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An Innovative Model for Dementia Care

Author Information (click to view)

Malaz A. Boustani, MD, MPH

Associate Professor of Medicine

Indiana University School of Medicine

Associate Director

Indiana University Center for Aging Research

Research Scientist

Regenstrief Institute, Inc.

Malaz A. Boustani, MD, MPH, has indicated to Physician’s Weekly that he has received grants/research aid in the past from Novartis and Forest Pharmaceuticals.

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Malaz A. Boustani, MD, MPH (click to view)

Malaz A. Boustani, MD, MPH

Associate Professor of Medicine

Indiana University School of Medicine

Associate Director

Indiana University Center for Aging Research

Research Scientist

Regenstrief Institute, Inc.

Malaz A. Boustani, MD, MPH, has indicated to Physician’s Weekly that he has received grants/research aid in the past from Novartis and Forest Pharmaceuticals.

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A new collaborative model of care uses standard protocols to initiate treatment and identify, monitor, and treat behavioral and psychological symptoms of dementia, stressing non-pharmacological management.
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The Alzheimer’s Association estimates that about 5.3 million Americans have Alzheimer’s disease. Within this group, roughly eight of 10 people have dementia but live outside of nursing homes. Many of these patients have significant behavioral or psychological symptoms that require medical and psychological care. About 10 million Americans are family caregivers for sufferers of dementia, but these people aren’t typically the focus of efforts to improve care for patients.

The HABC Care Model for Dementia

In the May 10, 2006 JAMA, my colleagues and I developed and assessed a new collaborative model of care for dementia in which patients received 1 year of care management by an interdisciplinary team that was led by an advanced practice nurse working with family caregivers and integrated within primary care. The team used standard protocols to initiate treatment and identify, monitor, and treat behavioral and psychological symptoms of dementia, stressing non-pharmacological management. In this analysis, collaborative care resulted in significant improvements in quality of care and in behavioral and psychological symptoms of dementia among primary care patients and their caregivers.

“Improved dementia care benefits patients, their family caregivers, and the entire healthcare system.”

In the January 2011 issue of Aging & Mental Health, we successfully translated the memory care model we developed in the 2006 JAMA study into actual practice. We used the framework of the complex adaptive system and reflective adaptive process to translate the results of the dementia care trial into the Healthy Aging Brain Center (HABC). We essentially extended the definition of “patient” to include family members who enable cognitively impaired individuals to live in the community. Within 12 months of the initial HABC visit by care providers, only 28% of patients had at least one visit to an emergency room, compared with 50% of similar patients not seen at the HABC. Just 14% of HABC patients were hospitalized, with an average length of stay of 5 days, compared with a 7-day average length of stay for non-HABC patients. Only 5% of HABC patients received an order for neuroleptic therapies, and only 16% had simultaneous orders for both inappropriate anticholinergic and appropriate anti-dementia drugs.

Improving Dementia Care Benefits

The data we observed on the HABC model demonstrate clearly that improved dementia care benefits patients, their family caregivers, and the entire healthcare system. The HABC model stipulates that patients with dementia receive prescription and over-the-counter medications that do not harm the aging brain. These individuals do not require emergency treatment as often as others. If they’re hospitalized, they spend significantly less time there than those who do not receive dementia care within the HABC model. In addition to the benefits on health, the HABC model puts less emotional and financial burden on the individual, family members, and the system paying for healthcare.

The HABC model is currently serving patients from metropolitan Indianapolis, throughout the Midwest, and from as far away as Texas and California. HABC physicians, nurses, social workers, and other staff members work closely with dementia sufferers and family caregivers in the medical office and the home, as well as over the phone and via e-mail. The hope is that more research will further demonstrate that the HABC model will continue to deliver efficient, good care while also reducing depression and improving physical health for people with dementia. It’s an exciting time, as the HABC model is also being studied by others who provide memory care at sites across the United States and in Europe.

 

Readings & Resources (click to view)

Boustani MA, Sachs GA, Alder CA, et al. Implementing innovative models of dementia care: The Healthy Aging Brain Center. Aging Ment Health. 2011;15:13-22.Abstract available at:http://www.informaworld.com/smpp/content~db=all~content=a932727367~frm=titlelink.

Callahan CM, Boustani MA, Weiner M, et al. Implementing dementia care models in primary care settings: The Aging Brain Care Medical Home. Aging Ment Health. 2011;15:5-12.

Callahan CM, Boustani MA, Unverzagt FW, et al. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial. JAMA. 2006 May 10;295(18):2148-57. Available at: http://jama.ama-assn.org/content/295/18/2148.long.

Fortinsky RH, Kulldorff M, Kleppinger A, Kenyon-Pesce L. Dementia care consultation for family caregivers: collaborative model linking an Alzheimer’s association chapter with primary care physicians.Aging Ment Health. 2009;13:162-170.

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