Mary Guerriero Austrom

Implementing Innovative Models of Dementia Care: The Healthy Aging Brain Center

Background: Recent randomized controlled trials have demonstrated the effectiveness of the collaborative dementia care model targeting both the patients suffering from dementia and their informal caregivers. Objective: To implement a sustainable collaborative dementia care program in a public health care system in Indianapolis. Methods: We used the framework of Complex Adaptive System and the tool of the Reflective Adaptive Process to translate the results of the dementia care trial into the Healthy Aging Brain Center (HABC). Results: Within its first year of operation, the HABC delivered 528 visits to serve 208 patients and 176 informal caregivers. The mean age of HABC patients was 73.8 (standard deviation, SD 9.5), 40% were African-Americans, 42% had less than high school education, 14% had normal cognitive status, 39% received a diagnosis of mild cognitive impairment, and 46% were diagnosed with dementia. Within 12 months of the initial HABC visit, 28% of patients had at least one visit to an emergency room (ER) and 14% were hospitalized with a mean length of stay of five days. The rate of a one-week ER revisit was 14% and the 30-day rehospitalization rate was 11%. Only 5% of HABC patients received an order for neuroleptics and only 16% had simultaneous orders for both definite anticholinergic and anti-dementia drugs. Conclusion: The tools of ‘implementation science’ can be utilized to translate a health care delivery model developed in the research laboratory to a practical, operational, health care delivery program.

The CAMDEX: A Standardized Instrument for the Diagnosis of Mental Disorder in the Elderly: A Replication with a US Sample

The Cambridge Mental Disorders of the Elderly Examination (CAMDEX) was developed by Roth, et al (1986) to assist in the early diagnosis and measurement of dementia in the elderly. In this study the CAMDEX was administered to a mixed group of independently diagnosed elderly psychiatric patients and control subjects in the United States. The CAMDEX was found to have a high interrater reliability with a mixed group of clinicians of varying backgrounds. The diagnostic scales and the cognitive section of the CAMDEX demonstrated considerable promise in distinguishing between independently diagnosed populations of depressed, demented, and normal subjects. The results suggest comparability between samples of subjects in England and the US, and that the CAMDEX is a promising instrument for use in both research and clinical settings.

Depressed Mood in Informal Caregivers of Individuals With Mild Cognitive Impairment

This study estimates the prevalence of depressed mood in caregivers of individuals with mild cognitive impairment (MCI) and assesses whether demographics, stressors, intrapsychic strain, and gain are associated with depressed mood. A secondary analysis of baseline data from the Alzheimers Disease Cooperative Study MCI trial was conducted using a cross-sectional, correlational design. Descriptive statistics to estimate the prevalence of caregiver depressed mood and univariate and block-wise logistic regression analyses were used. The prevalence of depressed mood in 769 caregivers was 24.6% (95% confidence interval, 21.5-27.7). The odds of being depressed were significantly higher in younger, nonspousal caregivers with less education, who cared for MCI patients with lower activities of daily living functioning, and who perceived greater relational deprivation, higher levels of self-loss, and personal gain. Controlling for relevant variables, relational deprivation and caregiver education continued to be significantly associated with depressed mood. Relational deprivation may be important for future interventions.

Predictors of life satisfaction in retired physicians and spouses

Abstract.Background: With the current demographic changes, adjustment to retirement has become a major concern for physicians. Yet information on adjustment to retirement gathered from retired physicians is sparse. Information on physician spouses following retirement is currently not available. Therefore, we conducted a survey of a multi-disciplinary group of retired physicians and their spouses on adjustment to retirement. Methods: A mail survey was sent to 1834 alumni who graduated from medical school prior to 1965. Responses were received from 795 (43 %) physicians and 455 spouses. Of the physicians, 678 indicated that they were retired or semi-retired. Life satisfaction was measured on a 9-point Likert scale. Results: Levels of life satisfaction were high for both physicians and spouses. Approximately 88 % of both groups reported being mostly satisfied or better with their lives. Factors associated with better life satisfaction for physicians included better health, optimism, feelings of financial security, participation in activities and hobbies and a good sexual relationship. For spouses, good health, having a husband willing to help with chores, quality of relationships including sexual relationship and attending theatre or sporting events were associated with higher levels of life satisfaction. Spouses who had never worked reported higher levels of life satisfaction than spouses who had worked and were now retired. For changes in life satisfaction since physician retirement, predictors for both physicians and spouses were similar to those for life satisfaction. However, for physicians, both younger age and more years in retirement were independently associated with improved life satisfaction. Issues regarding loss of role and methods and reasons for retirement influenced satisfaction in the early retirees. For spouses, major challenges involved coping with changes in the marital relationship. Conclusions: Physicians and their spouses reported high levels of life satisfaction. The factors predicting life satisfaction and change in life satisfaction following retirement differed for physicians and spouses. For physicians, life satisfaction and change in life satisfaction were affected by time since retirement.

New Workforce Development in Dementia Care: Screening for “Caring”: Preliminary Data

The United States has a significant shortage of trained geriatricians and of nurses, social workers, and paraprofessionals educated to care for elderly adults. As the aging population continues to grow, providing high‐quality care will require new models that better address the many needs of aging individuals and their caregivers, using cost‐effective strategies. Responding to this need, the Indiana University Center for Aging Research implementation scientists developed, tested, and are now scaling up a successful collaborative care coordination model for older adults with dementia, depression, or both: the Aging Brain Care program. This model now includes a newly created frontline care provider position, the Care Coordinator Assistant. The Care Coordinator Assistant works with individuals and caregivers to monitor biopsychosocial needs and deliver evidence‐based and individualized care protocols, with close supervision from the registered nurse Care Coordinator. Recognizing that current hiring practices for frontline providers were insufficient to screen for critical abilities expected in this new position, including the ability to express “caring” and empathy, a new screening process was created building on the Multiple Mini Interview (MMI) format. The Care Coordinator Assistant MMI comprised six stations, each created to simulate challenging scenarios that will be frequently encountered and to assess important candidate abilities. Overall, the six‐station MMI, with two to three items per station, provided factorially valid measures and good predictive ability. The process did not appear to be overly burdensome for candidates, and interviewers noted that it was helpful in discriminating between candidates.

Caregiver and Noncaregiver Attitudes Toward Dementia Screening

OBJECTIVES: To compare attitudes toward dementia screening of older adults with and without an experience of dementia caregiving.

Distress Responses and Self-Care Behaviors in Dementia Family Caregivers With High and Low Depressed Mood

BACKGROUND: Most caregiving intervention studies have focused on reducing caregiver depression. Little is known about how caregivers manage their own symptoms, particularly caregivers with high depressed mood. OBJECTIVES: To compare caregiving stress, health status, physical function, symptom presence and severity, and self-care behaviors in family caregivers with high and low depressed mood. STUDY DESIGN: This study used a cross-sectional design. RESULTS: Caregivers with high depressed mood reported higher levels of caregiving stress, experienced more symptoms and more symptom severity, and had more physical performance difficulty than those caregivers with low depressed mood. However, they did not report a higher rate of asking for professional help per symptom. CONCLUSIONS: There is a need for developing outreach programs and coordinating information to encourage caregivers to address their own symptoms, identify services available in the community, and learn how to access them.

A care management model for enhancing physician practice for alzheimer disease in primary care

ABSTRACT Previous research has indicated that passive distribution of educational material by itself has little impact on physician behavior. In this paper, a collaborative care management program for the treatment and management of dementia in primary care (The PREVENT Study) is described. The essential components of the integrated program are: 1) a comprehensive screening and diagnosis protocol; 2) a multidisciplinary team approach coordinated by a geriatric advance practice nurse; and 3) a proactive longitudinal tracking system. The key role of the geriatric nurse practitioner is emphasized. While the clinical trial is still on-going, we can report that the intervention has been well received by primary care physicians, patients and their families.

Frontotemporal Dementia Caregivers and Researchers Partnering for Brain Donation

This study utilized a community-based, participatory research model between the Association for Frontotemporal Degeneration (AFTD) and the Education Core of the Indiana Alzheimer Disease Center. A total of 30 caregivers of persons with frontotemporal dementia (FTD) participated in 6 focus groups in 3 cities. The majority of participants were spouses of the person with FTD and had been providing care for an average of 6 years. Transcript analysis revealed 7 prominent themes: willingness to participate, when/how the issue of brain donation is raised, who initiates discussion about brain donation, who is involved in decisions about brain donation, motivation for participating in brain donation, lack of effective communication, and barriers to research participation. Caregivers demonstrated a strong desire to participate in research and contribute to advancing knowledge. The lack of effective communication between the clinicians and caregivers was a barrier to developing positive rapport, detrimentally impacting research participation.

The Aging Brain Care Medical Home: Preliminary Data

The Aging Brain Care (ABC) Medical Home aims to improve the care, health outcomes, and medical costs of Medicare beneficiaries with dementia or depression across central Indiana. This population health management program, funded by the Centers for Medicare and Medicaid Services Innovation Center, expanded an existing collaborative dementia and depression care program to serve 1,650 older adults in a local safety‐net hospital system. During the first year, 20 full‐time clinical staff were hired, trained, and deployed to deliver a collaborative care intervention. In the first 18 months, an average of 13 visits was provided per person. Thirty percent of the sample had a diagnosis of dementia, and 77% had a diagnosis of depression. Sixty‐six percent of participants with high depression scores (Patient Health Questionnaire‐9 score ≥14) had at least a 50% reduction in their depressive symptoms. Fifty‐one percent of caregivers of individuals with dementia had at least a 50% reduction in caregiver stress symptoms (measured by the Healthy Aging Brain Care Monitor‐Caregiver Version). After 18 months, the ABC Medical Home has demonstrated progress toward improving the health of older adults with dementia and depression. Scalable and practical models like this show initial promise for answering the challenges posed by the nations rapidly aging population.