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Zwingmann I, Hoffmann W, Michalowsky B, Wucherer D, Eichler T, Teipel S, Dreier-Wolfgramm A, Kilimann I, Thyrian JR. [Unmet needs of family dementia caregivers of persons with dementia : Primary medical care]. DER NERVENARZT 2018; 89:495-499. [PMID: 29619534 DOI: 10.1007/s00115-018-0509-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Results of current research studies revealed that providing informal care for people with dementia (PwD) is associated with caregivers' burden and a variety of health impairments. In order to provide optimal support for family caregivers of PwD, general practitioners and specialists should be able to identify caregivers' unmet needs in primary care. OBJECTIVES The present article provides an overview of unmet needs of family caregivers that are relevant for general practitioners as well as specialists in neurology, psychiatry, psychotherapy and psychosomatics. MATERIAL AND METHODS The present overview is based on current reviews on unmet needs of caregivers of PwD and on results of the general practitioner-based, cluster-randomized controlled intervention trial DelpHi-MV (Life- and person-centred help in Mecklenburg-Western Pomerania, Germany; Identifier: NCT01401582). RESULTS The article provides an overview of unmet needs of family caregivers for PwD, especially in the domains of social integration, psychological and physical health, legal and financial issues, as well as available and valid measurements. DISCUSSION The article illustrates the importance and the possibilities for general practitioners and specialists to identify caregivers' unmet needs. The question to what extent unmet needs' assessments for family caregivers of PwD could be implemented and financed in routine care is still under debate.
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Affiliation(s)
- I Zwingmann
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland.
| | - W Hoffmann
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
- Institut für Community Medicine, Abteilung Versorgungsepidemiologie und Community Health, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - B Michalowsky
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
| | - D Wucherer
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
| | - T Eichler
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
| | - S Teipel
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
- Klinik für Psychosomatik und Psychotherapeutische Medizin, Universitätsmedizin Rostock, Rostock, Deutschland
| | - A Dreier-Wolfgramm
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
| | - I Kilimann
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
- Klinik für Psychosomatik und Psychotherapeutische Medizin, Universitätsmedizin Rostock, Rostock, Deutschland
| | - J R Thyrian
- Standort Rostock/Greifswald, Deutsches Zentrum für Neurodegenerative Erkrankungen e. V. (DZNE), Ellernholzstr. 1-2, 17487, Greifswald, Deutschland
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Teipel SJ, Keller F, Thyrian JR, Strohmaier U, Altiner A, Hoffmann W, Kilimann I. Hippocampus and Basal Forebrain Volumetry for Dementia and Mild Cognitive Impairment Diagnosis: Could It Be Useful in Primary Care? J Alzheimers Dis 2018; 55:1379-1394. [PMID: 27834778 DOI: 10.3233/jad-160778] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Once a patient or a knowledgeable informant has noticed decline in memory or other cognitive functions, initiation of early dementia assessment is recommended. Hippocampus and cholinergic basal forebrain (BF) volumetry supports the detection of prodromal and early stages of Alzheimer's disease (AD) dementia in highly selected patient populations. OBJECTIVE To compare effect size and diagnostic accuracy of hippocampus and BF volumetry between patients recruited in highly specialized versus primary care and to assess the effect of white matter lesions as a proxy for cerebrovascular comorbidity on diagnostic accuracy. METHODS We determined hippocampus and BF volumes and white matter lesion load from MRI scans of 71 participants included in a primary care intervention trial (clinicaltrials.gov identifier: NCT01401582) and matched 71 participants stemming from a memory clinic. Samples included healthy controls and people with mild cognitive impairment (MCI), AD dementia, mixed dementia, and non-AD related dementias. RESULTS Volumetric measures reached similar effect sizes and cross-validated levels of accuracy in the primary care and the memory clinic samples for the discrimination of AD and mixed dementia cases from healthy controls. In the primary care MCI cases, volumetric measures reached only random guessing levels of accuracy. White matter lesions had only a modest effect on effect size and diagnostic accuracy. CONCLUSIONS Hippocampus and BF volumetry may usefully be employed for the identification of AD and mixed dementia, but the detection of MCI does not benefit from the use of these volumetric markers in a primary care setting.
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Affiliation(s)
- Stefan J Teipel
- German Center for Neurodegenerative Diseases (DZNE) -Rostock/Greifswald, Rostock, Germany.,Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany
| | - Felix Keller
- German Center for Neurodegenerative Diseases (DZNE) -Rostock/Greifswald, Rostock, Germany.,Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany
| | - Jochen R Thyrian
- German Center for Neurodegenerative Diseases (DZNE) -Rostock/Greifswald, Greifswald, Germany
| | - Urs Strohmaier
- German Center for Neurodegenerative Diseases (DZNE) -Rostock/Greifswald, Greifswald, Germany.,Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Attila Altiner
- Institute of General Practice, University of Rostock, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE) -Rostock/Greifswald, Greifswald, Germany.,Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE) -Rostock/Greifswald, Rostock, Germany.,Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany
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Implementation of [18F]-labeled amyloid brain PET imaging biomarker in the diagnosis of Alzheimer’s disease. Nucl Med Commun 2018; 39:186-192. [DOI: 10.1097/mnm.0000000000000787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Michalowsky B, Flessa S, Eichler T, Hertel J, Dreier A, Zwingmann I, Wucherer D, Rau H, Thyrian JR, Hoffmann W. Healthcare utilization and costs in primary care patients with dementia: baseline results of the DelpHi-trial. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:87-102. [PMID: 28160100 DOI: 10.1007/s10198-017-0869-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 01/10/2017] [Indexed: 05/18/2023]
Abstract
The objectives of this cross-sectional analysis were to determine healthcare resource utilization and cost for community-dwelling patients with dementia (PWD) from a payer's and societal perspective, and to analyze the associations between costs and sociodemographic and clinical variables. Analysis of healthcare costs from a payer's perspective was based on a sample of 425 PWD, analysis of healthcare costs from societal perspective on a subsample of 254 PWD and their informal caregivers. Frequency of healthcare resource utilization was assessed by means of questionnaires. Informal care and productivity losses were assessed by using the Resource Utilization in Dementia questionnaire (RUD). Costs were monetarized using standardized unit costs. To analyze the associations, multiple linear regression models were used. Total annual costs per PWD valued 7016€ from a payer's and 25,877€ from a societal perspective, meaning that societal cost is approximately three and a half times as much as payer's expenditures. Costs valuated 5456 € for medical treatments, 1559 € for formal care, 18,327€ for informal care. Productivity losses valued 1297€ for PWD caregivers. Informal care could vary substantially (-21%; +33%) concerning different valuation methods. Medical care costs decreased significantly with progression of dementia and with age. Costs of care double over the stages of dementia. Formal care costs were significantly higher for PWD living alone and informal care costs significantly lower for PWD with an employed caregiver. For all cost categories, deficits in daily living activities were major cost drivers.
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Affiliation(s)
- Bernhard Michalowsky
- Department Translational Health Care Research, German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany.
| | - Steffen Flessa
- Department of General Business Administration and Health Care Management, Ernst Moritz Arndt University Greifswald, 17489, Greifswald, Germany
| | - Tilly Eichler
- Department Translational Health Care Research, German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany
| | - Johannes Hertel
- Department Translational Health Care Research, German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany
| | - Adina Dreier
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany
| | - Ina Zwingmann
- Department Interventional Health Care Research, German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany
| | - Diana Wucherer
- Department Translational Health Care Research, German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany
| | - Henriette Rau
- Department Translational Health Care Research, German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany
| | - Jochen René Thyrian
- Department Interventional Health Care Research, German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany
| | - Wolfgang Hoffmann
- Department Translational Health Care Research, German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstrasse 1-2, 17487, Greifswald, Germany
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Abstract
BACKGROUND Older people have a higher risk of drug-related problems (DRPs). However, little is known about the prevalence of DRPs in community-dwelling people who screened positive for dementia. Our study aimed to determine (1) the prevalence and types of DRPs and (2) the socio-demographic and clinical variables associated with DRPs in people screened positive for dementia in primary care. METHODS The Dementia: life- and person-centered help in Mecklenburg-Western Pomerania (DelpHi-MV) study is a general practitioner (GP)-based cluster-randomized controlled intervention study to implement and evaluate an innovative concept of collaborative dementia care management in the primary care setting in Germany. Medication reviews of 446 study participants were conducted by pharmacists based on a comprehensive baseline assessment that included a computer-based home medication assessment. ClinicalTrials.gov Identifier: NCT01401582. RESULTS A total of 1,077 DRPs were documented. In 414 study participants (93%), at least one DRP was detected by a pharmacist. The most frequent DRPs were administration and compliance problems (60%), drug interactions (17%), and problems with inappropriate drug choice (15%). The number of DRPs was significantly associated with the total number of drugs taken and with a formal diagnosis of a mental or behavioral disorder. CONCLUSIONS Degree of cognitive impairment (MMSE defined) and formal diagnosis of dementia were not risk factors for an increased number of DRPs. However, the total number of drug taken and the presence of a diagnosis of mental and behavioral disorders were associated with an increased total number of DRPs.
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Thyrian JR, Eichler T, Michalowsky B, Wucherer D, Reimann M, Hertel J, Richter S, Dreier A, Hoffmann W. Community-Dwelling People Screened Positive for Dementia in Primary Care: A Comprehensive, Multivariate Descriptive Analysis Using Data from the DelpHi-Study. J Alzheimers Dis 2017; 52:609-17. [PMID: 27031481 DOI: 10.3233/jad-151076] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Efficient help and care for people with dementia (PWD) is dependent on knowledge about PWD in primary care. OBJECTIVE This analysis comprehensively describes community-dwelling PWD in primary care with respect to various dementia care specific variables. METHODS The analyses are based on baseline data of the ongoing general practitioner-based, randomized, controlled intervention trial DelpHi-MV (Dementia: life- and person-centered help). 6,838 patients were screened for dementia in 136 GP practices; 17.1% were screened positive, 54.4% of those agreed to participate and data could be assessed in n = 516 subjects. We assessed age, sex, living situation, cognitive status, functional status, level of impairment, comorbidities, formal diagnosis of dementia, depression, neuropsychiatric symptoms, quality of life, utilization of medical support, and pharmacological therapy. RESULTS Concerning clinical-, dementia-, and health-related variables, the sample under examination was on average mildly cognitively and functionally impaired (MMSE, m = 22.2; BADL, m = 3.7). A level of care was assigned in 38.0%. Depression was identified in 15.4% and other frequent comorbidities were high blood pressure (83.3%), coronary heart diseases (37.1%), cerebrovascular diseases (22.3%), among others. In 48.6%, neuropsychiatric symptoms were present in a clinically relevant severity. Pharmacological treatment with antidementia medication was received by 25.8% and antidepressant medication by 14.0%. Utilization of services was generally low. CONCLUSION The comprehensive description of people screened positive for dementia in primary care reveals a complex and unique population of patients. They are considerably underdiagnosed and in their majority mildly to moderately affected. More in-depth analyses are needed to study relations, associations and interactions between different variables.
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Affiliation(s)
- Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Melanie Reimann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Steffen Richter
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany
| | - Adina Dreier
- Institute for Community Medicine, University of Greifswald, Epidemiology of Health Care and Community Health, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), site Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, University of Greifswald, Epidemiology of Health Care and Community Health, Greifswald, Germany
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Thyrian JR, Hertel J, Wucherer D, Eichler T, Michalowsky B, Dreier-Wolfgramm A, Zwingmann I, Kilimann I, Teipel S, Hoffmann W. Effectiveness and Safety of Dementia Care Management in Primary Care: A Randomized Clinical Trial. JAMA Psychiatry 2017; 74:996-1004. [PMID: 28746708 PMCID: PMC5710469 DOI: 10.1001/jamapsychiatry.2017.2124] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE Dementia care management (DCM) can increase the quality of care for people with dementia. Methodologically rigorous clinical trials on DCM are lacking. OBJECTIVE To test the effectiveness and safety of DCM in the treatment and care of people with dementia living at home and caregiver burden (when available). DESIGN, SETTING, AND PARTICIPANTS This pragmatic, general practitioner-based, cluster-randomized intervention trial compared the intervention with care as usual at baseline and at 12-month follow-up. Simple 1:1 randomization of general practices in Germany was used. Analyses were intent to treat and per protocol. In total, 6838 patients were screened for dementia (eligibility: 70 years and older and living at home) from January 1, 2012, to March 31, 2016. Overall, 1167 (17.1%) were diagnosed as having dementia, and 634 (9.3%) provided written informed consent to participate. INTERVENTIONS Dementia care management was provided for 6 months at the homes of patients with dementia. Dementia care management is a model of collaborative care, defined as a complex intervention aiming to provide optimal treatment and care for patients with dementia and support caregivers using a computer-assisted assessment determining a personalized array of intervention modules and subsequent success monitoring. Dementia care management was targeted at the individual patient level and was conducted by 6 study nurses with dementia care-specific qualifications. MAIN OUTCOMES AND MEASURES Quality of life, caregiver burden, behavioral and psychological symptoms of dementia, pharmacotherapy with antidementia drugs, and use of potentially inappropriate medication. RESULTS The mean age of 634 patients was 80 years. A total of 407 patients received the intended treatment and were available for primary outcome measurement. Of these patients, 248 (60.9%) were women, and 204 (50.1%) lived alone. Dementia care management significantly decreased behavioral and psychological symptoms of dementia (b = -7.45; 95% CI, -11.08 to -3.81; P < .001) and caregiver burden (b = -0.50; 95% CI, -1.09 to 0.08; P = .045) compared with care as usual. Patients with dementia receiving DCM had an increased chance of receiving antidementia drug treatment (DCM, 114 of 291 [39.2%] vs care as usual, 31 of 116 [26.7%]) after 12 months (odds ratio, 1.97; 95% CI, 0.99 to 3.94; P = .03). Dementia care management significantly increased quality of life (b = 0.08; 95% CI, 0 to 0.17; P = .03) for patients not living alone but did not increase quality of life overall. There was no effect on potentially inappropriate medication (odds ratio, 1.86; 95% CI, 0.62 to 3.62; P = .97). CONCLUSIONS AND RELEVANCE Dementia care management provided by specifically trained nurses is an effective collaborative care model that improves relevant patient- and caregiver-related outcomes in dementia. Implementing DCM in different health care systems should become an active area of research. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01401582.
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Affiliation(s)
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany,Department of Psychiatry and Psychotherapy, Greifswald Medical School, University of Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | | | - Adina Dreier-Wolfgramm
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Greifswald Medical School, University of Greifswald, Greifswald, Germany
| | - Ina Zwingmann
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany,Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Greifswald Medical School, University of Greifswald, Greifswald, Germany
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Translation of imaging biomarkers from clinical research to healthcare. Z Gerontol Geriatr 2017; 50:84-88. [DOI: 10.1007/s00391-017-1225-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 03/10/2017] [Accepted: 03/13/2017] [Indexed: 01/12/2023]
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[People with dementia in primary care : Prevalence, incidence, risk factors and interventions]. Z Gerontol Geriatr 2017; 50:32-38. [PMID: 28386806 DOI: 10.1007/s00391-017-1223-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 03/02/2017] [Accepted: 03/08/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Approximately 110 years after the first description of Alzheimer's disease (AD) healthcare systems worldwide face the challenge of increasing numbers of people affected by dementia. There is a need to develop (national) dementia plans on a societal level to implement strategies to combat these challenges. These plans, among other topics, explicitly aim at scientific and research strategies as well as support and healthcare structures. OBJECTIVE This article describes a selection of current healthcare research studies and projects in Germany. Selected studies are presented which deliver concepts and approaches to answer the most pressing issues in dementia healthcare research in primary care and the scientific evidence is summarized. Future needs in dementia research and healthcare research are presented. MATERIAL AND METHODS The projects under examination are (a) the Leipzig longitudinal study of the aged (LEILA75+), (b) the German study on aging, cognition and dementia (AgeCoDe), (c) the dementia care initiative in primary practice (IDA), (d) the Dementia: life- and person-centered help in Mecklenburg-Western Pomerania (DelpHi) trial, (e) studies analyzing dementia care networks (IDEMUCK and DemNet-D) and (f) the general hospital study (GHoSt). RESULTS AND DISCUSSION Prevalence and incidence studies have shown how high the impact of AD is on the current healthcare systems and how it is expected to be in the future. Other studies have identified risk factors as well as protective factors that can serve as target points for the development of effective interventions. They also give hints on where the healthcare system might benefit from changes. Healthcare research has identified scientific methods helpful in providing sound evidence for decision makers in health policy. These have been applied in healthcare research close to routine care and have shown their impact on routine care; however, there are healthcare-specific challenges when applying scientific methods in routine care, which are briefly described.
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Dreier-Wolfgramm A, Michalowsky B, Austrom MG, van der Marck MA, Iliffe S, Alder C, Vollmar HC, Thyrian JR, Wucherer D, Zwingmann I, Hoffmann W. Dementia care management in primary care : Current collaborative care models and the case for interprofessional education. Z Gerontol Geriatr 2017; 50:68-77. [PMID: 28364258 DOI: 10.1007/s00391-017-1220-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/27/2017] [Accepted: 03/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Dementia is one of the most prevalent diseases in the older population. Various dementia care models have been developed to address patient's healthcare needs. They can be described as "collaborative care" or "person-centered care". Referring to the needs of the workforce working with persons with dementia, a key element is the use of interprofessional education (IPE). OBJECTIVE The purpose of this article is to describe different international collaborative care models to define a minimum standard of healthcare professions for collaborative dementia care in primary care. This helps to identify requirements for IPE to optimize care of people with dementia and to support informal caregivers in the future. MATERIAL AND METHODS In this article six dementia care models from 4 different countries (Germany, USA, UK and Netherlands) are described and compared regarding aims, interventions and healthcare professionals involved. RESULTS Care teams are minimally comprised of general practitioners or primary care providers, nurses, and social workers. Additional healthcare disciplines may be involved for specific interventions. Mostly, care team members received specific training but such training did not necessarily incorporate the IPE approach. To ensure successful collaboration of professions, IPE training programs should at least consist of the following core topics: (1) early diagnosis, (2) postdiagnostic support, (3) advanced care planning for patients and caregivers and (4) effective collaborative care. CONCLUSION The IPE programs for dementia should be expanded and must be widely implemented in order to assess the impact on collaborative practice. This study will provide the knowledge base for structuring IPE trainings developing educational agendas and adapting existing guidelines to improve collaborative dementia care in the future.
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Affiliation(s)
- Adina Dreier-Wolfgramm
- Institute for Community Medicine, Dept. Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany.
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - Mary Guerriero Austrom
- Department of Psychiatry, Indiana Alzheimer Disease Center, Indiana University Center for Aging Research (IU-CAR), Indiana University School of Medicine (IUSM), Indianapolis, USA
| | - Marjolein A van der Marck
- Radboud Institute for Health Sciences, Department of Geriatric Medicine/Radboudumc Alzheimer Centre, Radboud university medical centre, Nijmegen, Netherlands
| | - Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Catherine Alder
- USA Regenstrief Institute, Inc., Eskenazi Health, Indianapolis, USA
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany.,Institute of General Practice and Family Medicine, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - Ina Zwingmann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine, Dept. Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany.,German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
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Eichler T, Hoffmann W, Hertel J, Richter S, Wucherer D, Michalowsky B, Dreier A, Thyrian JR. Living Alone with Dementia: Prevalence, Correlates and the Utilization of Health and Nursing Care Services. J Alzheimers Dis 2017; 52:619-29. [PMID: 27031480 DOI: 10.3233/jad-151058] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Little is known about the proportion and the characteristics of community-dwelling people with dementia (PWD) living alone in Germany. OBJECTIVES To analyze the prevalence of PWD living alone (with and without the support of an informal caregiver) and socio-demographical and clinical characteristics as well as health and nursing care utilization associated with living alone. METHODS DelpHi-MV (Dementia: Life- and person-centered help in Mecklenburg-Western Pomerania) is a general practitioner-based, randomized controlled intervention trial. The present analyses are based on baseline data of 511 patients (≥70 years, community-dwelling) who had screened positive for dementia (DemTect <9). RESULTS N = 251 (51%) of the patients lived alone. PWD living alone were statistically significantly more often female, older, and more often widowed than those not living alone. About 9% of the patients (n = 24) were not supported by any informal caregiver. Regarding the clinical variables (cognitive and functional impairment, depression, falls, number of drug-related problems, malnutrition, quality of life), there were no statistically significant group differences. Patients living alone utilized professional services such as home care, help with medication, home-delivered meals, or housekeeping assistance significantly more often. Multivariate analyses confirmed these findings. CONCLUSION Our results reveal the high proportion of PWD living alone in Germany. PWD living alone did not seem to be at an increased health risk. Our findings indicate that living alone with dementia is possible. In order to ensure the sufficient provision of health and nursing care services for PWD living alone, providers should consider the present results for future planning.
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Affiliation(s)
- Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany.,Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Steffen Richter
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Adina Dreier
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
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Wucherer D, Eichler T, Hertel J, Kilimann I, Richter S, Michalowsky B, Thyrian JR, Teipel S, Hoffmann W. Potentially Inappropriate Medication in Community-Dwelling Primary Care Patients who were Screened Positive for Dementia. J Alzheimers Dis 2017; 55:691-701. [PMID: 27716668 PMCID: PMC5147617 DOI: 10.3233/jad-160581] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2016] [Indexed: 01/25/2023]
Abstract
BACKGROUND Potentially inappropriate medication (PIM) in older people is a risk factor for adverse drug effects. This risk is even higher in older people with dementia (PWD). OBJECTIVE Our study aimed to determine (1) the prevalence of PIM among primary care patients who were screened positive for dementia and (2) the sociodemographic and clinical variables associated with the use of PIM. METHODS DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania) is a general practitioner-based, cluster-randomized, controlled intervention study to implement and evaluate an innovative concept of collaborative dementia care management in Germany. The comprehensive baseline assessment includes a home medication review. The present analyses are based on the data from 448 study participants (age 70+, DemTect <9). PIMs were identified using the list of Potentially Inappropriate Medications in the Elderly (Priscus). RESULTS (1) A total of 99 study participants (22%) received at least one PIM. The highest prevalence was found for antidepressants, benzodiazepines, and analgetics. The most frequently prescribed PIMs were amitriptyline, etoricoxib, and doxazosin. (2) Use of a PIM was significantly associated with a diagnosis of a mental or behavioral disorder. CONCLUSIONS The prescription rate of PIMs for community-dwelling PWD was comparable with the rates found for the general population of older people in Germany (20-29%). Antidepressants with anticholinergic properties and long-acting benzodiazepines were the most prescribed PIMs, despite having an unfavorable benefit-risk ratio. This high prevalence of PIM prescriptions in a vulnerable population of PWD indicates that standard care for dementia should include careful medication review and management.
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Affiliation(s)
- Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Rostock, Germany
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany
| | - Steffen Richter
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Rostock, Germany
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
- Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Eichler T, Thyrian JR, Hertel J, Richter S, Wucherer D, Michalowsky B, Teipel S, Kilimann I, Dreier A, Hoffmann W. Unmet Needs of Community-Dwelling Primary Care Patients with Dementia in Germany: Prevalence and Correlates. J Alzheimers Dis 2016; 51:847-55. [PMID: 26890767 DOI: 10.3233/jad-150935] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To provide an optimal care for persons with dementia (PWD), their individual unmet needs have to be identified and comprehensively addressed. OBJECTIVES Present analyses aim to describe the number and types of unmet needs of German primary care patients screened positive for dementia and factors associated with the number of unmet needs. METHODS DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania) is a general practitioner-based, cluster-randomized controlled intervention trial. Analyses are based on the baseline data of 227 PWD (≥70 years, living at home) of the intervention group who had screened positive for dementia (DemTect<9) and received a standardized computer-assisted needs assessment. RESULTS PWD had on average 8.77±5.04 unmet needs (Range = 0-31). More than 90% of the PWD had three or more unmet needs. Unmet needs were identified across all predefined 26 subcategories. The majority of unmet needs occurred in the domains "nursing treatment and care" (38%), "social counseling and legal support" (20%), and "pharmacological treatment and care" (15%). More impairment in the activities of daily living was the only factor that was significantly associated with a higher number of unmet needs, independent of age, gender, living situation, presence of an informal caregiver, cognitive impairment, and depression. CONCLUSIONS Present results demonstrate that community-dwelling PWD had a broad range of varying unmet needs. These findings emphasize the importance of a comprehensive needs assessment that allows the identification of individual needs as the basis for a tailored intervention- such as Dementia Care Management- that can address these needs.
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Affiliation(s)
- Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany.,Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Steffen Richter
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Rostock, Germany.,Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Rostock, Germany
| | - Adina Dreier
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany.,Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany.,Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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Abstract
Amyloid plaques, along with neurofibrillary tangles, are a neuropathologic hallmark of Alzheimer disease (AD). Recently, amyloid PET radiotracers have been developed and approved for clinical use in the evaluation of suspected neurodegenerative disorders. In both research and clinical settings, amyloid PET imaging has provided important diagnostic and prognostic information for the management of patients with possible AD, mild cognitive impairment (MCI), and other challenging diagnostic presentations. Although the overall impact of amyloid imaging is still being evaluated, the Society of Nuclear Medicine and Molecular Imaging and Alzheimer's Association Amyloid Imaging Task Force have created appropriate use criteria for the standard clinical use of amyloid PET imaging. By the appropriate use criteria, amyloid imaging is appropriate for patients with (1) persistent or unexplained MCI, (2) AD as a possible but still uncertain diagnosis after expert evaluation and (3) atypically early-age-onset progressive dementia. To better understand the clinical and economic effect of amyloid imaging, the Imaging Dementia-Evidence for Amyloid Scanning (IDEAS) study is an ongoing large multicenter study in the United States, which is evaluating how amyloid imaging affects diagnosis, management, and outcomes for cognitively impaired patients who cannot be completely evaluated by clinical assessment alone. Multiple other large-scale studies are evaluating the prognostic role of amyloid PET imaging for predicting MCI progression to AD in general and high-risk populations. At the same time, amyloid imaging is an important tool for evaluating potential disease-modifying therapies for AD. Overall, the increased use of amyloid PET imaging has led to a better understanding of the strengths and limitations of this imaging modality and how it may best be used with other clinical, molecular, and imaging assessment techniques for the diagnosis and management of neurodegenerative disorders.
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Affiliation(s)
- Atul Mallik
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT.
| | - Alex Drzezga
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Satoshi Minoshima
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT
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Michalowsky B, Thyrian JR, Eichler T, Hertel J, Wucherer D, Flessa S, Hoffmann W. Economic Analysis of Formal Care, Informal Care, and Productivity Losses in Primary Care Patients who Screened Positive for Dementia in Germany. J Alzheimers Dis 2016; 50:47-59. [PMID: 26639964 DOI: 10.3233/jad-150600] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The majority of people with dementia (PwD) live at home and require professional formal care and informal care that is generally provided by close relatives. OBJECTIVE To determine the utilization and costs of formal and informal care for PwD, indirect costs because of productivity losses of caregivers, and the associations between cost, socio-demographic and clinical variables. METHODS The analysis includes the data of 262 community-dwelling PwD and their caregivers. Socio-demographics, clinical variables, and the utilization of formal care were assessed within the baseline assessment. To evaluate informal care costs, the Resource Utilization in Dementia (RUD) questionnaire was used. Costs were calculated from a social perspective. Associations were evaluated using multiple linear and logistic regression models. RESULTS Formal care services were utilized less (26.3%) than informal care (85.1%), resulting in a cost ratio of one to ten(1,646 €; 16,473 €, respectively). In total, 29% of caregivers were employed, and every seventh (14.3%) experienced productivity losses, which corresponded to 1,258 € annually. Whereas increasing deficits in daily living activities were associated with higher formal and higher informal costs, living alone was significantly associated with higher formal care costs and the employment of a caregiver was associated with lower informal care costs. CONCLUSION Informal care contributes the most to total care costs. Living alone is a major cost driver for formal costs because of the lower availability of potential informal care. The availability of informal care is limited and productivity losses are increased when a caregiver is employed.
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Affiliation(s)
- Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Steffen Flessa
- Department of General Business Administration and Health Care Management, Ernst Moritz Arndt University Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany
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Thyrian JR, Winter P, Eichler T, Reimann M, Wucherer D, Dreier A, Michalowsky B, Zarm K, Hoffmann W. Relatives' burden of caring for people screened positive for dementia in primary care : Results of the DelpHi study. Z Gerontol Geriatr 2016; 50:4-13. [PMID: 27534949 DOI: 10.1007/s00391-016-1119-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/14/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is a lack of data describing caregiver burden in primary care where most (informal) caregiving is provided. OBJECTIVE The aims of the paper are to describe the burden of people caring for persons with dementia (PWD) in primary care in multiple dimensions and to analyze factors associated with specific dimensions of caregiver burden. MATERIAL AND METHODS Analyses are based on cross-sectional data of the general physician-based, cluster-randomized, controlled intervention trial DelpHi-MV (Dementia: life and person-centered help). A sample of n = 310 community dwelling PWD screened positive for dementia (DemTect < 9) and their caregivers provided sociodemographic and disease-related data, caregiver burden was assessed in 20 dimensions using the Berlin inventory on relatives' burden in dementia (Berliner Inventar zur Angehörigenbelastung - Demenz, BIZA-D). RESULTS Depending on the dimension of objective burden due to caring, between 71.3 % and 92.3 % of the caregivers reported an objective burden. The average burden ranged from 3.68 to 9.81 (scale range 0-16). The subjective burden due to caring ranged from 0.1 to 1.1 (scale range 0-4). Between 22.6 and 51.6 % of our sample indicated burdens due to perceived conflicts. Logistic regression models associating caregiver burden with specifics of PWD and caregivers reached statistical significance for nearly all dimensions of the BIZA-D. Functional and cognitive impairment were statistically significant factors in 12 out of 20 and 5 out of 20 dimensions, respectively. CONCLUSION This is first quantitative in-depth analysis of burden for caregiver of people screened positive for dementia in primary care in Germany. In general, caregiver burden was perceived as being low to moderate by caregivers and lower than reported from other settings.
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Affiliation(s)
- Jochen René Thyrian
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany.
| | - Paula Winter
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Melanie Reimann
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Adina Dreier
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany
| | - Katja Zarm
- German Center for Neurodegenerative Diseases, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases, Ellernholzstr. 1-2, 17489, Greifswald, Germany.,Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, Universitymedicine Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany
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Depressive symptoms and depression in people screened positive for dementia in primary care - results of the DelpHi-study. Int Psychogeriatr 2016; 28:929-37. [PMID: 26785854 DOI: 10.1017/s1041610215002458] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Dementia and depression are common syndromes in the elderly. There is lack of knowledge concerning the frequency of depressive symptoms in people with dementia (PWD) and factors associated with depression. The aim of this analysis is to (a) describe the frequency of depressive symptoms in people screened positive for dementia, (b) describe differences between PWD with and without depressive symptoms, and (c) analyze associations between depressive symptoms and other dementia-related variables. METHODS Analyses are based on data of the GP-based intervention trial DelpHi-MV. A sample of 430 (6.29%) people screened positive for dementia in primary care was analyzed regarding depression according to the German version of the Geriatric Depression Scale (GDS, 15-items), demographic variables, and dementia/depression-related variables. Multivariate analyses were conducted to identify factors associated with depressive symptoms. RESULTS The mean GDS-score of depressive symptoms in n = 430 PWD was m = 3.21 (SD 2.45) with 67 PWD (15.55%) showing clinically relevant depression (GDS < 5) m = 7.71 (SD = 1.92). A total of n = 72 (16.74%) received a formal diagnosis of depression and n = 62 (14.42%) received antidepressive drug treatment. Depressive symptoms are significantly associated with age (OR = 0.93), functional impairment (OR = 1.36), and quality of life (OR = 0.01, CI: 0.00-0.06). CONCLUSION Our results support previous findings that clinically relevant depressive symptoms are more common in people screened positive for dementia than in the general population and are often missed or mismanaged. Our findings underline the importance of managing quality of life, functional status, or depressive symptoms. Also, the results highlight the benefit of including the partner (and probably other carers) for adequate treatment of PWD.
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Thyrian JR, Eichler T, Pooch A, Albuerne K, Dreier A, Michalowsky B, Wucherer D, Hoffmann W. Systematic, early identification of dementia and dementia care management are highly appreciated by general physicians in primary care - results within a cluster-randomized-controlled trial (DelpHi). J Multidiscip Healthc 2016; 9:183-90. [PMID: 27143912 PMCID: PMC4844257 DOI: 10.2147/jmdh.s96055] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background There is evidence about the benefits of early detection of dementia and subsequent provision of adequate treatment and care. However, there is a lack of knowledge about the acceptance of detection and intervention procedures. These analyses describe the attitudes of general physicians [GPs] toward 1) dementia in general, 2) systematic detection of people with dementia, and 3) an intervention approach after they have experienced both. Comparisons are made based on experience with systematic screening and dementia-specific intervention. Methods Postal, cross-sectional survey to all n=1,252 GPs in the Mecklenburg-Western Pomerania, Germany. A subsample was drawn based on participation in the randomized, controlled, prospective intervention DelpHi-MV trial (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania). In this trial, systematic screening is implemented and an intervention group receives support through dementia care management (DCM). GPs were categorized into either GPs with DCM and systematic screening (DCM-GP), GPs with systematic screening only (DelpHi-GP), or GPs not participating in the trial. Data from n=257 GPs were available. Attitudes toward dementia were assessed using a validated questionnaire. Results There was strong agreement toward the helpfulness of implementing a brief cognitive screening test (89.9% agreed). Approximately two-thirds of the respondents indicated that they had identified at least some patients as being cognitively impaired for the first time. The majority of the respondents indicated agreement toward DCM. It was described as supportive and helpful. The qualified nurses were perceived as competent in dementia care and 79.3% would like to be supported with DCM. Attitudes toward dementia are positive and do not differ between groups. Conclusion The results indicate that early recognition and DCM is highly appreciated by GPs and is considered feasible or wanted to be implemented in routine care.
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Affiliation(s)
- Jochen René Thyrian
- German Center for Neurode-generative Diseases (DZNE), Site Greifswald, WG Interventional Health Care Research, Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurode-generative Diseases (DZNE), Site Greifswald, WG Interventional Health Care Research, Greifswald, Germany
| | - Andrea Pooch
- German Center for Neurode-generative Diseases (DZNE), Site Greifswald, WG Interventional Health Care Research, Greifswald, Germany
| | - Kerstin Albuerne
- German Center for Neurode-generative Diseases (DZNE), Site Greifswald, WG Interventional Health Care Research, Greifswald, Germany
| | - Adina Dreier
- Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurode-generative Diseases (DZNE), Site Greifswald, WG Interventional Health Care Research, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurode-generative Diseases (DZNE), Site Greifswald, WG Interventional Health Care Research, Greifswald, Germany
| | - Wolfgang Hoffmann
- German Center for Neurode-generative Diseases (DZNE), Site Greifswald, WG Interventional Health Care Research, Greifswald, Germany; Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University of Greifswald, Greifswald, Germany
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Healthcare resource utilization and cost in dementia: are there differences between patients screened positive for dementia with and those without a formal diagnosis of dementia in primary care in Germany? Int Psychogeriatr 2016; 28:359-69. [PMID: 26446797 DOI: 10.1017/s1041610215001453] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND It is well-known that dementia is undiagnosed, resulting in the exclusion of patients without a formal diagnosis of dementia in many studies. Objectives of the present analyses were (1) to determine healthcare resource utilization and (2) costs of patients screened positive for dementia with a formal diagnosis and those without a formal diagnosis of dementia, and (3) to analyze the association between having received a formal dementia diagnosis and healthcare costs. METHOD This analysis is based on 240 primary care patients who screened positive for dementia. Within the baseline assessment, individual data about the utilization of healthcare services were assessed. Costs were assessed from the perspective of insurance, solely including direct costs. Associations between dementia diagnosis and costs were evaluated using multiple linear regression models. RESULTS Patients formally diagnosed with dementia were treated significantly more often by a neurologist, but less often by all other outpatient specialists, and received anti-dementia drugs and day care more often. Diagnosed patients underwent shorter and less frequent planned in-hospital treatments. Dementia diagnosis was significantly associated with higher costs of anti-dementia drug treatment, but significantly associated with less total medical care costs, which valuated to be € 5,123 compared, to € 5,565 for undiagnosed patients. We found no association between dementia diagnosis and costs of evidence-based non-medication treatment or total healthcare cost (€ 7,346 for diagnosed vs. € 6,838 for undiagnosed patients). CONCLUSION There are no significant differences in total healthcare cost between diagnosed and undiagnosed patients. Dementia diagnosis is beneficial for receiving cost-intensive anti-dementia drug treatments, but is currently insufficient to ensure adequate non-medication treatment for community-dwelling patients.
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Dreier A, Thyrian JR, Eichler T, Hoffmann W. Qualifications for nurses for the care of patients with dementia and support to their caregivers: A pilot evaluation of the dementia care management curriculum. NURSE EDUCATION TODAY 2016; 36:310-317. [PMID: 26277428 DOI: 10.1016/j.nedt.2015.07.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 07/15/2015] [Accepted: 07/24/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND A substantial increase of people with dementia (PwD) is predicted for the future. Nurses are taking over important tasks to support PwD, which requires a specialized qualification. OBJECTIVES The aim was to identify points for revision and to further improve the Dementia Care Manager (DCM) curriculum as a basis for probable qualification of nurses caring for PwD. DESIGN We conducted a summative evaluation study to revise the first version of the DCM curriculum. SETTING The study was conducted in the primary health care setting. PARTICIPANTS Nurses and lecturers of the first theoretical and practical implementation were involved. METHODS Questionnaire-based interviews with nurses and lecturers after every module during the theoretical qualification. Besides, nurses rated the curriculum after the end of the theoretical part and evaluated the DCM tasks and the usefulness of the curriculum contents after the practical phase in questionnaire-based interviews. Descriptive statistics were used for analysis. RESULTS A total of five nurses and 33 lecturers participated in the first theoretical and practical implementation of the DCM qualification. Generally, nurses and lecturers assessed the curriculum contents as "very important" or "important." In particular, the job-related issues, the variety of course topics and the close combination of theory and practice were highly valued. The practical implementation of the DCM was rated predominantly as "important" by nurses for the delivery of care for PwD. To optimize the theoretical DCM curriculum, participants suggested increasing the number of lessons for two of the modules (gerontopsychiatry, interdisciplinary case reviews). Furthermore, nurses preferred a longer practical phase, whereas some lecturers called for larger group sizes of participants. CONCLUSIONS The DCM qualification enhances nurses' competencies to care for PwD. The curriculum regards an interprofessional, cooperative team approach as the potential to improve health care supply for demented people and to better support their caregivers.
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Affiliation(s)
- Adina Dreier
- Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; German Center for Neurodegenerative Diseases (DZNE), Ellernholzstr. 1-2, Greifswald 17487, Germany.
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Ellernholzstr. 1-2, Greifswald 17487, Germany.
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Ellernholzstr. 1-2, Greifswald 17487, Germany.
| | - Wolfgang Hoffmann
- Department Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany; German Center for Neurodegenerative Diseases (DZNE), Ellernholzstr. 1-2, Greifswald 17487, Germany.
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Teipel S, Drzezga A, Grothe MJ, Barthel H, Chételat G, Schuff N, Skudlarski P, Cavedo E, Frisoni GB, Hoffmann W, Thyrian JR, Fox C, Minoshima S, Sabri O, Fellgiebel A. Multimodal imaging in Alzheimer's disease: validity and usefulness for early detection. Lancet Neurol 2015; 14:1037-53. [PMID: 26318837 DOI: 10.1016/s1474-4422(15)00093-9] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 05/07/2015] [Accepted: 05/15/2015] [Indexed: 01/18/2023]
Abstract
Alzheimer's disease is a progressive neurodegenerative disease that typically manifests clinically as an isolated amnestic deficit that progresses to a characteristic dementia syndrome. Advances in neuroimaging research have enabled mapping of diverse molecular, functional, and structural aspects of Alzheimer's disease pathology in ever increasing temporal and regional detail. Accumulating evidence suggests that distinct types of imaging abnormalities related to Alzheimer's disease follow a consistent trajectory during pathogenesis of the disease, and that the first changes can be detected years before the disease manifests clinically. These findings have fuelled clinical interest in the use of specific imaging markers for Alzheimer's disease to predict future development of dementia in patients who are at risk. The potential clinical usefulness of single or multimodal imaging markers is being investigated in selected patient samples from clinical expert centres, but additional research is needed before these promising imaging markers can be successfully translated from research into clinical practice in routine care.
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Affiliation(s)
- Stefan Teipel
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany; DZNE, German Center for Neurodegenerative Diseases, Rostock, Germany.
| | - Alexander Drzezga
- Department of Nuclear Medicine, University of Cologne, Cologne, Germany
| | - Michel J Grothe
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany; DZNE, German Center for Neurodegenerative Diseases, Rostock, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | | | - Norbert Schuff
- Department of Veterans Affairs Medical Center and Department of Radiology, University of California in San Francisco, San Francisco, CA, USA
| | - Pawel Skudlarski
- Olin Neuropsychiatry Research Center, Hartford Hospital and Institute of Living, Hartford, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Enrica Cavedo
- LENITEM Laboratory of Epidemiology, Neuroimaging, and Telemedicine-IRCCS Centro San Giovanni di Dio-FBF, Brescia, Italy; Sorbonne Universités, Université Pierre et Marie Curie, Paris 06, Institut de la Mémoire et de la Maladie d'Alzheimer and Institut du Cerveau et de la Moelle Epinière, UMR S 1127, Hôpital de la Pitié-Salpêtrière Paris and CATI Multicenter Neuroimaging Platform, France
| | - Giovanni B Frisoni
- LENITEM Laboratory of Epidemiology, Neuroimaging, and Telemedicine-IRCCS Centro San Giovanni di Dio-FBF, Brescia, Italy; Memory Clinic and LANVIE-Laboratory of Neuroimaging of Aging, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Wolfgang Hoffmann
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany; DZNE, German Centre for Neurodegenerative Diseases, Greifswald, Germany
| | - Jochen René Thyrian
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany; DZNE, German Centre for Neurodegenerative Diseases, Greifswald, Germany
| | - Chris Fox
- Dementia Research Innovation Group, Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Satoshi Minoshima
- Neuroimaging and Biotechnology Laboratory, Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Osama Sabri
- Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany
| | - Andreas Fellgiebel
- Department of Psychiatry, University Medical Center of Mainz, Mainz, Germany
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72
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Eichler T, Thyrian JR, Hertel J, Wucherer D, Michalowsky B, Reiner K, Dreier A, Kilimann I, Teipel S, Hoffmann W. Subjective memory impairment: No suitable criteria for case-finding of dementia in primary care. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2015; 1:179-86. [PMID: 27239503 PMCID: PMC4876911 DOI: 10.1016/j.dadm.2015.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
INTRODUCTION Subjective memory impairment (SMI) might be used for the case-finding of dementia. Present analyses aim to determine the diagnostic value and the predictive ability of SMI and related worries for the discrimination of patients screened positive or negative for dementia. METHODS The analyses are based on data derived from the ongoing German general practioner (GP)-based, randomized controlled trial DelpHi-MV. A total of 5106 patients (age ≥ 70, living at home) were first asked for SMI and related worries and then screened for dementia in 110 participating GP practices (November 2011 to August 2014; preliminary data) using the DemTect. RESULTS A total number of 2556 patients (50%) stated that they experience SMI and 892 patients (17%) screened positive for dementia. The sensitivity of SMI for the correct classification of positively screened patients was 54%, the positive predictive value (PPV) 19%. The specificity of SMI was 51%; the negative predictive value (NPV) 84%. Among 2480 patients with SMI, 45% reported SMI-related worries (sensitivity 52%; specificity 57%; PPV 22%; NPV 84%). Receiver operating characteristics analyses showed no statistically significant improvement in the area under the curves when using SMI or related worries as predictors (additional to age and sex) for the discrimination between positively and negatively screened patients. DISCUSSION The analyses showed that the risk of overlooking cognitive impairment in the subgroup of patients who state that they do not experience SMI would be unreasonable high. Thus, the results provide clear evidence that neither SMI nor related worries can be used as a valid criteria to decide whether an elderly primary care patient should be tested for dementia. TRIALS REGISTRATION ClinicalTrials.gov Identifier: NCT01401582.
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Affiliation(s)
- Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | | | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | | | - Katinka Reiner
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
| | - Adina Dreier
- Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Greifswald, Germany
- Department of Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
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73
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Thyrian JR, Eichler T, Hertel J, Wucherer D, Dreier A, Michalowsky B, Killimann I, Teipel S, Hoffmann W. Burden of Behavioral and Psychiatric Symptoms in People Screened Positive for Dementia in Primary Care: Results of the DelpHi-Study. J Alzheimers Dis 2015; 46:451-9. [DOI: 10.3233/jad-143114] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Adina Dreier
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Ingo Killimann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Rostock, Germany
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Rostock, Germany
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
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74
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Vollmar HC, Thyrian JR, LaMantia MA, Alder CA, Guerriero Austrom MM, Callahan C, Leve V, Hoffmann W, Boustani M. [Aging Brain Care Program from Indianapolis: Transferability to the German healthcare system]. Z Gerontol Geriatr 2015; 49:32-6. [PMID: 26014477 DOI: 10.1007/s00391-015-0904-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND New and innovative concepts of care management have been developed to improve the health of older adults with dementia and depression. AIM This article describes the American aging brain care (ABC) program and the possible transfer to the German healthcare system is discussed. MATERIAL AND METHODS The ABC medical home model in Indianapolis incorporates a specialized geriatric healthcare center which is affiliated to the Eskenazi Hospital as well as a program involving home-based domestic visits by healthcare personnel to affected people. The diagnoses are made in the geriatric center where therapy and treatment are also planned. These stages are carried out in a multiprofessional team, which identifies the individual needs of the patients and relatives and discusses these in family conferences as well as in close consultation with the primary care center of the hospital. The care, diagnosis and therapy are coordinated using a self-developed software for the program and via predetermined pathways and procedural instructions on the approach in the healthcare center and in the domestic visit program. RESULTS AND CONCLUSION From the perspective of the authors the core elements of the program include not only the use of a home-based care model but also the selection and training of a new type of front-line care provider. Models like the program presented here show great promise for meeting the demands of a rapidly expanding population of vulnerable older adults.
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Affiliation(s)
- H C Vollmar
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5/Geb. 14.97, 40225, Düsseldorf, Deutschland. .,Institut für Allgemeinmedizin und Familienmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Herdecke, Deutschland.
| | - J R Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Standort Rostock/Greifswald, Greifswald, Deutschland
| | - M A LaMantia
- Indiana University Center for Aging Research (IU-CAR), Indiana University School of Medicine (IUSM), Indianapolis, USA.,Regenstrief Institute, Inc., Indianapolis, USA
| | - C A Alder
- Regenstrief Institute, Inc., Indianapolis, USA.,Eskenazi Health, Indianapolis, USA
| | - M M Guerriero Austrom
- Indiana University Center for Aging Research (IU-CAR), Indiana University School of Medicine (IUSM), Indianapolis, USA.,Department of Psychiatry, IUSM, Indianapolis, USA.,Indiana Alzheimer Disease Center, IUSM, Indianapolis, USA
| | - C Callahan
- Indiana University Center for Aging Research (IU-CAR), Indiana University School of Medicine (IUSM), Indianapolis, USA
| | - V Leve
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5/Geb. 14.97, 40225, Düsseldorf, Deutschland
| | - W Hoffmann
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Standort Rostock/Greifswald, Greifswald, Deutschland.,Institute for Community Medicine, University of Greifswald, Greifswald, Deutschland
| | - M Boustani
- Indiana University Center for Aging Research (IU-CAR), Indiana University School of Medicine (IUSM), Indianapolis, USA.,Regenstrief Institute, Inc., Indianapolis, USA.,Center for Health Innovation and Implementation Science (CHIIS), IUSM, Indianapolis, USA
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75
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Eichler T, Thyrian JR, Hertel J, Michalowsky B, Wucherer D, Dreier A, Kilimann I, Teipel S, Hoffmann W. Rates of formal diagnosis of dementia in primary care: The effect of screening. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2015; 1:87-93. [PMID: 27239495 PMCID: PMC4876881 DOI: 10.1016/j.dadm.2014.11.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Screening could improve recognition of dementia in primary care. We sought to determine the effect of screening for dementia in primary care practices on the formal diagnosis rate; the distribution of differential diagnoses; and the factors associated with receiving a formal diagnosis. METHODS The "Dementia: life- and person-centered help in Mecklenburg-Western Pomerania" is an ongoing general practitioner (GP)-based, randomized, controlled intervention trial. A total of 4064 community dwelling patients (aged ≥70 years) were screened for dementia in 108 GP practices. Of these patients, 692 (17%) had positive screening results (DemTect score <9). Of these 692 patients, 406 (59%) provided informed consent. The analyses included the data from 243 patients with a complete baseline assessment (preliminary data; January 2014). RESULTS Of 146 patients without a formal diagnosis of dementia, 72 (49%) received a formal diagnosis after a positive screening outcome (69% with "unspecified dementia"). Female sex was significantly associated with receiving a formal diagnosis (multivariate analyses). CONCLUSION Screening improved the identification of dementia considerably. Because of the risk of receiving a false-positive diagnosis, additional diagnostic assessment should be mandatory.
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Affiliation(s)
- Tilly Eichler
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Johannes Hertel
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
| | - Adina Dreier
- Institute for Community Medicine, Section of Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Rostock, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Rostock, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Greifswald, Germany
- Institute for Community Medicine, Section of Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
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76
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Gaertner B, Herzog A, Holzhausen M, Schmidt S. „Case-management“-Studien für Personen ab 65 Jahren in Deutschland. Z Gerontol Geriatr 2015; 48:529-38. [DOI: 10.1007/s00391-014-0839-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 11/05/2014] [Accepted: 11/18/2014] [Indexed: 10/24/2022]
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77
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Abstract
BACKGROUND Neuropsychiatric symptoms are major determinants for caregiver distress and institutionalization in dementia. Little is known about the prevalence of neuropsychiatric symptoms and their association with use of medication, caregiver distress, and resource utilization in primary care. METHODS We assessed frequency of neuropsychiatric symptoms in a sample retrieved from a primary care intervention study. Patients were screened for dementia by their primary care physicians. A study nurse assessed neuropsychiatric symptoms in 176 patients using the neuropsychiatric inventory (NPI) through face-to-face interviews by proxy during home visits. In addition, data on global cognition (MMSE), quality of life (QoL-AD), resource utilization in dementia (RUD), caregiver distress (BIS), and use of psychotropic medication in patients were obtained. We used linear mixed effect models taking into account the clustering of patients within general physician practices. RESULTS Clinically relevant neuropsychiatric symptoms (NPI score ≥ 4) occurred in about 53% of the patients. Higher NPI scores were significantly associated with more severe cognitive impairment, higher caregiver distress, and higher utilization of caregiver resources by patients but not with a formal diagnosis of dementia from the primary care physician. Use of antipsychotics was associated with higher NPI scores, particularly in non-psychotic domains. CONCLUSIONS Neuropsychiatric symptoms in a primary care cohort screened positive for dementia were associated with resource utilization and distress of caregivers. In contrast to guideline recommendations, the use of antipsychotics was associated with non-psychotic domains of behavioral symptoms. These findings underscore the relevance of neuropsychiatric symptoms for the design of future interventions in primary care.
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78
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Patterson SM, Cadogan CA, Kerse N, Cardwell CR, Bradley MC, Ryan C, Hughes C. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev 2014:CD008165. [PMID: 25288041 DOI: 10.1002/14651858.cd008165.pub3] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Inappropriate polypharmacy is a particular concern in older people and is associated with negative health outcomes. Choosing the best interventions to improve appropriate polypharmacy is a priority, hence interest in appropriate polypharmacy, where many medicines may be used to achieve better clinical outcomes for patients, is growing. OBJECTIVES This review sought to determine which interventions, alone or in combination, are effective in improving the appropriate use of polypharmacy and reducing medication-related problems in older people. SEARCH METHODS In November 2013, for this first update, a range of literature databases including MEDLINE and EMBASE were searched, and handsearching of reference lists was performed. Search terms included 'polypharmacy', 'medication appropriateness' and 'inappropriate prescribing'. SELECTION CRITERIA A range of study designs were eligible. Eligible studies described interventions affecting prescribing aimed at improving appropriate polypharmacy in people 65 years of age and older in which a validated measure of appropriateness was used (e.g. Beers criteria, Medication Appropriateness Index (MAI)). DATA COLLECTION AND ANALYSIS Two review authors independently reviewed abstracts of eligible studies, extracted data and assessed risk of bias of included studies. Study-specific estimates were pooled, and a random-effects model was used to yield summary estimates of effect and 95% confidence intervals (CIs). The GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach was used to assess the overall quality of evidence for each pooled outcome. MAIN RESULTS Two studies were added to this review to bring the total number of included studies to 12. One intervention consisted of computerised decision support; 11 complex, multi-faceted pharmaceutical approaches to interventions were provided in a variety of settings. Interventions were delivered by healthcare professionals, such as prescribers and pharmacists. Appropriateness of prescribing was measured using validated tools, including the MAI score post intervention (eight studies), Beers criteria (four studies), STOPP criteria (two studies) and START criteria (one study). Interventions included in this review resulted in a reduction in inappropriate medication usage. Based on the GRADE approach, the overall quality of evidence for all pooled outcomes ranged from very low to low. A greater reduction in MAI scores between baseline and follow-up was seen in the intervention group when compared with the control group (four studies; mean difference -6.78, 95% CI -12.34 to -1.22). Postintervention pooled data showed a lower summated MAI score (five studies; mean difference -3.88, 95% CI -5.40 to -2.35) and fewer Beers drugs per participant (two studies; mean difference -0.1, 95% CI -0.28 to 0.09) in the intervention group compared with the control group. Evidence of the effects of interventions on hospital admissions (five studies) and of medication-related problems (six studies) was conflicting. AUTHORS' CONCLUSIONS It is unclear whether interventions to improve appropriate polypharmacy, such as pharmaceutical care, resulted in clinically significant improvement; however, they appear beneficial in terms of reducing inappropriate prescribing.
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Affiliation(s)
- Susan M Patterson
- No affiliation, 12-22 Linenhall Street, Belfast, Northern Ireland, UK, BT2 8BS
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79
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The benefits of implementing a computerized intervention-management-system (IMS) on delivering integrated dementia care in the primary care setting. Int Psychogeriatr 2014; 26:1377-85. [PMID: 24811145 DOI: 10.1017/s1041610214000830] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND A computerized Intervention-Management-System (IMS) has been developed and implemented to facilitate dementia care management. IMS is a rule-based expert decision support system that matches individual patient characteristics to a computerized knowledge base. One of the most important functionalities of IMS is to support the compilation of the individual intervention plan by systematically identifying unmet needs and suggesting the corresponding specific interventions for recommendation to the general practitioner (GP). The present analysis aimed to determine if the implementation of IMS improves the identification of unmet needs and the recommendation of adequate specific interventions. In addition, the feasibility and acceptability of the IMS were evaluated. METHODS Delphi-MV is an on-going GP-based, cluster-randomized, controlled intervention trial to implement and evaluate a collaborative dementia care management program for community-dwelling PWDs and their caregivers. IMS was developed and implemented over the course of the DelpHi-trial. The identified unmet needs and the interventions that were recommended to the GP before and after the implementation of IMS were compared. To evaluate the feasibility and acceptability of the IMS, a survey was conducted among the current users of IMS. RESULTS AND CONCLUSIONS After the implementation of IMS, the number of specific interventions recommended to the GP increased by 85%. Our findings provide evidence that IMS improves the systematic identification of unmet needs and the subsequent recommendation of interventions to address these needs. The users evaluated IMS as very helpful and would like to use it for their future work. However, the usability could be further improved.
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Dementia care management: going new ways in ambulant dementia care within a GP-based randomized controlled intervention trial. Int Psychogeriatr 2014; 26:247-56. [PMID: 24152974 PMCID: PMC3891295 DOI: 10.1017/s1041610213001786] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Increasing prevalence of dementia is a major challenge for the German healthcare system. The study DelpHi-MV ("Dementia: life- and person-centered help in Mecklenburg-Western Pomerania") aims to implement and evaluate an innovative subsidiary support system for persons with dementia (PwDs) living at home and their caregivers. METHODS DelpHi-MV is a GP-based cluster randomized controlled intervention trial. DelpHi-Intervention aims to provide "optimum care" by integrating multi-professional and multimodal strategies to individualize and optimize treatment of dementia within the framework of the established healthcare and social service system. The intervention is conducted by Dementia Care Managers (DCMs)--nurses with dementia-specific training--at the people's homes. Based on German guidelines for evidence-based diagnoses and treatment of dementia, a comprehensive set of 95 interventio--modules--the "DelpHi-Standard"--was defined. Each module consists of predefined trigger condition(s), a subsequent intervention task, as well as at least one criterion for its completion. The intervention begins with a comprehensive assessment of the care situation, needs, and resources. The DCM develops and implements an intervention plan tailored to the individual conditions in close cooperation with the GP. EXPECTED RESULTS AND CONCLUSIONS: We expect statistically significant differences between control and intervention group in primary outcomes (quality of life, behavioral and psychological symptoms of dementia, pharmacotherapy, caregiver burden). Results can provide evidence for the effectiveness and efficacy of dementia care management according to the "Delphi-Standard"--prerequisites for implementing this concept into routine healthcare.
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81
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Fiß T, Thyrian JR, Wucherer D, Aßmann G, Kilimann I, Teipel SJ, Hoffmann W. Medication management for people with dementia in primary care: description of implementation in the DelpHi study. BMC Geriatr 2013; 13:121. [PMID: 24225205 PMCID: PMC3840668 DOI: 10.1186/1471-2318-13-121] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 11/01/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND As the population ages, the relative and absolute number of age-associated diseases such as dementia will increase. Evaluation of the suitability and intake of medication and pharmacological treatment is an important aspect of care for people with dementia, especially if they live at home. Regular medication reviews and systematic cooperation between physicians and pharmacists are not common in routine care. Medication management (MM), based on such a comprehensive home medication review could help to reduce drug-related problems and costs. The present article presents a medication management specifically for the application in the ambulatory setting and describes its implementation as part of a larger trial. METHODS/DESIGN A home medication review (HMR) and MM is implemented as part of the DelpHi study, a population based prospective, cluster-randomized controlled intervention study to test the efficacy and efficiency of the implementation of a collaborative care model in primary care. PARTICIPANTS people with dementia (PWD) and their caregivers are recruited by the patient's general practitioner. Inclusion criteria are a positive screening result for dementia, living at home and regular intake of drugs. PWD are asked to specify their regular pharmacy which is asked to participate in the study, too. INTERVENTION a comprehensive HMR is conducted as computer-assisted personal interview by specifically qualified Dementia Care Manager (DCM) at the people's home. It includes detailed information about drugs taken, their storage, administration, adherence and adverse events. The MM is conducted in cooperation between DCM, pharmacist and general practitioner and consists of a pharmaceutical evaluation, pharmaceutical recommendations and their application. Pharmacists are trained and provided with regularly updated information. The MM is designed to give information and recommendations concerning antidementia drugs, occurrence of drug related problems, intake of anticholinergic drugs, potentially clinically relevant drug-drug-interactions, adverse drug events and medication adherence. DISCUSSION The DelpHi-approach for medication management employs comprehensive instruments and procedures in the primary care setting under routine care conditions, and this approach should be useful in improving pharmacotherapy as part of the comprehensive treatment and care for people with dementia. TRIAL REGISTRATION The trial is registered at ClinicalTrials.gov, number NCT01401582.
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Affiliation(s)
- Thomas Fiß
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
- Institute for Community Medicine, University of Greifswald, Ellernholzstr 1-2, 17489 Greifswald, Germany
| | - Diana Wucherer
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - Grit Aßmann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - Ingo Kilimann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
- Department of Psychosomatic Medicine, University Hospital Rostock, Gehlsheimer Straße 28, 18147 Rostock, Germany
| | - Stefan J Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
- Department of Psychosomatic Medicine, University Hospital Rostock, Gehlsheimer Straße 28, 18147 Rostock, Germany
| | - Wolfgang Hoffmann
- German Center for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
- Institute for Community Medicine, University of Greifswald, Ellernholzstr 1-2, 17489 Greifswald, Germany
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