The United States spends well over $100 billion for millions of people affected by Alzheimer?s disease and related dementias (ADRD) and for their family caregivers. Most people with ADRD have multiple chronic comorbid conditions requiring help from family members for proper management. A lack optimal care for the cognitive, behavioral and functional needs of persons with dementia further compounds the challenge of managing chronic comorbid disease. Family caregivers of persons with dementia have many unmet needs as well. This adversely affects caregivers? ability to manage the chronic medical conditions of the person with dementia and may explain the greater use of emergency departments (EDs) and more return visits for those with dementia compared to those without dementia. How best to support family caregivers in preventing the need for emergency care has not been tested. The goal of this study is to test whether a novel care management program for family caregivers of persons with dementia can reduce the need for ED use. We will also test whether this intervention will lead to more activated caregivers who may also benefit by having fewer symptoms of depression and anxiety, and experiencing greater social support. This study focuses on family and friends who serve as caregivers of people with probable dementia who reach the crisis of needing emergency department care. The proposed intervention, the Program of Intensive Support in Emergency Departments for Care Partners of Cognitively Impaired Patients (POISED-CPCIP), will start in the emergency departments of two medical centers at academic institutions, New York University (NYU) and Indiana University (IU) and will recruit family caregivers and their care recipients (dyads) among patients who perform poorly on cognitive testing (indicating a high likelihood of dementia) and who are going to be discharged to home. We will randomize dyads to either the POISED intervention or to usual care. POISED will use typical dementia care management procedures provided by nurse care managers and care manager assistants who will additionally employ an intensive focus on understanding and supporting the needs of chronic disease management and on caregiver activation. In POISED, we will apply the principles of root cause analysis, a well-known quality improvement technique (that was started in the NASA space industry and later applied to health care) to understand what led to the ED visit and then apply what is learned to six months of care management. If this randomized controlled trial demonstrates reduced rates of ED use and a decrease in caregiver psychosocial symptoms, we will have validated a scalable program for supporting caregivers of people with dementia that should lead to significant healthcare cost reductions while providing much needed support for persons with dementia and for their family caregivers.
Dementia is a common problem for older patients presenting to emergency departments (EDs) and for their family caregivers, who often lack the support, understanding, and skill to manage the myriad of problems that may be related to the need for that ED visit. The POISED randomized controlled trial will use previously untested methods of root cause analysis to uncover reasons for ED use and will focus on caregiver activation within a program of dementia care management to reduce recurrent ED visits and improve caregiver symptoms of depression, anxiety and need for social support. If successful, POISED could provide large reductions in acute care utilization with associated benefits in health and psychosocial states for persons with dementia and for the family members who support them.
|Chodosh, Joshua; Thorpe, Lorna E; Trinh-Shevrin, Chau (2018) Changing Faces of Cognitive Impairment in the U.S.: Detection Strategies for Underserved Communities. Am J Prev Med 54:842-844|