have other dementias. Older people with dementia need both medical care and social services, such as transportation to healthcare services, delivered meals, and assistance with activities of daily life such as eating, and bathing. At the same time, older adults’ caregivers also need training to care for the complications of the disease and support, such as counseling and respite care that allows them to take breaks from their demanding roles.
Though patients with dementia benefit most when they get coordinated medical and social care, few older people get such care. Most physicians, including geriatricians – doctors who specialize in caring for the most complex older patients – don’t have enough time to manage both the medical and social services that these complex patients need. For that reason, they focus on these patients’ medical needs.
There are, however, a few community-based, dementia-care programs that provide both coordinated medical and social services for older people with dementia and help their family caregivers. A program at Indiana University, for example, has trained dementia care managers who coordinate older patients’ medical and social services. The program has shown that, when medical and social services for older adults are coordinated, these patients get better quality care, and have fewer behavioral problems. And when that happens, caregivers are less stressed and health care utilization may be decreased.
Two years ago the University of California at Los Angeles (UCLA) Health System launched the UCLA Alzheimer’s and Dementia Care (ADC) program to provide comprehensive, coordinated, patient-centered care for older adults with dementia. The goals of the program are to enable these patients to function to the greatest extent possible, and have as much independence and dignity as possible. The UCLA ADC program is also designed to lower caregiver strain and burnout, and reduce unnecessary care costs.
After enrolling in the UCLA ADC program, a patient with dementia goes through a multi-step evaluation with a nurse practitioner Dementia Care Manager (DCM) to determine what kind of needs – both medical and social needs – they have and what kind of support their caregivers need. Based on these evaluations, the DCM – with guidance from a physician dementia specialist – works with the patient and his or her family caregiver to develop a personal care plan. This plan is then presented to the primary care or referring physician for a review and, if appropriate, modification. The DCM then implements the care plan in a co-management model keeping the primary care or referring informed and involved as needed. As the dementia patient’s health and needs change, the DCM , family members, and primary physicians continue to work together to update his or her care plan.
“The most successful efforts to improve dementia care have relied on co-management models that typically engage a nurse practitioner focused on dementia and, in some programs, other geriatric conditions,” writes lead author David Reuben, MD, of the David Geffen School of Medicine at the University of California Los Angeles and co-authors.
The UCLA ADC program has built on these previous successes at other institutions and has adapted them to a university-based healthcare system that provides primary and specialty care for a large population. The program will be evaluated on how well it achieves the triple aim of better health care, better health, and lower costs, as how well it achieves person-centered centered goals. Although the results of these evaluations are several years away, to date, individuals, caregivers, and referring physicians have been enthusiastic about the program. If it succeeds its goal of meeting the triple aim, the program has the potential to become a national model for comprehensive dementia care.
This summary is from the full report titled, “The University of California at Los Angeles Alzheimer’s and Dementia Care Program for Comprehensive, Coordinated, and Patient-Centered Care: Preliminary Data.” It appears in the December 2013 issue of the Journal of the American Geriatrics Society. The report is authored by David B. Reuben, MD; Leslie C. Evertson, GNP; Neil S. Wenger, MD, MPH; Katherine Serrano, BA; Joshua Chodosh, MD; Linda Ercoli, PhD; and Zaldy S. Tan; MD, MPH.