Collaborative Dementia Care Tied With Improved Outcomes
Collaborative dementia care management (CDCM) was associated with improved patient and caregiver outcomes over 3 years after the initial care period, according to results from a randomized controlled trial published in JAMA Network Open.
“While younger patients and patients with mild cognitive impairment have been more frequently diagnosed with dementia in recent years in primary care, which is an important aspect of disease-modifying treatments, there is still potential for increasing dementia diagnostics in older patients, demonstrating an implementation prerequisite for CDCM,” noted lead author Bernhard Michalowsky, PhD, German Center for Neurodegenerative Diseases, Rostock/Greifswald, Greifswald, Germany, and co-authors. “Therefore, further research is needed to monitor primary dementia care.”
The secondary analysis was part of a general practitioner-based, cluster randomized, 2-arm clinical trial conducted in Germany from 2012 to 2014, with follow-up until 2018. Participants were aged 70 years and older and living at home with dementia. The intervention group received a CDCM program, involving individualized care from dementia-trained nurses in collaboration with GPs for 6 months, while the control group received usual care. Key outcomes assessed included neuropsychiatric symptoms, caregiver burden, health-related quality of life, medication use, and cost-effectiveness, with comparisons made between the groups using multivariate regression models.
A total of 308 patients, of whom 221 (71.8%) received CDCM (mean age, 80.1 years; 142 [64.3%] women) and 87 (28.2%) received usual care (mean age, 79.2 years; 50 [57.5%] women), were included in the clinical effectiveness analyses, while 428 patients (303 [70.8%] CDCM, 125 [29.2%] usual care) were included in the cost-effectiveness analysis (including 120 patients who had died). Participants who received CDCM showed significantly fewer behavioral and psychological symptoms, better mental health, and lower caregiver burden.
Authors recognized a few limitations that could have affected study results. Generalizability of results is limited to patients with mild cognitive impairment in a rural German setting, with potential biases due to imbalanced group distribution, data collection by the same nurses, and the use of screening rather than advanced diagnostic procedures. These factors, along with the sample size calculation focused only on primary outcomes, may have affected the validity and generalizability of secondary and economic outcome conclusions.
“Further research is needed to monitor primary dementia care,” authors concluded. “As a result, it is imperative that policymakers are informed about the evidence, starting government-led initiatives to support CDCM evidence transfer into health policies and care practice.”
