A new study by researchers at Johns Hopkins University found that an in-home care coordination program for people with dementia improved their quality of care, quality of life, and ability to remain in home.
The study, which was presented July 18 at the Alzheimer’s Association International Conference in Vancouver, found that of those who received the in-home care coordination with follow-up visits, 70 percent were still living at home at the end of the 18-month study, while only 50 percent of a control group who received an initial consultation and usual care (without the in-home care coordination visits) remained at home. The other 50 percent of the control group had moved into a nursing home, hospital or assisted-living facility, or had died.
In addition, those who received the in-home care coordination reported fewer unmet needs and higher quality of life at the end of the study, than did those in the control group.
“Our study provides promising preliminary evidence that the [in-home care coordination] intervention can promote the ability to age in place and improve care quality,” said study author Quincy Miles Samus, Ph.D., of Johns Hopkins University School of Medicine, in a press release issued by the Alzheimer’s Association.
“We are hopeful this study will help guide how community-based dementia care can be effectively and efficiently delivered in the future,” Dr. Samus said.
“We estimate [administering a similar home-based care coordination program to community-dwelling seniors] would probably cost $1,000 to $2,000 per person per year,” Dr. Samus told HealthDay.
“In contrast, nursing homes can cost between $30,000 and $100,000 a year,” said the study’s co-author Gary Kennedy, M.D., of Montefiore Medical Center in New York City. “It would appear advantageous to Medicare’s expenditures to pay for [an at-home program],” he added.
“Our number one long-term goal is to gather enough evidence to be used by health care providers like Medicare to decide if they could pay for it,” Dr. Samus said.
Following is a full report on the study, its methodology and findings contained in a news release issued by the Alzheimer’s Association International Conference on July 18, 2012:
Care Coordination Program Improves Quality of Care and Quality of Life of People with Dementia
“Previous research shows that people with Alzheimer’s and other dementia disorders are at increased risk for disability, medical and mental health conditions, and placement in assisted living or nursing home settings. Similarly, their caregivers are also at increased risk for a host of medical, mental health, social and economic difficulties.
Evidence also suggests that education about and management of the disease, focused on identifying and treating symptoms and providing practical and emotional support, can provide multiple benefits for those with Alzheimer’s and their loved ones by minimizing the risk of complications and improving quality of life, mood, overall health, and prolonging independence.
Quincy Miles Samus, PhD, and colleagues at the Johns Hopkins University School of Medicine tested the efficacy of a multidimensional care coordination model to improve quality of care and other outcomes for community residing people with memory disorders, known as The Maximizing Independence at Home (MIND at Home) trial.
The 18-month controlled trial included 303 people with cognitive disorders (265 with dementia; 38 with mild cognitive impairment) age 70+, living at home in 28 zip codes near Baltimore, MD. Participants were randomized to receive the care coordination intervention (n=110) or augmented usual care (n=193). The intervention team included paraprofessionals specially trained in evidence-based dementia care, a psychiatric nurse, and a geriatric psychiatrist. The team implemented a standardized care coordination protocol consisting of a multidimensional needs assessment, community resource referrals, memory disorder education, counseling, and problem-solving, which were supported by a customized web-based application to monitor care progress.
Primary outcomes included unmet needs and time to transfer out of the home. Secondary outcomes were participant quality of life, neuropsychiatric symptoms, and depression.
The researchers found that study participants had a wide range of unmet needs. Home and personal safety issues, general medical care, meaningful activities, and legal issues were the most common. The intervention group had a greater decrease in total unmet needs from the beginning of the study to 18 months compared to the control group, with the most significant reductions in safety and legal issues. In addition, intervention participants were less likely to permanently leave their home or die compared to controls (30.0% vs. 45.6%) and had a significant reduction in time to leaving the home for any reason. Self-reported quality of life was better in the intervention group at 18 months. No group differences were found on proxy-rated quality of life, neuropsychiatric symptoms, or depression.
“Our study provides promising preliminary evidence that the intervention can promote the ability to age in place and improve care quality,” Samus said. “We are hopeful this study will help guide how community-based dementia care can be effectively and efficiently delivered in the future.”
“Further work is needed to evaluate how beneficial this intervention would be in other communities, such as those who live in disadvantaged areas. Plus, we need to work out how it might be paid for, sustained, and made available to larger groups of people over the long term,” Samus said.
Recently, the Alzheimer’s Association launched a new online assessment program, Alzheimer’s Navigator™ (www.alzheimersnavigator.org), to help caregivers and people with dementia evaluate their needs, identify action steps and connect with local programs and services. Developed with feedback from people living with Alzheimer’s and caregivers, Alzheimer’s Navigator allows users to reassess needs and adjust care plans as the disease progresses. Users can create and manage care teams so that multiple people, including long-distance caregivers, can access and participate in the customized action plan.
Alzheimer’s Association chapters nationwide facilitate more than 4,500 support groups and conduct 20,000 education programs annually. The Association provides consultation to 250,000 people in need each year through its toll-free 24/7 Helpline (1-800-272-3900). The only one of its kind, the Helpline is staffed by masters-level counselors and provides information and guidance in more than 170 languages and dialects.
The Alzheimer’s Association International Conference® (AAIC) is the world’s largest conference of its kind, bringing together researchers from around the world to report and discuss groundbreaking research and information on the cause, diagnosis, treatment and prevention of Alzheimer’s disease and related disorders. As a part of the Alzheimer’s Association’s research program, AAIC serves as a catalyst for generating new knowledge about dementia and fostering a vital, collegial research community.
About the Alzheimer’s Association®
The Alzheimer’s Association is the world’s leading voluntary health organization in Alzheimer’s care, support and research. Our mission is to eliminate Alzheimer’s through the advancement of research, to provide and enhance care and support for all affected, and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer’s. Visit www.alz.org or call 800-272-3900.”
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