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Improving Care for Dementia Patients and Caregivers

Substantial benefits were realized by coordinating care.

Nonpharmacologic interventions can improve health for people with dementia and their caregivers, but implementation can be difficult for individual primary care clinicians. In two studies, researchers assessed coordinated and comprehensive interventions for dementia patients and their caregivers.

In a California study, 18 primary care clinics in three healthcare organizations were randomized to provide either usual care (9 clinics; 170 patient/caregiver pairs) or a care-management intervention (9 clinics; 238 pairs) for longer than 12 months. The intervention provided standardized assessment, care algorithms, and care coordination protocols; each patient was assigned at least two care managers, and primary care clinicians were offered educational seminars. At 2 years, the percentage of care that met 23 practice-guideline goals was higher in the intervention than in the usual-care group (64% vs. 33%).

In a five-city U.S. study, researchers enrolled 642 people who provided at least 4 hours of care daily for relatives with dementia. The caregivers were randomized to a control group (2 brief phone calls and mailed educational materials) or to an intervention that provided skills training, stress management advice, support groups, and strategies to manage troublesome dementia behaviors. At 6 months, Hispanic and white caregivers in the intervention group showed the most improvement on a quality-of-life scale that included depressive symptoms, caregiver burden, and patient problem behaviors. Among black caregivers, only spouses of patients reported significant improvements.

Comment: Editorialists note that the effects of these interventions are larger than those of dementia pharmacotherapies. They also note that office-based, fee-for-service care cannot deliver these interventions; to implement widespread, effective care, Medicare and other providers must cover caregiver services, team-based care management, and integrated care programs.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine December 21, 2006

Citation(s):

Vickrey BG et al. The effect of a disease management intervention on quality and outcomes of dementia care: A randomized, controlled trial. Ann Intern Med 2006 Nov 21; 145:713-26.

• Original article (Subscription may be required)
• Medline abstract (Free)

Belle SH et al. Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: A randomized, controlled trial. Ann Intern Med 2006 Nov 21; 145:727-38.

• Original article (Subscription may be required)
• Medline abstract (Free)

Covinsky KE and Johnston CB. Envisioning better approaches for dementia care. Ann Intern Med 2006 Nov 21; 145:780-1.

• Original article (Subscription may be required)
• Medline abstract (Free)