2015 DEPARTMENT OF MEDICINE RESEARCH DAY
Title of Poster: Dementia Care Co-management Improves One-Year Patient and
Caregiver Health Outcomes
Presenter: Lee A. Jennings, MD MSHS
Division: Geriatrics
☒Faculty ☐Fellow ☐Resident ☐Post-doc Research Fellow ☐Graduate Student ☐Medical Student ☐Other
Principal Investigator/Mentor: David B. Reuben, MD
Co-Investigators: Wenger N, Tan Z, Evertson L, Serrano K
Thematic Poster Category: Health Services and Economics of Health Care
Abstract
Background: Among dementia caregivers, strain, depression, and low self-efficacy for caregiving are
common and often poorly addressed in primary care. To better meet patient and caregiver needs, in
July 2012, UCLA launched the Alzheimer’s and Dementia Care (ADC) Program, a quality improvement
program that uses a co-management model with a nurse practitioner working with primary care
physicians and community organizations to provide comprehensive dementia care.
Methods:
Design: Pre-post evaluation one-year after program enrollment
Setting: Urban academic medical center with primarily fee-for-service reimbursement
Participants: Community-dwelling adults enrolled in the program
Measurements: Caregivers completed the Cornell Scale for Depression in Dementia and the
Neuropsychiatric Inventory Questionnaire (NPI-Q) about the patient; the Patient Health Questionnaire
(PHQ-9) and Modified Caregiver Strain Index (MCSI) about themselves; and a survey assessing
caregiver self-efficacy for managing dementia-related problems and accessing help developed for the
ADC Program. Scales were compared using paired t-tests or Wilcoxon signed rank sum tests. Survey
items were compared using McNemar’s test.
Results: 345 patient-caregiver dyads were seen for an annual follow-up visit (60% of enrollees
eligible), and 297 (86%) completed scales and surveys. Mean patient age was 82 years, 68% were
female, and 63% lived with the caregiver. 66% of caregivers were female and 91% were spouses or
children. Baseline scores for all scales, age, and gender did not differ between enrollees who
completed a one-year follow-up visit and those who did not.
One year after enrollment, patient cognitive and functional status had declined consistent with
expected rates for dementia. For patients, caregivers reported fewer depressive symptoms (Cornell)
and fewer behavioral symptoms (NPI-Q severity score). For themselves, caregivers reported fewer
depressive symptoms (PHQ-9), less distress related to patients’ behaviors (NPI-Q distress score), and
lower strain (MCSI). (Table)
Conclusions: The UCLA ADC program was able to improve patient and caregiver outcomes associated
with dementia. Higher self-efficacy for caregiving may result in improved behavioral management and
increased support leading to less caregiver strain. Whether these improved clinical outcomes are
associated with lower health care utilization remains to be determined.
UCLA Alzheimer’s and Dementia Care Program Annual Outcomes, N=297
Measure
Modified Caregiver Strain Index (MCSI), range 0-26
Caregiver Patient Health Questionnaire (PHQ-9), range 0-27
Neuropsychiatric Inventory Questionnaire (NPI-Q) severity score, range 036
Neuropsychiatric Inventory Questionnaire (NPI-Q) distress score, range 060
Mini Mental State Exam (MMSE), range 0-30
Functional Assessment Questionnaire (FAQ), range 0-30
Cornell Depression Scale in Dementia, range 0-38
Caregiver Survey of Dementia Care and Self-Efficacy, selected items
I have received advice about handling problems like the patient's memory
loss, wandering or behavior problems.
I know how to get community services that will help me provide care.
I feel confident that I can deal with the frustrations of caregiving.
I have a healthcare professional who helps me work through dementia care
problems.
p<0.01 for all comparisons, except NPI-Q severity score p=0.06.
For all scales, except the MMSE, a higher value indicates greater severity.
Baseline
M (SD)
10.8 (6.4)
4.6 (4.8)
9.8 (6.4)
Year 1
M (SD)
9.7 (6.0)
3.6 (4.1)
9.1 (6.4)
12.2 (9.3)
10.1 (8.6)
19.0 (6.2)
20.3 (8.4)
10.0 (5.9)
16.0 (7.0)
23.3 (7.8)
7.6 (5.7)
39%
82%
18%
35%
24%
58%
58%
72%