Can a Coordinated System of Care Improve the Quality of Care for People With Dementia?

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The summary below is from the full report titled "The Effect of a Disease Management Intervention on Quality and Outcomes of Dementia Care. A Randomized, Controlled Trial." It is in the 21 November 2006 issue of Annals of Internal Medicine (volume 145, pages 713-726). The authors are B.G. Vickrey, B.S. Mittman, K.I. Connor, M.L. Pearson, R.D. Della Penna, T.G. Ganiats, R.W. DeMonte Jr., J. Chodosh, X. Cui, S. Vassar, N. Duan, and M. Lee.

What is the problem and what is known about it so far?

Dementia is a progressive decline in thinking, memory, and the ability to learn. People with dementia need help with basic activities, such as cooking and bathing. Most also eventually need around-the-clock supervision from caregivers. Dementia has no cure, but providing support to caregivers helps. With caregiver support, symptoms of dementia can be improved. Support can also delay the caregiver's need to send the person they are helping to a nursing home. However, proper support requires multiple health care and social services.

Why did the researchers do this particular study?

To test a system that coordinates all the care and services needed by people with dementia and their caregivers.

Who was studied?

408 pairs of people with dementia and their caregivers.

How was the study done?

Pairs of participants received dementia care and services through a coordinated system or through their usual system of care. In the coordinated system, social workers and other personnel regularly assessed the pairs and helped them get the services they needed from doctors and community agencies in an ongoing fashion. In the usual system, pairs were responsible for coordinating their own doctor visits and social services. The researchers then compared the care and services received by each group.

What did the researchers find?

Pairs of participants cared for in the coordinated system received more and higher-quality health and social services than those in the usual system. Quality of life and social support were also better for those cared for in the coordinated system.

What were the limitations of the study?

Study participants were mostly white and well-educated. They also lived at home and had health insurance. The findings might not apply to other populations.

What are the implications of the study?

The quality of care for patients with dementia and their caregivers can be improved when a social worker or other professional helps them get the services they need from doctors and community agencies.