Best-practice Models for Alzheimer's Disease Require Primary Care Redesign

Adopting new best-practice approaches to dementia care would decrease caregiver burden, rule out onerous treatments, and improve the quality of care for older adults with Alzheimer’s disease, but the current primary care structure is an obstacle to implementation, according to a review published in the April 2014 issue of Health Affairs.

“To date, the development of a cure for Alzheimer's disease remains elusive,” lead study author Christopher M. Callahan, MD, founding director of the Indiana University Center for Aging Research, noted in a statement. “We need to devote more resources to providing humane, high-touch, less costly care today and for many years to come for the large number of individuals who are and will be affected.”

To address the prevalent issue, Callahan and his colleagues reviewed the common evidence-based components of new dementia care models, discussed the barriers to their implementation, and described current efforts to employ 2 such models on a broad scale with support from the Center for Medicare and Medicaid Innovation (CMMI).

According to the review authors, the new care models for Alzheimer’s disease seek to incorporate common recommendations for the condition — such as providing support for the care recipient—caregiver dyad, facilitating regular cognitive activity, and managing comorbid conditions in the context of dementia — into an integrated system.

Ultimately, they said, the 2 models “seek to improve care management to avoid the inappropriate use of costly services, rely on care delivery teams in which nurses and care managers collaborate with physicians to provide much of the coordination and hands-on care, and emphasize the patient’s quality of life and family and individual decision making.”

Although there is sufficient evidence of both models improving dementia care quality and outcomes, they still have not been widely implemented in clinical practices. According to the researchers, that is because the models’ features — which include a team-based approach to care, a focus on the caregiver, and long-term symptom management — are “not easily applied within the current structure of primary care.”

As a result, the authors said the new approaches would “require a redesign of the physical and cultural practice environment … and a workforce prepared to provide team-based care to people with dementia across sites of care, (though) such a workforce is available only in a small number of specialized clinical sites.”

While considerable resources would be needed to execute those changes, the funds would be available if the new models “reduced the costs of hospitalization and other expensive services and the use of unwanted care,” the researchers noted.

“Although the impact of these interventions is modest, their success counters arguments that ‘nothing works,’ ” the investigators concluded. “Achieving the goals of better outcomes and lower costs will require leadership from academe, industry, government, and advocacy groups to advance the debate about what is the optimal approach to care for older adults with dementia who are nearing the end of life.”