The Issue

People with Alzheimer’s disease and related dementias (ADRDs) often suffer from devastating symptoms: cognitive impairment, immobility and falls, swallowing disorders and aspiration pneumonia, and behavioral symptoms. Caregivers experience considerable stress as well.

Several dementia care programs aim to meet the needs of both patients and caregivers alike. Some are based within health care systems, while others are based in the community. In the UCLA Alzheimer’s and Dementia Care (ADC) Program, a health system–based model, nurse practitioners trained as dementia care managers work with primary care and specialty physicians to deliver care. The program has cared for more than 2,600 patients and caregivers since it was fully implemented in 2012.

A study published in the Journal of the American Geriatrics Society by Commonwealth Fund–supported researchers examined outcomes for dementia patients and their caregivers enrolled in the program after one year.

After one year, adults with ADRD improved on all scales, except on measures of cognition and functional status. Caregivers improved on all scales.

What the Study Found

  • After one year, adults with ADRD improved on all scales, except on measures of cognition and functional status. Caregivers improved on all scales.
  • Fifty-eight percent of patients, 63 percent of caregivers, and 75 percent of patients or caregivers demonstrated clinical benefit.
  • Patients who started with worse behavioral symptoms were more likely to improve, suggesting that the delivery of high-quality dementia care and caregiver education and support helped to manage these symptoms.
  • Caregivers who had the highest burden — distress, strain, and depression symptoms — benefited the most, suggesting the importance of specific interventions aimed at caregivers.
  • Being a male caregiver was also associated with caregiver improvement.

The Big Picture

While patients with Alzheimer’s disease and related dementias still experienced cognitive and functional decline, most patients and their caregivers participating in a health system–based comprehensive ADRD care program improved on measures of patient and caregiver symptoms. Having nurse practitioners comanage care for patients with ADRD could be a model for providing dementia care that meets the triple aim of quality care, lower costs, and better clinical outcomes.

The Bottom Line

A health system–based program where nurse practitioners trained as dementia care managers work closely with primary care and specialty physicians holds promise as a model for improving outcomes for dementia patients and their caregivers.