Interventions to Help Caregivers of Dementia Patients. Mark E. Kunik, MD, MPH Houston VAMC, Dept of Psychiatry, Houston HSR&D CoE AND Many Other Collaborators Funders: Dept. of Veterans Affairs, Health Services Research & Development, SCMIRECC Robert Wood Johnson Foundation
Mark E. Kunik, MD, MPH
Houston VAMC, Dept of Psychiatry, Houston HSR&D CoE
Many Other Collaborators
Funders: Dept. of Veterans Affairs, Health Services Research & Development, SCMIRECC
Robert Wood Johnson Foundation
2012 Alzheimer’s Disease Facts and Figures
Fisher G, Franks M, Plassman B, et al. 2011
Quality of Life
Care Receiver Relationship Satisfaction
Quality of Life
IllnessPatient and Caregiver Interaction
Adapted from Trivedi, Piette, Fihn, & Edelman, 2011
Do you routinely identify the primary caregiver(s) of your patients with dementia?
Do you inquire about the caregiver’s health/needs?
Do you ask your middle age/older patients about stresses like caregiving?
Do you talk with caregiver about community services and supports? Prepare them for roles as care coordinators, hands-on providers?
Education (workshops, materials, individual consultation)
Skill Training/Psychoeducational programs
Psychotherapy for more complex problems, distress
Environmental Modifications to improve safety/function
Care Management for coordinating multiple services
Respite Care for a break from caregiving
Multi-component programs draw from several of these
Belle S et al: Annals of Int Med 2006
Austrom et. a.al. The Gerontologist 2004
Callahan et. al., JAMA 2006
Need for comprehensive care for Veterans and their caregivers
Little attention to addressing emotional and behavioral needs of patient
Impact of dementia on other medical problems overlooked
Inadequate attention to caregivers’ and Veterans’ need for information, skills, emotional support
Need chronic care model of care (linkage between community and medical resources and attention over time )
Patients and caregiver find it difficult to negotiate health care system and the many transitions across settings ranging from home to hospice
VA medical center and Alzheimer’s Association Chapter
50% time of Community Partner Care Coordinator (1.0 FTE) Caseload 75-120 dyads
For each veteran-caregiver dyad:
Co-existing medical conditions
ADL and IADL dependencies
Capacity to CareIntervention Domains
One son and grandson living nearby –limited understanding of dementia
Issues identified: driving safety, gun safety, relationship strain,(“hypersexuality”)
urinary incontinence ,
AA Care Consultant: Caregiver stress plan, safety response
VA DCC communicated to get incontinence supplies, involve MD as needed
Less negative psychosocial outcomes for Veterans and caregivers
Less facility-based service use by Veterans
More VA outpatient service use by Veterans
Lower VA healthcare cost for Veterans
Greater benefits for Veterans and caregivers who had more difficulties at enrollment
Greater benefits when Veterans are more impaired
Cost-data for only VA services, included inpatient services, emergency department visits, all types of outpatient services, and pharmacy
Intervention- compared to comparison-group Veterans were not significantly different in total VA healthcare costs for12-month study period
PDC Care Coordination was cost neutral despite 80% of families having Action Steps related to overcoming problems accessing VA services and benefits
PDC helped most Veterans and caregivers access VA benefits and services
Most psychosocial outcomes significantly improved after 6 months
Improved psychosocial outcomes were maintained but not increased during months 7 to 12
Most psychosocial outcomes improved when Veterans had more severe impairments or difficulties at enrollment
Some reduction in use of facility-based services: hospital re-admissions and likelihood of nursing home placement
Most VA outpatient services increased
No difference in VA healthcare costs during the 12 month study period despite assistance with service access
How emotionally distressing do you find (patient’s) behavior?
How often in the past six months, have you felt like screaming or yelling at (patient) because of the way he/she behaved?
In the past month or so has caregiving made you feel overwhelmed or extremely tired?
In the past month, have you felt depressed, sad, had crying spells or felt like you often needed to cry?