Study Shows Benefits for Veterans with Dementia who Participate in VA Program Integrating Healthcare and Community Services
BACKGROUND:
To address the complex and diverse care issues associated with Alzheimer's disease, VA is working to develop a comprehensive system of support services for Veterans with dementia and their informal caregivers. This study tested the effectiveness of a telephone-based care-coordination program – Partners in Dementia Care (PDC) – that integrated healthcare and community services through structured coaching and support. Delivered via partnerships between VAMCs and Alzheimer's Association chapters, PDC targeted both Veterans and their primary informal caregivers (i.e., family member, friend). The intervention has four main ways of helping Veterans and their families: 1) providing educational information, 2) offering emotional support and coaching, 3) linking families to medical and non-medical services and resources, and 4) facilitating an informal care network. In this controlled trial, Veterans selected from two VISNs (1 and 16) received PDC for 12 months, while Veterans that were part of comparison sites in the same two VISNs received usual care. The study period was 12 months. Telephone interviews were conducted with Veterans at baseline (n=333), 6-month follow-up (n=263), and 12-month follow-up (n=194). Five self-reported outcomes from Veterans were assessed: 1) unmet needs, 2) embarrassment about memory problems, 3) isolation, 4) relationship strain, and 5) depression symptoms. In addition, a wide range of baseline measures were used to test for initial differences between Veterans in the PDC vs. usual care groups.
FINDINGS:
- Compared to usual care, PDC was associated with significantly lower levels of self-reported adverse outcomes. Improvements in all but one outcome (embarrassment about memory problems) were restricted to Veterans who were more cognitively impaired or had more difficulties with personal care.
- Beneficial effects after 6 months were evident in reduced relationship strain, depression, and unmet needs for more impaired Veterans – and reduced embarrassment about memory problems for all Veterans. In addition, between months 6 and 12, there were further reductions in unmet needs for more impaired Veterans.
- Nearly all Veterans in this study were men (97%), and nearly all caregivers were women (95%).
LIMITATIONS:
- This study did not test whether outcomes differed among Veterans depending on the specific tailored content of the PDC intervention.
IMPLICATIONS:
- Large-scale implementation of PDC outside of a research study will require more information on the cost, financing, reimbursement, marketing strategies, and ability to integrate it with existing services and information systems.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D. Drs. Kunik and Ms. Wilson are part of HSR&D's Houston Center for Innovations in Quality, Effectiveness and Safety.
Bass D, Judge K, Snow A, Wilson N, et al, and Kunik M. A Controlled Trial of “Partners in Dementia Care:” Veteran Outcomes after Six and Twelve Months. Alzheimer’s Research & Therapy February 28, 2014;6:9.
