May 9, 2006
A collaborative heath-care team, including the use of a nurse who specializes in treating Alzheimer's disease, may help to ease agitation, depression, and other behavioral and psychological symptoms of dementia. Collaborative care may also benefit those who care for loved ones with Alzheimer's disease by lowering stress levels and easing depression. These are the findings of a recent study reported in the Journal of the American Medical Association.
Like most older Americans, seniors with Alzheimer's disease tend to receive their medical care from a generalist, or primary care, physician. Although primary care doctors commonly prescribe medications to ease agitation and other behavior problems in these patients, most medical centers and clinics are not appropriately staffed and set up to provide comprehensive management of Alzheimer's disease, the study authors report.
Researchers at the Indiana University School of Medicine in Indianapolis conducted a randomized controlled trial to test the effectiveness of collaborative care management. Eighty-four patients received collaborative care, while sixty-nine patients received good, but standard, Alzheimer's care. Collaborative care included the use of a nurse or other care manager who supported the patient's caregiver and physician and adhered to recommended treatment protocols. The care manager took special care to identify, monitor, and treat behavioral and psychological symptoms of dementia, such as agitation or aggression, sleep disturbances, delusions or hallucinations, and depression. He or she also offered assistance with personal care and mobility issues. When appropriate, the treatment protocols stressed management without medications.
The minimum care that all treatment group caregivers and patients received included education on communication skills; caregiver coping skills; legal and financial advice; patient exercise guidelines, including a guidebook and videotape; and a caregiver guide. All of the components of this minimum intervention were provided by a geriatric nurse practitioner, who served as the care manager. Participants and their caregivers were also provided written materials and information describing local community resources, and received face-to-face counseling by a geriatric nurse practitioner.
The researchers found that those men and women with Alzheimer's who received the enhanced care had significantly fewer behavioral and psychological symptoms of dementia after 12 months, and again at 18 months. Caregivers also reported significant improvements in distress at 12 months; after 18 months, caregivers were also less likely to be suffering from depression. There was no evidence, however, that the enhanced care improved or worsened cognition, activities of daily living, or rates of nursing home placement.
"In summary, application of the current treatment guidelines for the care of older primary care patients with Alzheimer disease results in significant improvements in behavioral and psychological symptoms of dementia and significant improvement in caregiver stress," the authors conclude. "These improvements exceed those previously reported in studies focusing on pharmacological therapy alone. The intervention demonstrates that care for patients with Alzheimer disease can be improved in the primary care setting, but not without substantial changes in the system of care."
The findings bolster earlier reports from New York University and other medical centers that enhanced care offers many benefits for those who care for a loved one with Alzheimer's disease.
For more on Alzheimer's care and treatment, visit www.ALZinfo.org.
Christopher M. Callahan, MD, Malaz A. Boustani, MD, MPH, Frederick W. Unverzagt, PhD, et al: "Effectiveness of Collaborative Care for Older Adults with Alzheimer Disease in Primary Care: A Randomized Conrolled Trial." Journal of the American Medical Association, Volume 295, Number 18, May 10, 2006, pages 2148-2157.