With the aging of the baby boomers, the numbers of Americans
living with or affected by dementia will rise dramatically. By 2025, an
estimated 7.2 million Americans are expected to have Alzheimer’s
disease, which is the most common cause of dementia, accounting
for 60-80% of cases.

Objective: To assess whether MIND at Home, a community-based, multicomponent, care coordination intervention, reduces unmet caregiving needs and burden in informal caregivers of persons with memory disorders.

The workforce available to care for older adults has not kept pace with the need. In response to workforce limitations and the growing complexity of healthcare, scientists have tested new models of care that redesign clinical practice. This article describes why new models of care in aging, dementia, and mental health diffuse inadequately into the healthcare systems and communities where they might benefit older adults.

Sweeping changes and actions of multiple stakeholders are necessary to improve detection rates of mild cognitive impairment so that patients and families may benefit from timely interventions.

​

This Viewpoint describes barriers to comprehensive dementia care and proposes strategies for overcoming them.

The Integrated Memory Care Clinic (IMCC) is a patient-centered medical home as defined by the National Committee for Quality Assurance directed by advanced practice registered nurses (APRNs) caring for persons living with dementia (PLWD); physicians provide specialty consultation but do not direct care or care planning.

Dementia is associated with high health care costs, premature long-term care (LTC) placement, medical complications, reduced quality of life, and caregiver burden. Most health care providers and systems are not yet organized or equipped to provide comprehensive long-term care management for dementia, although a range of effective symptoms and supportive care approaches exist. The Maximizing Independence at Home-Streamlined (MIND-S) is a promising model of home-based dementia care coordination designed to efficiently improve person-centered outcomes, while reducing care costs. This report describes the rationale and design of an NIA-funded randomized controlled trial to test the impact of MIND-S on time to LTC placement, person with dementia outcomes (unmet needs, behavior, quality of life), family caregiver outcomes (unmet needs, burden), and cost offset at 18 (primary end point) and 24 months, compared to an augmented usual care group.

As the complexity of medical treatments and patient care systems have increased, the concept of patient navigation is growing in both popularity and breadth of application. Patient navigators are trained personnel whose role is not to provide clinical care, but to partner with patients to help them identify their needs and goals and then overcome modifiable patient‐, provider‐, and systems‐level barriers. Due to its high incidence, duration, and medical–social complexity, dementia is an ideal candidate for a patient‐centric health care delivery model such as care navigation.

With care coordination, problem solving, and an array of services, a model program helps dually eligible Medicare and Medicaid patients and their caregivers cope with dementia challenges.

Understanding experiences and challenges faced by persons living with Early-Onset Dementia (EOD) compared to individuals diagnosed with Late-Onset Dementia (LOD) is important for the development of targeted interventions.

Because of its often slowly progressive nature, dementia is often included among chronic disease management programs. Yet, for many reasons, its management demands different approaches.

Dementia is a chronic disease that requires medical and social services to provide high-quality care and prevent complications. As a result of time constraints in practice, lack of systems-based approaches, and poor integration of community-based organizations (CBOs), the quality of care for dementia is poorer than that for other diseases that affect older persons. The University of California at Los Angeles (UCLA) Alzheimer's and Dementia Care (UCLA ADC) program partners with CBOs to provide comprehensive, coordinated, patient-centered care for individuals with Alzheimer's disease and other dementias.

People living with dementia (PLWD) are among the highest-need and highest-cost individuals because of the complexity, duration, and range of medical, behavioral, environmental, and social needs. There is a growing evidence base showing that family-centered active management approaches that include activation and empowerment of care partners are well suited to improve care quality, health-related outcomes, and healthcare costs.

We, the authors, believe care could be vastly improved, and costs could be reduced, if all community-dwelling Medicare beneficiaries living with dementia could enroll in a comprehensive dementia care program that addresses the needs of both the persons living with dementia and their caregivers.

Objective: To investigate effects of a novel dementia care coordination program on health services utilization.

The current US system of reimbursement for dementia care does not support the complex biopsychosocial needs of families living with Alzheimer disease and related dementias. We propose an alternative payment system for dementia care that would provide insurance coverage for evidence-based, collaborative dementia care models.

The emergency department evaluates many patients with undiagnosed cognitive impairment and presents an opportune setting to facilitate early detection and referral to memory care specialists.

The Care Ecosystem exemplifies a scalable approach to dementia care, guided by implementation science principles to bridge the gap between research and real-world application. Its success in improving patient outcomes and reducing healthcare costs underscores its potential to enhance dementia care delivery on a broader scale. Future efforts should focus on refining implementation strategies, enhancing fidelity monitoring, and expanding partnerships to sustain and scale effective dementia care practices across diverse healthcare settings.

Dementia represents a growing healthcare challenge in the United States. The Care Ecosystem, an effective collaborative care model, bridges medical and social care needs for individuals with dementia.

We examine care partners' experience of the Maximizing Independence at Home (MIND) intervention, a multicomponent, home-based dementia care coordination program designed to provide high quality, wholistic care coordination for people and families living with dementia. The goal of the study was to understand 1. the unique dementia-related needs of Black care partners and barriers and challenges to caregiving experienced within the Black community, 2. perceived benefits of the MIND program, and 3. ways to improve the program and make it more culturally responsive to the Black community.

A substantial number of evidence-based dementia caregiving support programs positively impact family and friend caregivers. Researchers and service organizations have successfully translated and delivered a subset of these programs to caregivers and are included in Best Programs for Caregiving (BPC). This investigation examined the programmatic caregiver research outcomes reported in peer-reviewed articles of BPC programs to understand how programs impact caregivers in the community and identify underrepresented outcomes.

Multiple studies have shown that quality of care for dementia in primary care is poor with physician adherence to dementia quality indicators (QIs) ranging from 18-42%. In response, the University of California, Los Angeles Health System created the UCLA Alzheimer’s and Dementia Care (ADC) Program, a quality improvement program that uses a co-management model with a nurse practitioner dementia care manager (DCM) working with primary care physicians and community-based organizations to provide comprehensive dementia care. Our objective was to measure the quality of dementia care provided by nurse practitioner DCMs using the Assessing Care of Vulnerable Elders (ACOVE-3) and Physician Consortium for Performance Improvement QIs.

Pilot findings convey a need to continue creating and receiving feedback on culturally tailored psychoeducation programs for dementia caregivers. The next steps include applying results to fuel the success of the next iteration of CWB.

The benefits and harms of screening of Alzheimer disease and related dementias (ADRDs) are unknown. This study addressed the question of whether the benefits outweigh the harms of screening for ADRDs among older adults in primary care.

The University of California, Los Angeles Alzheimer’s and Dementia Care (ADC) program enrolls persons living with dementia (PLWD) and their family caregivers as dyads to work with nurse practitioner dementia care specialists to provide coordinated dementia care. At one year, despite disease progression, overall the PLWDs’ behavioral and depressive symptoms improved.

In this randomized trial of dementia care programs, no significant differences existed between health system-based and community-based care interventions nor between either active intervention or usual care regarding patient behavioral symptoms and caregiver strain.

Opportunities exist to increase knowledge of ADRD signs and symptoms, and awareness of risk and protective factors. Given the heterogeneity of Latinos in the US, more research is warranted to better elucidate nuances in conceptualizations of brain health and aging among diverse Latino subgroups.

These findings suggest that alternative payment models to ACOs may be needed to coordinate high-quality care with lower health care spending for Medicare beneficiaries with dementia at the end of life.

Compared with usual care, a dementia care management program improved various cost of care and utilization metrics in a Medicare managed care population at 12 months.

The Payment Model for Comprehensive Dementia Care Conference convened more than 50 national experts from diverse perspectives to review promising strategies for payment reform including ways to accelerate their adoption.

This report presents actionable recommendations to advance comprehensive dementia care and implement effective payment policies.

The purpose of this longitudinal cohort study was to explore the outcomes of persons living with dementia (PLWD) and their caregivers during their first 9 months at the Integrated Memory Care Clinic (IMCC).

Collaborative dementia care models with care navigation, including the Care Ecosystem, improve outcomes for persons living with dementia (PLWDs) and their caregivers. The effects of continuous care over long periods have not been studied.

Among the challenges of being diagnosed with dementia and caring for someone diagnosed with dementia is navigating the complicated health, legal, and social systems designed to help and protect people living with dementia.

Overall, improved outcomes for PWDs and caregivers in this translation study were similar to findings from previous randomized trials, and affirmed the value of the program when delivered as a regular service offering by health care and community service organizations.

Despite the importance of persons with dementia (PWDs) engaging in advance care planning (ACP) at a time when they are still competent to appoint a surrogate decision maker and meaningfully participate in ACP discussions, studies of ACP in PWDs are rare.

Cognitive impairment (CI) is one of several factors known to influence hospitalization, hospital length of stay, and rehospitalization among older adults. Redesigning care delivery systems sensitive to the influence of CI may reduce acute care utilization while improving care quality. To develop a foundation of fundamental needs for health care redesign, we conducted focus groups with inpatient and outpatient providers to identify barriers, facilitators, and suggestions for improvements in care delivery for patients with CI.

Persons living with dementia (PLWD), particularly those with higher levels of functional impairment, are at increased risk of hospitalization and higher hospital-associated health care costs. Our objective was to provide a nuanced description of reasons for hospitalizations over a 12-month period among community-living persons with dementia taking part in a dementia care coordination study using caregiver-reported data and to describe how reasons varied by disease stage.

Across the three overarching themes presented in this manuscript, the importance of engagement from site leaders, the multifaceted nature of the dementia care specialist role, and the value of technical assistance from qualified experts are apparent. However, for this work to continue to be successful, there needs to be more appropriate payment to cover needed services and a mechanism for supporting comprehensive dementia care over time.

In this qualitative interview study with 39 PCPs from across California, 6 themes associated with their perspectives on their role in dementia care were identified. These themes focused on their role in the diagnostic workup; the importance of long-term, trusting relationships with patients; the value of understanding patients’ life contexts; their work to educate families; their activities around coordinating dementia care; and the systems-level constraints they face.