Online Program

Results and lessons learned from the proactive memory care study

Monday, November 4, 2013 : 11:18 a.m. - 11:30 a.m.

Richard Fortinsky, PhD, UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT
Colleen Delaney, PhD, RN, AHN-BC, School of Nursing, University of Connecticut, Storrs, CT
Ofer Harel, PhD, University of Connecticut, Storrs, CT
Karen Pasquale, MPH, Connecticut Center for Primary Care, Inc., Farmington, CT
Elena Schjavland, School of Nursing, University of Connecticut, Storrs, CT
John Lynch, Connecticut Center for Primary Care, Inc., Farmington, CT
Background: Primary care physicians (PCPs) face numerous constraints to providing optimal dementia care. Recent randomized controlled trials using advanced practice nurses (APNs) to enhance PCP care for patients and family caregivers (CGs) yielded favorable results; however, none has been successfully implemented and sustained in community-based PCP settings. We report pilot results from Proactive Memory Care (PMC), a public health-oriented, APN-led intervention in partnership with three community-based PCP group practices. Methods: We targeted community-dwelling patients age >50 with recent PCP-diagnosed irreversible dementia, and their CGs. The 12-month in-home intervention included comprehensive clinical assessments and non-pharmacologic dementia care-related protocols. Controls received in-home visits to learn about available dementia-related educational and community resources. Patient outcomes were 12-month changes in neuropsychiatric symptoms and quality of life; CG outcomes were changes in depressive symptoms, burden, and dementia management self-efficacy. Patients, CGs, and PCPs independently rated satisfaction with the intervention. Results: Twenty-one intervention group and 10 control group dyads participated. Patient and CG outcomes did not differ by treatment group, but neither patient group experienced measurable cognitive decline over the 12-month observation period. Patients, CGs, and PCPs reported overwhelming satisfaction with the intervention. Conclusions: While detection of intervention effects was hampered by unchanged patient cognition and small samples, the PMC intervention showed promise as an acceptable dementia care model from multiple stakeholder perspectives. Recruitment challenges will help inform future efforts to partner APNs with community-based PCP networks to provide coordinated dementia care consistent with Patient-Centered Medical Homes and Medicare Accountable Care Organizations.

Learning Areas:

Chronic disease management and prevention
Provision of health care to the public
Public health or related nursing

Learning Objectives:
Discuss how advanced practice nurses could be used as partners with primary care physicians to improve dementia care. Explain barriers in conducting research to test the efficacy and effectiveness of advance practice nurse models of dementia care in the primary care setting.

Keyword(s): Dementia, Nurse Practitioners

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal or co-investigator for numerous NIH-funded and other externally funded grants focused on improving dementia care by working with primary care providers, patients, and family caregivers.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.