Proactive Primary Dementia Care

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DESCRIPTION (provided by applicant): Dementia, an age-associated clinical syndrome characterized by irreversible loss or decline in memory and other cognitive abilities, is a growing health problem. In 2008, an estimated 5.2 million Americans have Alzheimer's disease (AD), which comprises about 70 percent of all dementia; AD prevalence alone is projected to increase to more than 11 million by 2050. Family members caring for people with dementia often suffer adverse health consequences. Primary care physicians are usually the first contact for older people with memory loss complaints and their families, but substantial evidence shows that physicians face numerous constraints to providing comprehensive dementia care. Several recent randomized controlled trials to enhance primary care for these patients and families have found positive results; however, none has been successfully sustained beyond the study period or replicated in community-based primary care settings. Accordingly, the long range goal of this developmental study is to implement an evidence-based nurse-practitioner guided dementia care intervention, linked to one or more groups of primary care physicians in a defined geographic area, to maximize health-related outcomes in patients with new or recently diagnosed AD or other age-associated dementia and their family caregivers. The proposed 12-month intervention, Proactive Primary Dementia Care (PPDC), is grounded in the Progressively Lowered Stress Threshold model of dementia care, and utilizes evidence-based nonpharmacologic protocols along with medication and comorbidity monitoring in tandem with physicians. Specific aims and major hypotheses are: Specific Aim #1: Determine the preliminary efficacy of PPDC on health-related outcomes in patients and their primary family caregivers. Patient-specific hypotheses: Patients receiving PPDC will show reduced or more stabilized neuropsychiatric symptoms, and improved or more stabilized self-reported quality of life, compared to control group patients. Caregiver-specific hypotheses: Caregivers receiving PPDC will show reduced or more stabilized depressive symptoms and burden, and increased or more stabilized self-efficacy for managing dementia, compared to caregivers in the control group. Specific Aim #2: Determine the acceptability of PPDC to physicians, patients, and caregivers. Specific Aim #3: Examine the preliminary financial sustainability of PPDC. A total of 35 patient-caregiver dyads will be recruited to participate in PPDC from two primary care practice sites; 35 dyads will be recruited for the control group from two different practice sites, and they will receive and review with study personnel educational material about dementia and community resources, and will be encouraged to seek further information and help as they see fit. PUBLIC HEALTH RELEVANCE: Dementia is a public health problem of rapidly growing proportions. Cognitive and behavioral symptoms characteristic of dementia are often extremely stressful to patients and their families. The intervention proposed in this developmental study is based on substantial evidence that primary care physicians require assistance from other health care practitioners to meet the needs of patients and families from the point of diagnosis onward. Evidence-based, theoretically grounded interventions are needed to enhance dementia care in the primary care setting, in a proactive fashion from the time of diagnosis or as soon as possible thereafter, to avoid or alleviate poor health-related outcomes in patients and their family caregivers.