Objective: Dementia is a common problem among older adults attending primary care clinics. However, these clinics are seldom designed to provide the necessary comprehensive care for these patients and their families. The purpose of this presentation is to describe a multi-faceted case management intervention in a multi-racial primary care clinic with particular attention to the education and support of Alzheimer's disease (AD) patients and their caregivers.
Design: The intervention consists of three components:
1. a comprehensive screening and diagnosis protocol;
2. a multi-disciplinary team approach to care, coordinated by a geriatric nurse practitioner (gnp); and
3. a proactive longitudinal tracking program. Patients with a diagnosis of probable or possible AD are randomly assigned to a treatment or control group following consent.
Materials and Methods: A pyschosocial component for the integrated program of collaborative care was developed. The care is coordinated by a gnp who meets with patients, families, and the primary care physicians. The non-pharmacological protocols included general educational guidelines about AD as well as exercise recommendations. Specific protocols to treat the common behavioral disturbances associated with AD were also developed. A major component of the intervention was a monthly psycho-educational support group for caregivers and an exercise group for the patients.
Results: To date, the intervention has been well tolerated by patients, families, and physicians. Approximately one half of the treatment group has regularly participated in the support groups. Non-pharmacological behavioral protocols have been triggered in almost all subjects (e.g., 83% with depression; 73% with aggression/agitation; and 26% with psychotic symptoms), but few additional pharmacological interventions have been necessary.
Conclusion: A multi-faceted intervention program for a primary care clinic with a large proportion of minority patients and their caregivers is described. So far the intervention has been well accepted.
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