SummaryIn a partnership between Veterans Administration medical centers and local Alzheimer’s Association chapters in Boston and Houston, two-person care coordinator teams provided telephone-based support to patients with dementia and their caregivers over a 12-month period. The teams addressed medical and nonmedical needs through education, coaching, linkages to needed resources, and mobilization of an informal care network. Known as Partners in Dementia Care, the program consisted of an upfront assessment, development of care goals and action steps, and ongoing monitoring and intervention. The two care coordinators collaborated through weekly phone calls and via secure electronic communication. Coordinators and managers across the two sites participated in biweekly calls to share lessons and advice. The program improved psychosocial outcomes (e.g., depression, care-related strain) for veterans and their caregivers, reduced hospital readmissions and the likelihood of institutional placement for veterans with more severe problems, and enhanced access to outpatient services. The program was generally well accepted by patients/families, physicians, and sponsoring partner organizations, and has led to increased caregiver satisfaction with Veterans Administration services. Except for a small number of outlying high-cost veterans, use of the program was not related to increased or decreased costs of VA health care services.Moderate: The evidence consists of a matched, comparison group trial evaluating various psychosocial outcomes, service use outcomes, and VA service costs in program participants in two sites (Boston, MA and Houston, TX) to a group of similar dementia patients and caregivers receiving usual care in three sites (Providence, RI; Beaumont, TX; and Oklahoma City, OK). Additional evidence includes post-implementation reports from care coordinators on patient/family, physician, and partner organization acceptance and use of the program.
Developing OrganizationsBaylor College of Medicine; Benjamin Rose Institute on Aging; Cleveland State University; Department of Veterans Affairs
Researchers at Cleveland State University, the Benjamin Rose Institute on Aging, the Baylor College of Medicine, and the Department of Veterans Affairs (VA) developed the program in collaboration with researchers within or affiliated with local Alzheimer's Association chapters in Houston, TX; Boston, MA; Oklahoma City, OK; Providence, RI; Seattle, WA; and Tuscaloosa, AL. The program was implemented by VA medical centers and local Alzheimer's Association chapters in Boston and Houston, with the remaining sites serving as a comparison group.
Use By Other OrganizationsThe Administration on Aging (AoA) recently funded two projects that are making use of the single coordinator version of the program originally used in Cleveland—one in Georgia with three local area Agencies on Aging and a second in Tennessee that features a partnership between Alzheimer’s Tennessee, Inc. and Humana. In October 2011, AoA funded a replication of the Partners in Dementia Care program (entitled Partners in Dementia Care: A Dementia Capable System of Care for Ohio Veterans and Their Caregivers) in Ohio that will operate outside of a controlled research study. AoA has also supported adaptations of the program for individuals with other chronic diseases, including older adults with multiple chronic conditions.
Date First Implemented2006
The 5-year trial ran from 2006 to 2011.
Patient PopulationThe program served veterans age 60 and older with a diagnosis of Alzheimer's disease or other dementia who lived in the community at enrollment; during the trial, the vast majority of veterans were male and most caregivers female.
Problem AddressedDementia is a common disease that exacts a great toll on both patients and their caregivers. Clinicians caring for dementia patients often lack the time, knowledge, and resources to help in meeting the challenges caused by the disease. Various forms of assistance, including counseling, case management, and care coordination services, can be effective in meeting these needs, but relatively few patients and caregivers have access to such support.
- A common, devastating, and costly problem: Over 5 million Americans (including one in eight of those age 65 and over and nearly half of those 85 and older) live with Alzheimer’s disease, a figure that is expected to triple to 16 million by 2050. Alzheimer’s disease is the fifth-leading cause of death among older adults, and deaths due to the disease increased by 66 percent between 2000 and 2008 (a time when deaths due to many other major diseases fell). In 2010, 14.9 million family and friends provided 17 billion hours of unpaid care to those with Alzheimer’s and other forms of dementia; the economic value of these hours totaled $202.6 billion.1
- Leading to significant physical and emotional burden: In addition to dementia's devastating impact on patients, those who care for these patients face great challenges that frequently lead to high levels of emotional stress, depression, declining physical health, and problems with employment, income, and/or financial security.2 For example, more than 60 percent of Alzheimer’s and dementia caregivers rate the emotional stress of caregiving as high or very high; one-third report symptoms of depression.1 This collective burden increases the caregiver’s risk of death.3
- Unrealized potential of case management support: Interventions that provide counseling, case management, and care coordination services have been shown to reduce caregiver burden and improve their quality of life.4,5,6 Yet primary care practices and hospital-based providers, including those at the VA, often lack the time and resources to provide such support. In particular, they tend not to focus on issues related to caregivers and generally know little about community-based resources that can help.
Description of the Innovative ActivityIn a partnership between VA medical centers and local Alzheimer’s Association chapters in Boston and Houston, two-person care coordinator teams provided telephone-based support to patients with dementia and their caregivers over a 12-month period. The team addressed medical and nonmedical needs through education, coaching, linkages to needed resources, and mobilization of an informal care network. The program consisted of an upfront assessment, development of care goals and action steps, and ongoing monitoring and intervention by the two coordinators, who communicated with each other regularly. Major program elements included the following:
- Identifying and enrolling eligible patients: Eligible patients were identified through a search of electronic registries generated by the VA electronic medical record (EMR) system, with a focus on those diagnosed within the last 2 years. A VA-based care coordinator called eligible patients to explain the program and the role of the care coordinators, and then enrolled those interested. Outside of a trial setting, eligible patients can be referred by physicians, community-based organizations serving the elderly (e.g., senior centers, retirement communities, assisted living facilities), and/or patients and caregivers themselves.
- Assignment to two-coordinator team: Each family was assigned a team of two coordinators—one from the VA medical center and one from the local chapter of the Alzheimer’s Association. The VA-based coordinator generally focused on the veterans’ medical and nonmedical needs, and on helping veterans and family members effectively use VA resources. Alzheimer Association coordinators focused on the needs of informal caregivers (such as accessing non-VA resources that can help reduce their burden) and on the nonmedical needs of veterans that could not be handled by the VA.
- Initial assessment of care needs: Over the course of one or more calls, the VA-based care coordinator administered a multidimensional assessment of the patient and caregiver(s). Based on standardized tools, the assessment collected self-reported data on 23 domains for patients and 14 for caregivers. Caregivers answered questions on behalf of patients too impaired to do so. For domains in which the information collected suggested the need for more details, the tool triggered followup questions about the scope, severity, or urgency of the need. The VA coordinator typically conducted the followup for patient care-related issues, while the Alzheimer's Association coordinator took the lead on caregiver-related issues. During the trial, the typical family triggered just under nine domains, divided fairly evenly between patient and caregiver. Major patient needs included concerns about sensory issues, personal care, task assistance, falls, medications, home safety, pain, depression, sleep problems, difficult behaviors, and anxiety. For caregivers, major concerns included social isolation, capacity to provide care, anxiety, physical and emotional strain, need for informal support, depression, legal and financial problems, and emotional support.7
- Meeting to designate primary coordinator, develop care plan: After the assessment, the two care coordinators met (usually by phone but sometimes in person) to review and discuss the assessment results, prioritize patient and caregiver needs, determine who should serve as primary coordinator, and develop a care plan for patient and caregiver. Typically, the VA coordinator served as primary coordinator when the veterans’ needs were greatest, while the Alzheimer's Association coordinator did so when caregiver needs appeared most urgent. Designation of the primary coordinator could change as needs changed.
- Ongoing telephone-based support: Both coordinators maintained contact with the patient and family throughout the year, with calls scheduled according to a standardized protocol or more frequently as determined by veterans’ and caregivers’ needs. At a minimum, families received calls at least twice a month for the first 3 months, and then on a monthly basis thereafter. Over the course of the year, the typical patient–caregiver dyad had just over 14 contacts with care coordinators (eight by VA coordinators and six by Alzheimer's Association coordinators), with the average contact lasting 14 minutes.7,8 The vast majority (78 percent) took place by phone, with the remainder being by e-mail, regular mail, or in person.7,8 During these interactions, the coordinators focused on developing goals and related action steps for achieving them, and on monitoring progress in accomplishing action steps and/or adding new ones, as outlined below:
- Developing goals: The coordinators worked with the patient and caregiver to create specific goals to address the most important needs identified in the assessment. During the 12-month trial, the average patient-caregiver dyad had 5.2 goals identified. Goals typically related to any of four major ways that coordinators support families, including disease-related education and information, emotional support and coaching, linkages to medical and nonmedical resources, and mobilization of an informal care network.7,8
- Creating action steps: Action steps laid out concrete behavioral tasks to help the family achieve its goals. For example, one action step could be for the caregiver to contact a local daycare center to find out if it had space available and if the facility would be appropriate for the patient. Each action step identified the person responsible for completing it, an expected completion date, and, as appropriate, the names of agencies and/or professionals to be contacted. Over the course of the year, the typical family had 6.6 action steps identified. Action steps most frequently related to accessing various benefits and services, particularly from the VA (78.2 percent of families had this type of action step), community-based organizations (75.5 percent), and the local Alzheimer Association chapter (58.8 percent). Responsibility for completing the step most often fell to the caregiver (41.9 percent of the time), with a coordinator being assigned responsibility roughly one-third of the time. At the end of the trial, 59 percent of action steps had been successfully accomplished, with another 17.3 percent partially accomplished and still in progress.7,8
- Monitoring action steps: Both coordinators monitored the status of action steps on a regular basis to ensure timely completion of tasks and to address barriers, modify or add action steps, and identify new goals as necessary.
- Regular communication between coordinators: To facilitate the provision of seamless, coordinated support, the two care coordinators used a clinical information system developed specifically for this program to communicate securely with each other, along with weekly meetings to review cases, as outlined below:
- Communication and information-sharing through database: Care coordinators used a customized clinical information system known as the Care Coordination Information System to guide the delivery of services. The resulting database served as a shared electronic record for each participant and a tool to monitor the fidelity of the intervention. It included six types of information on each patient/caregiver served: contact, enrollment, and sociodemographic information; care needs; goals; action steps; ongoing monitoring; and information and educational resources. Coordinators regularly used it to monitor and update the status of goals and action steps and to communicate securely with each other via encrypted e-mail. VA coordinators could also use the system to communicate with other VA providers. The system generated a brief summary of all care coordination activities that was integrated into the EMR.
- Weekly meeting: Each week, the two coordinators talked by phone or met in person for 1 to 2 hours to review and discuss their active cases. Early on, these meetings provided an opportunity to review the initial assessment and develop an appropriate plan of action. Over time, they tended to focus more on logistical issues (e.g., who will conduct the next call with the patient/caregiver) and troubleshooting problems and challenges.
- Biweekly, cross-site calls to support coordinators: Care coordinators from the two implementing sites (Boston and Houston) participated in an hour-long training call every other week, facilitated by researchers with background and expertise in care coordination for dementia patients. These calls provided an opportunity to discuss challenges related to particular cases and adhering to the program’s protocols. The coordinators shared problems they faced, strategies for overcoming them, and other lessons learned, while the managers offered advice and guidance.
- Transition planning and final action plan: Because the trial lasted for 12 months, the care coordinators worked with the patient and caregiver at the end of the year to develop a final action plan. This plan included a review of progress to date along with a list of current and future goals and action steps and relevant contact information for community- and medical center–based resources needed by the patient and caregivers. Outside the context of a research study, this step may be unnecessary, as the program can continue indefinitely. After a year, many patients and caregivers will be in a stable situation and likely require only a monthly check-in, along with the option to call a care coordinator as needed.
Context of the InnovationThe Alzheimer's Association is a global, voluntary organization focused on Alzheimer's care and support, and the largest private, nonprofit funder of Alzheimer's research in the world. The VA is the largest health care system in the United States, operating 152 medical centers that provide comprehensive care to more than 5.5 million veterans each year, including more than 570,000 with dementia. The impetus for this program came from researchers at the Benjamin Rose Institute on Aging (in Cleveland), Cleveland State University, Baylor College of Medicine, and the VA, along with administrators, policy experts, and service providers from organizations across the country, including the Alzheimer’s Association. They felt this approach was ideally suited to helping primary care clinicians and other providers within VA medical centers better support dementia patients and their caregivers. Historically, these providers lacked the time and resources to attend to patient needs that went beyond diagnostic assessment and medication management. In particular, they had little familiarity with the many challenges faced by caregivers of dementia patients, or with how to access community-based resources that could help deal with these challenges.
The researchers decided to refine an existing care coordination model that had been used effectively elsewhere. The original model, developed at the Benjamin Rose Institute and the Cleveland chapter of the Alzheimer's Association in the mid-1990s, made use of a single care coordinator (referred to as a care consultant) who worked with both patients and caregivers. First implemented with Kaiser enrollees as part of the Cleveland Alzheimer’s Managed Care Demonstration, this program improved caregiver depression and satisfaction.9 However, it focused primarily on the community aspects of support, with little or no changes in Kaiser’s approach to managing dementia. A few years later, the Chronic Care Networks for Alzheimer’s Disease (CCN/AD) initiative modified the Cleveland approach by adopting a two-person care coordinator team as part of a comprehensive, multicomponent program that also assisted providers in diagnosing, assessing, and managing dementia. Adopted in six different geographic areas (including by five VA medical centers and local Alzheimer’s Association chapters in Upstate New York), this broad-based program achieved a variety of positive outcomes for providers and patients/caregivers, although the evaluation did not focus specifically on the impact of the care coordinator teams. Seeing the potential of the two-person coordinator team, researchers involved in CCN/AD, the Cleveland project, and the VA worked collaboratively to refine the care coordination component for use by VA medical centers and local Alzheimer's Association chapters.
Partners in Dementia Care was also guided or informed by five other investigations of the single care coordinator model conducted by the Benjamin Rose Institute and numerous collaborators, as outlined below:
- Integrated Care Management, Administration on Aging, 2005 to 2007
- Care Network for Depression for Older Adults and Family Caregivers, Aetna Foundation, 2006 to 2009
- Care Consultation Implementation in Cleveland, Ohio, Rosalynn Carter Institute on Caregiving, Johnson & Johnson Initiative, 2009 to 2011
- Tennessee Replication of Care Consultation, Administration on Aging, 2009 to 2012
- The Georgia Care Consultation Program, Administration on Aging, 2010 to 2013
ResultsThe program improved psychosocial outcomes for veterans and caregivers, reduced hospital readmissions and the likelihood of institutional placement for veterans with more severe problems, and enhanced access to VA outpatient services. The program was generally well accepted by patients/families, physicians, and sponsoring partner organizations. With the exception of a small number of outlying high-cost veterans, there were no differences in VA health care costs between those in the program and those in the comparison group.
Moderate: The evidence consists of a matched, comparison group trial evaluating various psychosocial outcomes, service use outcomes, and VA service costs in program participants in two sites (Boston, MA and Houston, TX) to a group of similar dementia patients and caregivers receiving usual care in three sites (Providence, RI; Beaumont, TX; and Oklahoma City, OK). Additional evidence includes post-implementation reports from care coordinators on patient/family, physician, and partner organization acceptance and use of the program.
- Improved psychosocial outcomes: Compared with a group of similar patients and caregivers receiving usual care and general dementia education, veterans and caregivers participating in the program achieved better psychosocial outcomes, as outlined below:
- Caregiver outcomes: Overall, 8 of 11 measured psychosocial outcomes were significantly better among caregiver participants than those in the comparison group, either for all caregivers or for the subset caring for more impaired veterans. After 6 months in the program, participating caregivers as a whole exhibited better outcomes related to levels of depression (with 15 percent fewer symptoms) and use of support services. Also after 6 months, participants caring for more severely impaired veterans exhibited fewer feelings of being trapped in their role, less physical health strain, greater satisfaction with the VA health care system, and fewer unmet needs. Between months 7 and 12, all of these improvements were maintained, and participating caregivers also gained access to more informal help and experienced less strain in their relationship with veterans.8
- Patient outcomes: Overall, 6 of 8 psychosocial outcomes were significantly better among participating dementia patients than among those in the comparison group, with the bulk of these improvements being for veterans with more severe impairments who could still complete the research interviews. After 6 months in the program, veterans participating in the program experienced less embarrassment about memory problems and had fewer unmet needs, lower levels of depression, and less relationship strain with their caregivers than did those in the comparison group. These gains largely held during the second half of the program, with the exception of level of embarrassment about memory problems.8
- Fewer readmissions, institutional placements among most impaired: Participants with more behavioral problems experienced 20 percent fewer hospital readmissions than similar members of the comparison group. Participants with greater cognitive impairments were less likely to be placed in a nursing home or assisted living facility, with only a fifth of participants experiencing such placements compared with roughly one-third of those in the comparison group. Outside of the readmission figure cited above, the program had no impact on the likelihood of an inpatient admission or emergency department visit.8
- Enhanced access to VA outpatient services: Participants were much more likely to have a neurology visit, mental health visit, and telephone-based care than those in the comparison group. In addition, participants with more personal care dependencies had more primary care visits. Use of outpatient surgery and other outpatient services, and the number of neurology, mental health, and telephone care contacts did not differ between the groups.8
- No Difference in Health Care Costs: After adjusting for a small number of outlying high-cost veterans, there were no significant differences in the costs of the VA health care services between program participants and the comparison group.
- Generally well received by key stakeholders: A survey of six care coordinators (three each from the VA medical centers and local Alzheimer's Association chapters) found that the program was generally well accepted and used by patients and families, physicians, and partner organizations. Rating the difficulty of implementation with each key stakeholder on a scale of 0 (indicating not a difficulty) to 2 (indicating major difficulty), care coordinators rated acceptance and use by patients and families as 1.33 (indicating moderate difficulty, which is understandable given the nature of the disease and the challenges faced by these families), physician participation as 0.58 (indicating little or no difficulty), and organizational partnership barriers as 0.88 (also indicating only minor difficulties).7
Planning and Development ProcessKey steps included the following:
- Identifying champions at partner organizations: Researchers identified administrators and/or physicians at VA medical centers and local Alzheimer’s Association chapters who had adequate resources and an interest in testing innovative models for dementia care. These champions sought the support of physicians, nurses, social workers, and support staff within their organizations.
- Refining existing program protocols: Researchers refined the program protocols developed as part of the Cleveland initiative and CCN/AD. This process included development of the following: procedures for identifying eligible patients and families, guidelines for the frequency and timing of contacts between care coordinators and patients/families, and procedures to promote effective collaboration between the partner organizations.
- Developing clinical information system: Researchers designed the information system to be easy to use and to allow for the effective communication and transfer of information between the coordinators in a manner that complied with VA security and information requirements.
- Training care coordinators: A psychologist and social worker with significant experience in dementia care led several half- and full-day training sessions for the care coordinators over a one-month period, with support from members of the project team. Training focused on the care coordinators’ roles and responsibilities, available services and resources in the community, procedures for sharing information and coordinating cases (including use of the clinical information system), and developing and writing goals and action steps that match the priorities and needs of patients and caregivers.
- Educating physicians: Respected physicians and program investigators within the medical centers led several group and individual meetings (often during lunch) with peers to describe the program, with an emphasis on how to identify and refer eligible patients.
Resources Used and Skills Needed
- Staffing: During the trial, the program required two half-time care coordinators at each site. One coordinator was employed by the VA and the other by the local Alzheimer’s association. Each coordinator team jointly managed between 75 and 120 families. Coordinators tended to be bachelor- or master's-level social workers, nurses, or counselors. In addition, a volunteer at the local association chapter provided administrative support (e.g., assistance with mailings), dedicating roughly 25 percent of his/her time to the program.
- Costs: Roughly 90 percent of costs go to salary and benefits for the care coordinators. One full-time, bachelor's-level coordinator earns around $50,000 a year plus benefits, while a master's-level coordinator would earn more. If a volunteer is not available, a paid quarter-time assistant would be needed. Other expenses include purchasing computers for the care coordinators (if necessary) and investing in marketing to generate referrals, including meetings with physicians and local outreach to potential referral sources.
Funding SourcesRobert Wood Johnson Foundation; Alzheimer's Association; VA Houston Center of Excellence; VA South Central Mental Illness Research and Education Center; Department of Veterans Affairs Health Services Research and Development
Tools and Other ResourcesMore information on the Partners in Dementia Care program can be found at: http://www.benrose.org/Research/EBP_CareConsultation.cfm.
Getting Started with This Innovation
- Identify and leverage champions: Success depends on having champions within each partner organization willing to promote the program. An effective physician champion can be instrumental in educating and reminding peers about the need to refer patients to the program. Sometimes a geriatrician who takes a holistic approach to medicine will be best suited to play this role.
- Invest in upfront training: Both care coordinators and referring physicians need to be educated on the program’s protocols as they are implemented.
- Invest in clinical information systems: The shared database functions as a “living, breathing” document that facilitates the provision of effective care coordination services.
- Consider structuring as ongoing program: Although the program has largely been implemented as part of time-limited research studies thus far, “real-world” implementers should consider making it an ongoing, permanent service. As noted, most long-time enrollees need only a monthly or quarterly check-in and the ability to contact a care coordinator on an as-needed basis.
Sustaining This Innovation
- Continue monitoring and training: The biweekly cross-site calls help ensure that care coordinators adhere to established protocols and allow for sharing of best practices and troubleshooting of difficult cases.
- Periodically remind providers about program: Busy physicians, social workers, and nurses may forget about the program in the absence of periodic reminders. To that end, send out monthly or quarterly communications urging referral of newly diagnosed dementia patients.
- Cultivate other referral sources: Organizations serving a captive audience of elderly individuals can be a good source of referrals, such as Medicare Advantage plans, area Agencies on Aging, senior centers, retirement communities, elder law attorneys, financial and retirement planning companies, and assisted living facilities. Area Agencies on Aging may be particularly attractive partners, as these organizations often view telephone-based support as a lower-cost alternative to inperson case management services already being offered. If resources allow, targeted radio, television, and billboard advertising can also be considered.
- Approach payers about potential for reimbursement: In the future, public and private payers may be willing to provide reimbursement for program-related services. To convince them, monitor and share data on the program’s impact, including its potential to reduce expensive health care episodes, such as inpatient readmissions, emergency department visits, and nursing home placements.
- Consider expansion to other chronic diseases: Based in large part on the well-established Chronic Care Model,10 this type of program can be used with patients who have other chronic conditions that require ongoing management and support from community-based resources, including those that do not involve a caregiver.
Contact the InnovatorKatherine S. Judge, PhD
Department of Psychology
Cleveland State University
Cleveland, OH 44115-2214
David M. Bass, PhD
Margaret Blenkner Research Institute of the Benjamin Rose Institute on Aging
11900 Fairhill Rd., Suite 300
Cleveland, OH 44120
Mark E. Kunik, MD, MPH
Houston Center for Quality of Care & Utilization Studies
Health Services Research and Development Service
Michael E. DeBakey Veterans Affairs Medical Center
Baylor College of Medicine
Veterans Affairs South Central Mental Illness Research, Education and Clinical Center.
Innovator DisclosuresDr. Judge, Dr. Bass, and Dr. Kunik have not indicated whether they have financial interests or business/professional affiliations relevant to the work described in this profile; however, information on funders is available in the Funding Sources section.
References/Related ArticlesJudge KS, Bass DM, Snow AL, et al. Partners in dementia care: a care coordination intervention for individuals with dementia and their family caregivers. Gerontologist. 2011;51(2):261-72. [PubMed]
Bass DM, Clark PA, Looman WJ, et al. The Cleveland Alzheimer's managed care demonstration: outcomes after 12 months of implementation. Gerontologist. 2003;43(1):73-85. [PubMed]
Clark PA, Bass DM, Looman WJ, et al. Outcomes for patients with dementia from the Cleveland Alzheimer's Managed Care Demonstration. Aging Ment Health. 2004;8(1):40-51. [PubMed]
Gallagher KS, Bass DM, Judge KS, et al. Satisfaction with dementia care. (Accepted for publication/Federal Practitioner).
Shub D, Bass DM, Morgan RO, et al. Prevalence and associations of symptoms of irritability and social isolation in dementia patients with and without depression. (Accepted for publication/J Geriatr Psychiatry Neurol).
Bass DM, Judge KS, Snow L, et al. Prevalence and predictors of depression, care-related strain, and unmet needs among caregivers of patients with dementia. (Accepted for publication/Am J Geriatr Psychiatry).
Bradford A, Upchurch C, Bass DM, et al. Knowledge of documented diagnosis and treatment in veterans with dementia and their caregivers. Am J Alzheimers Dis Other Dem. 2011;26(2):127-33. [PubMed]
Shrestha S, Judge KS, Wilson NL, et al. Utilization of legal and financial services in partners in dementia care study. Am J Alzheimers Dis Other Dem. 2011;26(2):115-20. [PubMed]
Maslow K, Selstad J. Chronic care networks for Alzheimer’s disease: approaches for involving and supporting family caregivers in an innovative model of dementia care. Alzheimer’s Care Quarterly. 2001;2:33-46.
Schulz R, Martire LM. Family caregiving of persons with dementia: prevalence, health effects, and support strategies. Am J Geriatr Psychiatry. 2004;12(3):240-9. [PubMed]
Schulz R, Beach SR. Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA. 1999;282(23):2215-9. [PubMed]
4 Brodaty H, Green A, Koschera A. Meta-analysis of psychosocial interventions for caregivers of people with dementia. J Am Geriatr Soc. 2003;51(5):657-64.
Schulz R, Martire LM, Klinger JN. Evidence-based caregiver interventions in geriatric psychiatry. Psychiatr Clin North Am. 2005;28(4):1007-38. [PubMed]
Belle SH, Burgio L, Burns R, et al. Enhancing the quality of life of dementia caregivers from different ethnic or racial groups: a randomized, controlled trial. Ann Intern Med. 2006;145(10):727-38. [PubMed]
Judge KS, Bass DM, Snow AL, et al. Partners in dementia care: a care coordination intervention for individuals with dementia and their family caregivers. Gerontologist. 2011;51(2):261-72. [PubMed]
8 Partners in Dementia Care: A Care Coordination Intervention for Veterans with Dementia and Their Family Caregivers. December, 2011. Summary of Findings Report submitted to Department of Veterans Affairs and Alzheimer’s Association.
Bass DM, Clark PA, Looman WJ, et al. The Cleveland Alzheimer's managed care demonstration: outcomes after 12 months of implementation. Gerontologist. 2003;43(1):73-85. [PubMed]
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Original publication: February 29, 2012.
Original publication indicates the date the profile was first posted to the Innovations Exchange.
Last updated: February 06, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.
Date verified by innovator: January 14, 2013.
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