Effectiveness and Safety of Dementia Care Management in Primary Care

Thyrian, Jochen René; Hertel, Johannes; Wucherer, Diana; Eichler, Tilly; Michalowsky, Bernhard; Dreier-Wolfgramm, Adina; Zwingmann, Ina; Kilimann, Ingo; Teipel, Stefan J.; Hoffmann, Wolfgang

doi:10.1001/jamapsychiatry.2017.2124

Cited by 149 publications

(203 citation statements)

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“…Other models include addressing the needs of family caregivers simultaneously with comprehensive disease management of people living with dementia to improve the quality of life of both 498 . Several evaluations have suggested that such approaches have considerable potential for improving outcomes for people with dementia and their family caregivers (for example, delayed nursing home admission and reduction in caregiver distress) 499‐508 . Current research is attempting to determine the feasibility of these models beyond the specialty settings in which they currently operate 509‐512 …”

Section: Caregivingmentioning

confidence: 99%

“…498 Several evaluations have suggested that such approaches have considerable potential for improving outcomes for people with dementia and their family caregivers (for example, delayed nursing home admission and reduction in caregiver distress). [499][500][501][502][503][504][505][506][507][508] Current research is attempting to determine the feasibility of these models beyond the specialty settings in which they currently operate. [509][510][511][512] In 2016, the National Academies of Sciences, Engineering, and Medicine released Families Caring for an Aging America, a seminal report that includes a number of recommendations to refocus national health care reform efforts from models of care that center on the patient (person-centered care) to models of care that also explicitly engage and support the patient's family (family-centered care).…”

Section: Enhancing Health Care For Family Caregiversmentioning

confidence: 99%

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2020 Alzheimer's disease facts and figures

2020

Alzheimer's & Dementia

2,033

653

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This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the future challenges of meeting care demands for the growing number of people living with Alzheimer's dementia in the United States with a particular emphasis on primary care. By mid‐century, the number of Americans age 65 and older with Alzheimer's dementia may grow to 13.8 million. This represents a steep increase from the estimated 5.8 million Americans age 65 and older who have Alzheimer's dementia today. Official death certificates recorded 122,019 deaths from AD in 2018, the latest year for which data are available, making Alzheimer's the sixth leading cause of death in the United States and the fifth leading cause of death among Americans age 65 and older. Between 2000 and 2018, deaths resulting from stroke, HIV and heart disease decreased, whereas reported deaths from Alzheimer's increased 146.2%. In 2019, more than 16 million family members and other unpaid caregivers provided an estimated 18.6 billion hours of care to people with Alzheimer's or other dementias. This care is valued at nearly $244 billion, but its costs extend to family caregivers’ increased risk for emotional distress and negative mental and physical health outcomes. Average per‐person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2020 for health care, long‐term care and hospice services for people age 65 and older with dementia are estimated to be $305 billion. As the population of Americans living with Alzheimer's dementia increases, the burden of caring for that population also increases. These challenges are exacerbated by a shortage of dementia care specialists, which places an increasing burden on primary care physicians (PCPs) to provide care for people living with dementia. Many PCPs feel underprepared and inadequately trained to handle dementia care responsibilities effectively. This report includes recommendations for maximizing quality care in the face of the shortage of specialists and training challenges in primary care.

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Section: Caregivingmentioning

confidence: 99%

Section: Enhancing Health Care For Family Caregiversmentioning

confidence: 99%

2020 Alzheimer's disease facts and figures

2020

Alzheimer's & Dementia

2,033

653

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“…In this service model, people living with dementia are allocated a care manager to coordinate care, facilitate collaboration between services and usually deliver care [49][50][51][52][53]. Dementia case management interventions have been associated with greater benefits for patient and carers if they are: for 6 months or more; multi-disciplinary, interprofessional, and delivered by a case worker with a skilled background (e.g.…”

Section: Dementia Case Management (Collaborative Care/care Coordination)mentioning

confidence: 99%

Developing the New Interventions for independence in Dementia Study (NIDUS) theoretical model for supporting people to live well with dementia at home for longer: a systematic review of theoretical models and Randomised Controlled Trial evidence

Lord

Beresford‐Dent

Rapaport

et al. 2019

Soc Psychiatry Psychiatr Epidemiol

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Purpose To build an evidence-informed theoretical model describing how to support people with dementia to live well or for longer at home. Methods We searched electronic databases to August 2018 for papers meeting predetermined inclusion criteria in two reviews that informed our model. We scoped literature for theoretical models of how to enable people with dementia to live at home independently, with good life quality or for longer. We systematically reviewed Randomised Controlled Trials (RCTs) reporting psychosocial intervention effects on time lived with dementia at home. Two researchers independently rated risk of bias. We developed our theoretical model through discussions with experts by personal, clinical and academic experiences, informed by this evidence base. Results Our scoping review included 52 studies. We divided models identified into: values and approaches (relational and recovery models; optimising environment and activities; family carer skills and support); care strategies (family carer-focused; needs and goal-based; self-management); and service models (case management; integrated; consumer-directed). The 11 RCTs included in our systematic review, all judged at low risk of bias, described only two interventions that increased time people with dementia lived in their own homes. These collectively encompassed all these components except for consumerdirected and integrated care. We developed and revised our model, using review evidence and expert consultation to define the final model. Conclusions Our theoretical model describes values, care strategies and service models that can be used in the design of interventions to enable people with dementia to live well and for longer at home. Trial registration PROSPERO 2018 registration number: CRD42018099693 (scoping review). PROSPERO 2018 registration number: CRD42018099200 (RCT systematic review).

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“…This analysis is based on data from a telephone-based questionnaire and semi-structured interview assessment in a convenience sample of n=141 people with cognitive impairment in the primary care setting in Mecklenburg-Western Pomerania and North-Rhine-Westphalia, respectively. Participants were recruited from currently running interventional trials intersec-CM (Supporting elderly people with cognitive impairment during and after hospital stays with intersectoral care management) [30] and the DCM:IMPact study (Dementia Care Management: Implementation into different Care Settings), an implementation study of the dementia care management of the DelpHi-MV trial [31][32][33]. The assessments were conducted during the time of the lockdown during study contacts between 22 nd of March and 5 th of June 2020, before restrictions were lifted.…”

Section: Methodsmentioning

confidence: 99%

“…DCM:IMPact complements the DelpHi-trial (Dementia: Lifeand person-centered help). In this study, the effective [32] and cost-e cient [33] dementia care management is implemented in different care settings, including ambulatory care services, dementia care networks, and hospitals.The study aims to evaluate various care setting for need and implementation barriers for such a model of care, and in how its effects could be optimized. The DCM:IMPact study started in 2019.…”

Section: Samplementioning

confidence: 99%

The situation of elderly with cognitive impairment living at home during lockdown in the Corona-pandemic in Germany

Thyrian

Kracht

Nikelski

et al. 2020

Preprint

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Abstract Background: The outbreak of the Corona virus is a challenge for health care systems worldwide. Elderly people with comorbidities are at a higher risk and the different levels of government in Germany reacted jointly to the challenge with social distancing and a lockdown. Little empirical evidence exists about the psychosocial situation of elderly people during this time. Thus, the aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety, and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of health care provision of people with cognitive impairment during social distancing and lockdown in the primary care system and daily living at home in Germany. Methods: This analysis is based on data from standardized telephone interviews in a convenience sample of n=141 people with known cognitive impairment in the primary care setting. Participants were recruited from currently running interventional trials. Therefore, data on e.g. cognitive and psychological status prior to the pandemic was available. Attitudes, knowledge about and perceived personal impact of the pandemic, social support, loneliness, anxiety, depression, frequency of social activities due to the pandemic and perceived impact of the pandemic on health care services were assessed during the time of lockdown. Results: The vast majority of participants consider themselves sufficiently informed about Corona (85%) and most think that the measures taken are appropriate (64%). A total of 11% shows one main symptom of a depression according to DSM-V. The frequency of depressive symptoms has not increased between the time before pandemic and lockdown in almost all participants. The sample shows minimal (65.0%) or low levels of anxiety (25%). The prevalence of loneliness is 10%. On average seven activities have decreased in frequency due to the pandemic. Social activities related to meeting people, dancing or birthday visits have decreased significantly. Talking with friends by phone and activities like gardening have increased. Utilization of health care services like day clinics, relief services and prescribed therapies are reported to have worsened due to the pandemic. Also visits to general practitioners decreased. Discussion: The study shows a limited impact of the pandemic on psychological variables including depression, anxiety and loneliness in the short-term. People are well informed but not especially concerned about themselves or others. There is a decrease in social activities as expected, in line with the restrictions imposed. The impact on health care provision is prominent. There is a need for longitudinal studies to assess longer-term effects of the pandemic and social distancing on elderly people with cognitive impairment living at home and their caregivers. There is also a need for qualitative, in-depth studies to further interpret the results. In general, elderly people in the setting under examination and with the limitations of this specific study seem to compensate restrictions during the time of lockdown in Germany rather well.

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Effectiveness and Safety of Dementia Care Management in Primary Care

Abstract: clinicaltrials.gov Identifier: NCT01401582.

Cited by 149 publications

References 50 publications

2020 Alzheimer's disease facts and figures

2020 Alzheimer's disease facts and figures

Developing the New Interventions for independence in Dementia Study (NIDUS) theoretical model for supporting people to live well with dementia at home for longer: a systematic review of theoretical models and Randomised Controlled Trial evidence

The situation of elderly with cognitive impairment living at home during lockdown in the Corona-pandemic in Germany

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