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AAIC Press Release

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Contact: 
Alzheimer's Association®  |  Media line: 312.335.4078  |  E-mail: media@alz.org  |
AAIC 2013 press room, July 13-18: 617.954.3414

Alzheimer's Association Chapters Collaborate with Medical
Centers and Health Systems to Increase Early Detection, Service
Use and Decrease Costs

BOSTON, July 14, 2013 – Four programs featured at the Alzheimer's Association International Conference® 2013 (AAIC® 2013) in Boston are making important efforts to improve early detection and diagnosis of Alzheimer's disease and increase the use of information and support services. Alzheimer's Association chapters are leaders and/or key players in these collaborative efforts with health systems, health care providers, universities and government agencies.

"Research shows that families and caregivers who learn about the course of Alzheimer's disease, and who take advantage of support and respite, often cope much better with the changes that come their way during the Alzheimer's disease process," said Beth Kallmyer, MSW, vice president of constituent services at the Alzheimer's Association.

According to the Alzheimer's Association 2013 Alzheimer's Disease Facts and Figures report, more than 5 million Americans are living with Alzheimer's disease. By 2050, the number of people with Alzheimer's may nearly triple. Yet too many people with Alzheimer's or another dementia are undiagnosed — as many as 50 percent, according to some studies.

"The number of people with Alzheimer's is projected to rise significantly as more and more people reach the age of greatest risk for developing the disease," said Maria Carrillo, Ph.D., Alzheimer's Association vice president of medical and scientific relations. "The huge number of undiagnosed cases reflects the pervasive fear about Alzheimer's, yet it also means that more people could benefit from support and information provided by the Alzheimer's Association. We hope these four programs can serve as models for implementation in other communities."

San Francisco Dementia Support Network Improves the Knowledge and Skills of Caregivers

The growing population of older adults in the San Francisco Bay Area is projected to increase the number of people with dementia in the region by 61 percent between 2000 and 2030. According the San Francisco Department of Aging and Adult Services' 2009 "Strategy for Excellence In Dementia Care," San Franciscans with Alzheimer's or another dementia are more vulnerable than the general population of seniors in the U.S. because they are more likely to be members of racial or ethnic minority groups, born in another country, speak different languages, live in poverty or live alone.

Elizabeth Edgerly, Ph.D., chief program officer of the Alzheimer's Association Northern California and Northern Nevada Chapter, added that support for people with dementia is often the responsibility of family caregivers, and that caregiving is time consuming, difficult and makes it very hard to participate in activities that protect and preserve the caregivers' own health and security.

San Francisco is the only city in the United States with a strategic plan for addressing dementia. The San Francisco Dementia Support Network is a partnership between the University of California, San Francisco; the San Francisco Department of Aging and Adult Services; the Alzheimer's Association Northern California and Northern Nevada Chapter; and Kaiser Permanente San Francisco (KPSF). The Dementia Support Network provides a multi-faceted approach to improve the knowledge and skills of caregivers during times of medical, functional or caregiving crises.

Four major efforts were undertaken:

The program uses education services and a full-time social worker — a Dementia Care Expert. The six-month intervention aims to decrease preventable emergency room visits and/or hospitalizations and increase utilization of community-based services by caregivers. Importantly, the Dementia Care Expert had access to a pool of grants for respite care administered by the Alzheimer's Association Northern California and Northern Nevada Chapter, which allowed the family to purchase needed services (e.g., home health care). The University of California, San Francisco, collected data on project effectiveness through pre/post-test evaluations, and medical service utilization data from patient medical records.

At AAIC 2013, Edgerly reported that 105 patient and caregiver partners have been enrolled and participant demographics are highly diverse. Post-test evaluations are ongoing; a comprehensive data analysis will be conducted. One outcome of the project has been amending the electronic health records at Kaiser San Francisco to include caregiver information in the patient's Alzheimer's disease care plan.

"Our preliminary findings show improvement in caregiver experience and effectiveness, and positive feedback from education and support group surveys," Edgerly said. "The medical service utilization analysis is still pending, but our preliminary findings will be included in the AAIC 2013 presentation."

Alzheimer's Association Massachusetts/New Hampshire Chapter Collaborates with Major Health Insurer and Leading Medical Centers and to Improve Health and Reduce Costs

Building on past collaborations between the Alzheimer's Association and the Veterans Administration (VA), the Massachusetts/New Hampshire Chapter has launched two unique collaborations with a major insurance company and with three Boston teaching hospitals. Between 2007 and 2011, the VA and the Alzheimer's Association conducted the Partners in Dementia Care Study, which looked at veterans with dementia whose care was jointly coordinated by the VA and the Association. They found better health and psychological outcomes for caregivers and veterans, and lower rates of hospitalization and institutionalization.

"The two new partnerships feature direct referrals of people with dementia and their caregivers to the Alzheimer's Association for assessment, care recommendations, and education by a dedicated care consultant," said Nicole McGurin, MS, director of clinical services at the Alzheimer's Association Massachusetts/New Hampshire Chapter. "The care consultant then provides written feedback to the referral source for inclusion in the patient record."

McGurin described the two partnerships:

Tufts Health Plan is partnering with the Massachusetts/New Hampshire chapter of the Alzheimer's Association to provide increased education and care coordination to members/caregivers regarding cognitive decline and dementia, increased access to services and community support, and training for the health plan's care management team. Tufts Health Plan has hired a special dementia care consultant to work and train at the Alzheimer's Association. The new program launched on June 1st.

At AAIC 2013, McGurin shared proposed new methods and tools for effectively operating and managing the direct referral systems. "At the completion of these projects, we hope to show that significant cost savings and better health outcomes for people with Alzheimer's and caregivers that receive care coordination from the Alzheimer's Association," said McGurin. "We encourage the development of similar partnerships, and we plan to share our program parameters and research findings to help others to be successful."

Alzheimer's Community Intervention in Missouri Increases Early Detection, Improves Knowledge and Reduces Burden

Alzheimer's disease is relatively common among older adults and yet many individuals with the disease never receive a formal diagnosis. And, when there is a diagnosis, it too often occurs after a health crisis or other emergency because symptoms of the disease were not recognized or treated earlier, according to James Galvin, M.D., M.P.H., professor of neurology, psychiatry, nursing, nutrition and population health at New York University School of Medicine.

At AAIC 2013, Galvin and colleagues reported on an innovative collaboration between New York University, the Missouri Department of Health and Senior Services, four Alzheimer's Association chapters in Missouri, and 10 Area Agencies on Aging (AAA). Known as Project Learn MORE (Missouri Outreach and Referral Expanded), it was a two-year study to increase detection of new cases of dementia and refer persons with dementia (PWDs) and family caregivers to Alzheimer Association chapters to receive supportive services and increase coping skills.

Missouri AAA caseworkers used the AD8 Dementia Screen to detect incident cases; it was incorporated into their in-home geriatric assessments. People with cognitive impairment were then referred to the Alzheimer's Association participate in the Project Learn MORE intervention that included a care consultation; 3,960 older adults were assessed during the study, and 317 people with cognitive decline were detected.

Care consultation services help Alzheimer's caregivers and other family members build a plan for the current and future care of their loved one. They receive one-to-one assistance to better understand Alzheimer's disease, manage the dementia symptoms and cope better with the changes brought on by the progression of the disease.

According to Galvin, who was lead investigator of the study, "The Area Agency on Aging staff reported the AD8 was easy to administer, useful to detect cognitive impairment and made it easier to discuss memory loss with clients."

Galvin reported that pre- and post-intervention surveys showed that Project Learn MORE:

"Our study demonstrated that community-based interventions, such as care consultations offered by the Alzheimer's Association, can significantly improve patient- and caregiver-centered outcomes," Galvin said.

Minnesota Collaborative Creates Two Tools for Doctors to Encourage Alzheimer's Diagnosis

One barrier to early detection and treatment of Alzheimer's is lack of dementia education and training for physicians. "Some doctors mistakenly believe that significant memory loss is a normal part of aging, a diagnosis of Alzheimer's cannot be made until autopsy or available treatments and support services have no benefit," according to Terry Barclay, Ph.D., director of neuropsychology at HealthPartners and Regions Hospital in St. Paul, Minn. "They may be reluctant to investigate memory concerns because the evaluation and management of dementia is perceived to be complex, time consuming and burdensome."

To help change this situation, a state-wide collaborative was developed in Minnesota called ACT on Alzheimer's©. ACT on Alzheimer's was charged with transforming the state's medical and long-term care systems and communities by promoting early diagnosis and more comprehensive support of individuals with dementia and their families. The group includes medical, academic, community, government, business and nonprofit stakeholders, including the Alzheimer's Association Minnesota-North Dakota Chapter.

Looking first at overcoming obstacles in primary care, ACT on Alzheimer's created two evidence-based tools designed to demystify and simplify dementia management in primary care:

"Two Minnesota-based health systems have started using the tools, and two more are currently considering them," said Barclay, who is chair of the Medical and Scientific Advisory Council for the Alzheimer's Association Minnesota and North Dakota Chapter and is a dementia consultant for the Minnesota Department of Human Services.

About AAIC

The Alzheimer's Association International Conference (AAIC) is the world's largest conference of its kind, bringing together researchers from around the world to report and discuss groundbreaking research and information on the cause, diagnosis, treatment and prevention of Alzheimer's disease and related disorders. As a part of the Alzheimer's Association's research program, AAIC serves as a catalyst for generating new knowledge about dementia and fostering a vital, collegial research community.

About the Alzheimer's Association

The Alzheimer's Association is the world's leading voluntary health organization in Alzheimer care, support and research. Our mission is to eliminate Alzheimer's disease through the advancement of research; to provide and enhance care and support for all affected; and to reduce the risk of dementia through the promotion of brain health. Our vision is a world without Alzheimer's. Visit www.alz.org or call 800.272.3900.

# # #

Proposal ID: 39788
Topic: Public Health and Psychosocial
Subtopic: Assessment and care planning
Presentation: Poster session, Monday, July 15, 2013, 11:45 am ET

The San Francisco Dementia Support Network: Enhancing Quality of Care for Persons with Dementia in Managed Care

Presenting author: Elizabeth Edgerly, Alzheimer's Association, Northern California and Northern Nevada Chapter.

Background: The growing rate of seniors in the San Francisco Bay Area is projected to increase the number of people with dementia by 61 percent between 2000 and 2030. San Franciscans with dementia are more vulnerable than the general population of seniors in the United States because they are more likely to be members of racial/ethnic minority groups, born in another country, speak languages other than English, live in poverty or live alone. Support for dementia patients is often the responsibility of informal caregivers; however, caregiving is time consuming, difficult and strains the ability to engage in activities that protect and preserve caregivers' own health and security.

Methods: Uniquely, San Francisco is the only city in the United States with a Strategic Plan for addressing dementia. Thus, the San Francisco Dementia Support Network — a collaborative partnership between University of California, Alzheimer's Association, and Kaiser Permanente San Francisco — is providing a three-pronged approach to improve the self-efficacy, knowledge and skills of caregivers during times of medical, functional or caregiving crisis through education services and a full-time social worker, a Dementia Care Expert. The six-month intervention aims to decrease preventable emergency room visits and/or hospitalizations and increase utilization of community-based services by caregivers. Effectiveness is measured through pre/post-test evaluations.

Results: To date, 105 patient-caregiver dyads have been enrolled and post-test evaluations are on-going. Participant demographics are highly diverse. Among dementia patients: 86 are age 60+; 55 females; 41 and 40 cared for by their spouse or child, respectively; 39 White Non-Hispanic, 8 White Hispanic, 26 Asian, 17 African-American; and 21 Veterans. Among caregivers: 54 are age 60+; 70 females; 36 White Non-Hispanic, 8 White Hispanic, 30 Asian, 21 African-American; and 12 Veterans.

Conclusions: The intervention period will conclude by March 2013, at which point, a comprehensive data analysis will be conducted. Additionally, one outcome of the project has been amending the electronic health records at Kaiser Permanente San Francisco to include caregiver information in the patient's Alzheimer's disease care plan. Preliminary findings show an increase in caregiver efficacy and positive qualitative feedback from caregivers. Service utilization analysis is still pending, but these findings will be included in the presentation.

Proposal ID: 38100
Topic: Public Health & Psychosocial
Subtopic: Psychosocial; Assessment and care planning
Presentation: Dementia Care @ AAIC poster session, Wednesday, July 17, 2013, 11:15 a.m.

Integrating Dementia Care and Health Care Systems

Presenting author: Nicole McGurin , Alzheimer's Association, Massachusetts/New Hampshire Chapter.

Background: Based on the results of a five-year study featuring collaboration between the Veterans Administration and the Alzheimer's Association, the Alzheimer's Association Massachusetts/New Hampshire Chapter is pursuing two new projects that integrate care coordination with health care systems. The Partners in Dementia Care Study (2007-2011) looked at veterans with dementia whose care was jointly coordinated by the Veterans Administration and the Alzheimer's Association and found better psychosocial outcomes for caregivers and veterans and lower rates of hospitalization and institutionalization. No significant differences in health care costs were found.

Methods: Two new partnerships will feature direct referrals of patients with dementia and their caregivers to the Alzheimer's Association for assessment, care recommendations and education by a dedicated care consultant who will provide written feedback to the referral source for inclusion in the patient record.

Results: There are no results available yet, as both projects are just beginning. We may have some preliminary data at the time of the AAIC conference. We would like to share methods and tools for operationalization of direct referral systems and case examples from participants.

Conclusions: At the completion of these projects, we hope to show that significant cost savings and better psychosocial and health outcomes for patients and caregivers that receive care coordination from the Alzheimer's Association. For the purposes of the Dementia Care@AAIC Conference, we would like to encourage the development of similar partnerships and share our findings thus far to help others to be successful.

Proposal ID: 38031
Topic: Public Health and Psychosocial
Subtopic: Epidemiology of risk factors of Alzheimer's disease
Presentation: Poster session, Tuesday, July 16, 2013, 11:45 am ET

Project Learn MORE: Expanding Service Usage of Individuals with Early Stage Alzheimer's Disease

Presenting author: James Galvin , New York University School of Medicine.

Background: The Missouri Department of Health and Senior Services, the four Missouri Alzheimer's Association Chapters and ten Area Agencies on Aging (AAA's) collaborated in a two-year study to increase usage of available services by Missourians with Alzheimer's disease. Project Learn MORE (Missouri Outreach and Referral Expanded) proposed using the AD8 Dementia Screen by AAA caseworkers to detect incident cases, and referral of persons with dementia (PWDs) and family caregivers to Alzheimer Association chapters to receive supportive services and an intervention to increase coping skills.

Methods: Training on dementia, screening, and referral services was provided to AAA and Alzheimer Association staff. The AD8 was incorporated into the in-home geriatric assessments performed by the Missouri AAA. Incident cases were referred to participate in the Project Learn MORE intervention that included a care consultation. Pretest/posttests evaluated program effectiveness.

Results: During the two-year study, 3,960 older adults were assessed. The AAA staff reported the AD8 was easy to administer (94 percent), useful to detect dementia (92 percent) and made it easier to discuss memory loss with clients (78 percent). 317 incident cases of dementia were referred to Alzheimer Association chapters for support services; 249 enrolled in Project Learn MORE. PWDs reported improved knowledge about AD (p=.002) and reduced depression (p=.007). Family caregivers reported improved care confidence (p=.01), knowledge about AD (p=.003) and increased ability to identify sources of support (p=.008) but more burden after the intervention (p=.02) related to increased awareness of AD. Female caregivers gained greater increases in care confidence compared with male caregivers (p<.001). Project Learn MORE increased the likelihood the PWD would seek a formal diagnosis and treatment compared with previous interventions (p=.002).

Conclusions: Our intervention was successful in improving detection of incident cases of dementia in the community using a brief screening instrument, the AD8. We found that Project Learn MORE: (1) reduced depression and increased knowledge in PWDs; (2) improved caregivers' overall care confidence and knowledge but also their sense of burden; and (3) increased medical help-seeking behaviors compared with previous interventions. Our findings support the use of community service partners to detect dementia and that early diagnosis and intervention may improve patient- and family-centered outcomes.

Proposal ID: 39966
Topic: Diagnosis and Prognosis
Subtopic: Clinical
Presentation: Poster session, Wednesday, July 17, 2013, 11:45 am ET

Evidence-Based Provider Tools for Efficient Identification and Management of Cognitive Impairment

Presenting author: Terry Barclay, HealthPartners and Regions Hospital in St. Paul, MN

Background: Dementia is common among elderly patients yet often goes unrecognized in the primary care setting. Despite the availability of gold standard diagnostic guidelines and the recent inclusion of cognitive screening as a component of the Medicare Annual Wellness visit, few physicians assess for dementia as part of routine care. Many providers are still extremely reluctant to embrace dementia screening and diagnosis because the work-up and management of these patients in everyday practice is perceived to be unclear, complex, time consuming and burdensome.

Methods: ACT on Alzheimer's© is a state-wide collaboration between medical, academic, community, government, business and nonprofit stakeholders working to transform Minnesota's medical and long term care systems and communities to better support individuals with dementia and their families. These efforts have resulted in several tools designed to demystify and simplify dementia management in primary care.

Results: Our "practice parameter" provides doctors with a streamlined, one-page protocol to guide decision making in each of three topics: cognitive screening, dementia work-up/diagnosis and disease management. The guidelines incorporate existing best practice recommendations and are presented in a manner that allows for full appreciation of the steps involved in efficient and appropriate dementia care. Moreover, the protocols are easily adaptable to different settings and diverse practice groups.

A second tool provides a recipe for taking full advantage of the electronic medical record system (EMR) to further simplify and streamline the evaluation, diagnosis, and management of patients with dementia. The tool is not specific to any one EMR product but rather designed to guide efficiencies within existing systems (e.g., EPIC, McKesson, etc). The tool provides a way for healthcare systems, clinics, and hospitals to promote best practices in dementia care in a format that allows providers to quickly access and administer desired screening measures, place orders for appropriate labs and other diagnostics, make appropriate referrals and connect patients and families to helpful resources at the point of diagnosis.

Conclusions: Several evidence-based tools are now available to simplify and streamline dementia management in primary care.

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Make history at AAIC 2013 • Boston, MA • July 13-18, 2013