Care Management Program Is Reducing Need for Anti-anxiety Medication and Visits to the Hospital
"Alzheimer's and dementia clinicians are aware that medications alone do not effect disease progression and have only modest symptomatic affects," says research principal investigator Barry Reisberg, MD, professor of psychiatry and director of the Zachary and Elizabeth M. Fisher Alzheimer Disease Education and Resources program at NYU Langone. "Our new research shows that a comprehensive, patient-centered care program brings significant benefits in daily activities, which are important to individuals with Alzheimer's and those who care for and about them."
The new studies measured the added benefits the Comprehensive, Individualized, Person-Centered Management program (CI-PCM) had on patients allowing for the reduced need of potentially harmful anxiolytic (anti- anxiety) medications by 100%; hospitalization by 67%, and emergency room visits by 50%. Dr. Reisberg stated, the "CI-PCM study appears to be one of the first non-pharmacological intervention study associated with a decrease in anxiolytic medication usage in AD persons. We now know that anxiolytic medication causes an increase in death, stroke, and accelerated cognitive decline in AD persons."
The CI-PCM's system of care includes care partner training, residence assessment, therapeutic home visits, and care partner support groups, all developed and conducted by study co-investigator Sunnie Kenowsky, DVM, co-director of the Fisher Alzheimer's Disease Program and clinical instructor of Psychiatry at NYU Langone.
In a 28-week, blinded, randomized controlled trial, 10 patient-care partner dyads enrolled in the CI-PCM program were compared against 10 patients and their care partners receiving standard community care. The standard care included referrals to resources for caregiver training, care counseling, physical, speech and occupational therapy, of medic-alert bracelets, day care centers and support group programs.
The two groups were compared at the end of the 28 week study using a clinical test which measures losses in the ability of a person to independently carry out daily activities, such as dressing, bathing and toileting. According to Dr. Kenowsky, successful replication of the new findings of a 67% decreased risk of hospitalization and 50% decreased risk of emergency room visits for AD persons who are under the guidance of the CI-PCM program, may lead to potentially, significant reduced AD care costs.
Alzheimer's disease has been considered a degenerative condition, so there is currently little emphasis on retraining patients, says Reisberg. The team's prior work had shown that losses in function related to Alzheimer's occur in reverse order from the sequence in which the skills are acquired in the first place during normal development. They coined this process "retrogenesis,"
The CI-PCM system used in the study included care partner training, and "memory coaching" a technique created by Sunnie Kenowsky, D.V.M., that teaches patients how to accomplish skills they lost, in combination with other supportive programs. This new research validates this hypothesis, says Reisberg, and shows that significant improvements are possible in some of the most disturbed and impaired community-residing people with Alzheimer's.
"While there are many great resources for people with Alzheimer's and their families within communities, direct training in basic skills in more severe and more disturbed persons with Alzheimer's is an underutilized and understudied treatment method can potentially be of great help to persons with Alzheimer's and those who care for and about them. " says Reisberg.
This study was supported by the Fisher Center for Alzheimer's Research Foundation (https://www.alzinfo.org/
The Fisher Center is one of the largest and most modern scientific facilities in the world dedicated to solving the puzzle of Alzheimer's disease. Our founding director is Nobel Laureate and neuroscientist Paul Greengard. He and his world-renowned team at the Fisher Center are leading the way to find a cure for Alzheimer's disease. Our Mission is to attack the scourge of Alzheimer's disease through a 3-pronged assault focused on finding a cure, understanding the causes of Alzheimer's disease; and improving the care of people living with Alzheimer's to enhance their quality of life.
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