Katie Maslow

Assessing Care of Vulnerable Elders—Alzheimer's Disease: A Pilot Study of a Practice Redesign Intervention to Improve the Quality of Dementia Care

OBJECTIVES: To determine whether a practice redesign intervention coupled with referral to local Alzheimers Association chapters can improve the quality of dementia care.

Caregiver outcomes of partners in dementia care: effect of a care coordination program for veterans with dementia and their family members and friends.

The objective is to test the effectiveness of Partners in Dementia Care (PDC), a care‐coordination program that integrates and improves access to medical and nonmedical services, while strengthening the informal care network and providing information, coaching, and emotional support. PDC was delivered via a partnership between Veterans Affairs (VA) Medical Centers (VAMCs) and Alzheimers Association chapters, for caregivers of veterans with dementia living in the community and receiving primary care from the VA. The initial sample was 486 caregivers of 508 veterans with diagnosed dementia. Outcomes were evaluated for 394 and 324 caregivers who completed 6‐ and 12‐ month follow‐up, respectively. PDC had a standardized protocol that included assessment and reassessment, action planning, and ongoing monitoring. It was delivered by telephone and e‐mail for cost efficiency and the ability to handle caseloads of 100 to 125. Care coordinators from VAMCs and Alzheimers Association chapters worked as a team using a shared computerized record. A variety of caregiver outcomes was measured after 6 and 12 months. Intervention group caregivers had significant improvements in outcomes representing unmet needs, three types of caregiver strains, depression, and two support resources. Most improvements were evident after 6 months, with more‐limited improvements from Months 6 to 12. Some outcomes improved for all caregivers, whereas some improved for caregivers experiencing more initial difficulties or caring for veterans with more‐severe impairments. PDC is a promising model that improves linkages between healthcare services and community services, which is a goal of several new national initiatives such as the National Plan to Address Alzheimers Disease and a proposed amendment to the Older Americans Act.

Advancing Alzheimer's disease diagnosis, treatment, and care: Recommendations from the Ware Invitational Summit

To address the pending public health crisis due to Alzheimers disease (AD) and related neurodegenerative disorders, the Marian S. Ware Alzheimer Program at the University of Pennsylvania held a meeting entitled “State of the Science Conference on the Advancement of Alzheimers Diagnosis, Treatment and Care,” on June 21‐22, 2012. The meeting comprised four workgroups focusing on Biomarkers; Clinical Care and Health Services Research; Drug Development; and Health Economics, Policy, and Ethics. The workgroups shared, discussed, and compiled an integrated set of priorities, recommendations, and action plans, which are presented in this article.

A controlled trial of Partners in Dementia Care: veteran outcomes after six and twelve months

Introduction“Partners in Dementia Care” (PDC) tested the effectiveness of a care-coordination program integrating healthcare and community services and supporting veterans with dementia and their caregivers. Delivered via partnerships between Veterans Affairs medical centers and Alzheimer’s Association chapters, PDC targeted both patients and caregivers, distinguishing it from many non-pharmacological interventions. Hypotheses posited PDC would improve five veteran self-reported outcomes: 1) unmet need, 2) embarrassment about memory problems, 3) isolation, 4) relationship strain and 5) depression. Greater impact was expected for more impaired veterans. A unique feature was self-reported research data collected from veterans with dementia.Methods and FindingsFive matched communities were study sites. Two randomly selected sites received PDC for 12 months; comparison sites received usual care. Three structured telephone interviews were completed every 6 months with veterans who could participate.ResultsOf 508 consenting veterans, 333 (65.6%) completed baseline interviews. Among those who completed baseline interviews, 263 (79.0%) completed 6-month follow-ups and 194 (58.3%) completed 12-month follow-ups. Regression analyses showed PDC veterans had significantly less adverse outcomes than those receiving usual care, particularly for more impaired veterans after 6 months, including reduced relationship strain (B = −0.09; p = 0.05), depression (B = −0.10; p = 0.03), and unmet need (B = −0.28; p = 0.02; and B = −0.52; p = 0.08). PDC veterans also had less embarrassment about memory problems (B = −0.24; p = 0.08). At 12 months, more impaired veterans had further reductions in unmet need (B = −0.96; p < 0.01) and embarrassment (B = −0.05; p = 0.02). Limitations included use of matched comparison sites rather than within-site randomization and lack of consideration for variation within the PDC group in amounts and types of assistance provided.ConclusionsPartnerships between community and health organizations have the potential to meet the dementia-related needs and improve the psychosocial functioning of persons with dementia.Trial RegistryNCT00291161

Problems in women's knowledge about menopause

Women need to know more about menopause to be able to make informed decisions about their own health. They need information about the usual short-term and long-term effects of menopause and about pharmacologic and non-pharmacologic approaches that may be helpful in responding to these effects. Some of this information does not exist at present, and what is known is not well disseminated. To address these problems, the research agenda on menopause should include studies specifically intended to produce the necessary information. Improved dissemination of the information will require the joint efforts of journalists, scientists, health care professionals, and women themselves.

Improving the Quality of Care for Dementia

ementia is a common problem in older individuals, and very prevalent in those over 85. But care provided for dementia is poor. Assessing Care of Vulnerable Elders-2 (ACOVE-2), a RAND Health project focused on redesigning primary care practices in order to improve care for elders, was successful in enhancing care for falls and urinary incontinence but not for dementia. Analysis of program results showed that physicians performed better on medical components (e.g., ordering tests) than on counseling and education for dementia patients and their caregivers. Alzheimer’s Association chapters provide these kinds of support services, but the medical community and Alzheimer’s Association chapters rarely communicate or collaborate. To address this need, RAND researchers strengthened ACOVE-2 in three ways: Participating primary care physicians were given feedback about their baseline performance, focus groups were conducted to gain provider perspective on unmet needs in managing dementia patients, and the project team worked directly with practices to customize the intervention in order to meet these needs and to improve quality of care. The third component included establishing referral links to local Alzheimer’s Association chapters to enhance patient and family education and community services. The improved intervention was pilot tested in two community-based physician practices and evaluated. Key findings from the evaluation include the following: