November 1, 2014
Elderly men and women with Alzheimer’s and other serious memory problems who got home visits and care assessments from a nurse and memory care coordinator were able to remain at home much longer than those who didn’t get such visits, a new study found. The results show that relatively simple measures like assessing home safety, vision and hearing checks and daily activity plans can produce improvements at relatively low costs.
The 18-month pilot study, from researchers at Johns Hopkins School of Medicine in Baltimore, assessed 303 elderly city residents with dementia and mild cognitive impairment. As part of the study, 110 of them got a home visit from a memory care coordinator and nurse.
The care team provided follow-up visits as needed and looked at various care needs, including home and driving safety checks and whether individuals were at risk of wandering and getting lost, concerns for a vast majority of the participants. The care team also addressed meal and nutrition plans, assessed what kinds of daily activities were available beyond simply watching TV, including programs at local community centers, taught patients and family members about Alzheimer’s, and provided informal counseling and discussed legal issues like advance directives and wills.
In addition to such services, the care team looked at untreated medical problems like hearing or vision loss, diabetes and high blood pressure and worked with a medical team to provide reviews of the medications that patients were taking.
The health team then developed a personalized care plan and, over time, worked with family members to oversee progress and attend to new needs that arose. Coordinators contacted family members at least once a month.
The experimental program, known as the Maximizing Independence (MIND) at Home, allowed those with Alzheimer’s and similar problems to stay in their homes almost 10 months longer than those who didn’t get such help, a two year follow-up found. Remaining at home, rather than going to a nursing home or assisted living center, was strongly preferred by those in the study.
“The project demonstrated that we were able to help such people age in place without sacrificing their quality of life,” said study leader Quincy Miles Samus, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins. “This can make a huge difference in terms of comfort, money and quality of life for those involved.” The findings were published in The American Journal of Geriatric Psychiatry.
The researchers found that participants who met regularly with coordinators were significantly less likely to leave their homes than those who didn’t get such care. They also lived longer, with a better quality of life.
The memory care coordinators were community workers and did not have clinical backgrounds or prior training in caring for people with memory disorders. They received four weeks of training, including lectures, role play and observation of dementia patients in clinical settings, so the investment in educating the care coordinators was not extensive.
Some insurance programs do not cover home help, so the study was designed to assess whether such programs can produce better results at lower costs. It seemed to do both, since care in nursing homes or hospitals costs far more than home care.
Sources: Johns Hopkins Medicine. Quincy M. Samus, Deirdre Johnston, Betty S. Black, Edward Hess, et al: “A Multidimensional Home-Based Care Coordination Intervention for Elders with Memory Disorders: The Maximizing Independence at Home (MIND) Pilot Randomized Trial .” The American Journal of Geriatric Psychiatry. Jan. 6, 2014.