A Multidimensional Home-Based Care Coordination Intervention for Elders with Memory Disorders: The Maximizing Independence at Home (MIND) Pilot Randomized Trial

Abstract

Objectives To assess whether a dementia care coordination intervention delays time to transition from home and reduces unmet needs in elders with memory disorders. Design 18-month randomized controlled trial of 303 community-living elders. Setting: 28 postal code areas of Baltimore, MD. Participants Age 70+, with a cognitive disorder, community-living, English-speaking, and having a study partner available. Intervention 18-month care coordination intervention to systematically identify and address dementia-related care needs through individualized care planning; referral and linkage to services; provision of dementia education and skill building strategies; and care monitoring by an interdisciplinary team. Measurements Primary outcomes were time to transfer from home and total percent of unmet care needs at 18 months. Results Intervention participants had a significant delay in time to all-cause transition from home and the adjusted hazard of leaving the home was decreased by 37% (HR = 0.63, 95% CI 0.42 to 0.94) compared to control participants. While there was no significant group difference in reduction of total percent of unmet needs from baseline to 18 months, the intervention group had significant reductions in the proportion of unmet needs in safety and legal/advance care domains relative to controls. Intervention participants had a significant improvement in self-reported quality of life (QOL) relative to control participants. No group differences were found in proxy-rated QOL, neuropsychiatric symptoms, or depression. Conclusions A home-based dementia care coordination intervention delivered by non-clinical community workers trained and overseen by geriatric clinicians led to delays in transition from home, reduced unmet needs, and improved self-reported QOL.

Caregivers as Therapeutic Agents in Dementia Care

“…These approaches include but are not limited to the use of innovative technologies to impart education and support (Czaja, Loewenstein, Schulz, Nair, & Perdomo, 2013;Glueckauf et al, 2012), multidisciplinary teams and collaborative primary care models (Callahan et al, 2011), community-based care management models Samus et al, 2014), clinic models (Huang et al, 2013), and interventions that feature a dyadic focus (Whitlatch, Judge, Zarit, & Femia, 2006). This recent ongoing phase also reflects attempts to examine a broader swath of outcomes, translate proven interventions for delivery and sustainability in service contexts Gitlin, Jacobs, & Earland, 2010;Gitlin, Marx, Stanley, & Hodgson, 2015;Nichols, Martindale-Adams, Burns, Graney, & Zuber, 2011), and replicate findings from previously tested interventions with different populations (Gaugler, Reese, & Mittelman, 2013).…”

A Randomized Controlled Trial of a Community-Based Dementia Care Coordination Intervention: Effects of MIND at Home on Caregiver Outcomes

“…The trial design and methods have been described previously (22). This 18-month randomized controlled trial included elders with memory disorders living at home (n=303) and their informal caregivers (n=278).…”

“…The intervention was developed to be applicable to a diverse group and implementable in a range of community settings (e.g., social service agencies). In a previous report on patient outcomes, we found that those receiving MIND experienced an overall delay in time to transition from home, reduced unmet care needs, and improved quality of life (QOL) compared to a similar group receiving augmented usual care over an 18 month period (22). …”

“…A recent randomized controlled trial, Maximizing Independence (MIND) at Home (22), used a comprehensive, multicomponent, home-based care coordination intervention to systematically identify and address dementia-related care needs of persons with memory disorders (i.e., dementia and mild cognitive impairment) and their caregivers through individualized care planning; referral and linkages to health and community services; provision of dementia education and skill building strategies to caregivers; and ongoing care monitoring by an interdisciplinary team comprised of non-clinical community workers (coordinators) linked to a nurse and a geriatric psychiatrist. The intervention was developed to be applicable to a diverse group and implementable in a range of community settings (e.g., social service agencies).…”

An evidence-based technological caregiver skill building intervention for dementia family caregivers: pilot study

“…In the fourth, and present phase of caregiver intervention research (2006 to present) there has been greater focus on the full continuum of dementia (i.e., early phase to end-of-life) [21], as well as greater use of innovative technology [25], multidisciplinary teams, collaborative primary care management models [21,[26][27], and dyadic focused interventions [28]. Nonetheless, continuing challenges with ADRD family caregiver interventions need to be addressed, such as translating these interventions and adapting them for integration into a care delivery setting and testing them on a larger scale [21].…”