Resources Key to Keeping Alzheimer’s Patients Home

Giving dementia patients living at home, and their caregivers, extra help in locating services allowed the patients to remain at home significantly longer before an eventual transfer to nursing homes, a researcher said here.

The mean time from baseline to a patient’s permanent move from home was 51 days longer for those assigned to the intervention, compared with “augmented usual care,” in an 18-month randomized trial, said Quincy M. Samus, PhD, of Johns Hopkins University.

Patients in the program — called Maximizing Independence (MIND) at Home — also had fewer unmet needs of certain types and better quality of life as determined by study investigators who were blinded to the trial assignments, she said at the Alzheimer’s Association International Conference.

“The most promising aspect is that, overwhelmingly… people [with dementia] would like to stay at home longer, and this preliminary study demonstrated that,” Samus said at a press briefing.

She also noted that, as a nonpharmacological intervention, the program had no adverse effects.

About 300 patients at least 70 years old and their families took part in the study, including 265 with overt dementia and 38 with mild cognitive impairment.

All participants received an extensive in-home visit at baseline, at which care needs were evaluated. Families and their primary care physicians received a report on the types of services they would probably need and where to find them.

The intervention, provided to about 40% of participants, gave them regular consultations with a care-coordination team including a psychiatric nurse, a geriatric psychiatrist, and other professionals. It included a customized web-based application as well as telephone and clinic contacts.

Participants in the control group were left on their own to identify needs and seek services to meet them, following the initial report.

Any move from the baseline home — including death or relocation to another private home as well as transfer to residential care — was considered an endpoint event. Such outcomes were tracked for 600 days from baseline.

The other primary outcome was the blinded evaluators’ identification of unmet patient needs within the original home.

The most prominent benefit was the delay in patients’ transition out of the home. Mean time to an endpoint event was 496 days in the intervention group versus 445 days in the control group (P=0.02).

About 31% of the interventional group had an endpoint event versus 46% of controls. Samus showed a Kaplan-Meier survival curve for endpoint events, indicating that a benefit for the intervention became apparent after about 200 days.

Unmet needs tended to decline more from baseline with the intervention, Samus also reported. Approximately 10% of total needs were unmet at baseline in both groups. At the 18-month evaluation, the percentage of unmet needs had fallen to 5.9% in the intervention group versus 7.7% in controls (P=0.054).

The intervention was more successful in meeting some types of needs than others. Reductions in safety problems and legal and advance care planning issues were significantly greater with the intervention, Samus said.

Self-rated quality of life was significantly better in the intervention group. It increased by one point on the Alzheimer’s Disease Quality of Life scale (from 37.16 to 38.16 during the trial), whereas the control group had a decrease of 0.9 points (P=0.027).

Samus said her group hadn’t examined cost-effectiveness yet, but it was probably favorable. She pointed out that the average cost of a nursing home is about $280 per day, so the mean delay of 51 days in relocation out of the home represented a considerable saving.

Maria Carillo, PhD, senior director of medical and scientific relations at the Alzheimer’s Association, who moderated the press briefing, said the availability of nonpharmacological interventions to maintain patients’ quality of life is vital.

“We’re trying to improve patients’ lives in every way possible,” she said. “Unfortunately, sometimes when we can’t handle the difficulties and the stress level of keeping loved ones [with dementia] at home, we have to make decisions to institutionalize [them]. This type of home-based care intervention has the potential to help people keep their loved ones at home longer.”

Samus said the next steps would be to establish the durability of the intervention’s benefits, to identify subgroups with greater or lesser responses to the intervention, and to test it in different communities.

It also will be important to determine who would pay for such a program and, assuming it can be replicated elsewhere, how it could be expanded to the general dementia population, she said.

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