Implementing innovative models of dementia care: The Healthy Aging Brain Center

Abstract

Background: Recent randomized controlled trials have demonstrated the effectiveness of the collaborative dementia care model targeting both the patients suffering from dementia and their informal caregivers.

Objective: To implement a sustainable collaborative dementia care program in a public health care system in Indianapolis.

Methods: We used the framework of Complex Adaptive System and the tool of the Reflective Adaptive Process to translate the results of the dementia care trial into the Healthy Aging Brain Center (HABC).

Results: Within its first year of operation, the HABC delivered 528 visits to serve 208 patients and 176 informal caregivers. The mean age of HABC patients was 73.8 (standard deviation, SD 9.5), 40% were African-Americans, 42% had less than high school education, 14% had normal cognitive status, 39% received a diagnosis of mild cognitive impairment, and 46% were diagnosed with dementia. Within 12 months of the initial HABC visit, 28% of patients had at least one visit to an emergency room (ER) and 14% were hospitalized with a mean length of stay of five days. The rate of a one-week ER revisit was 14% and the 30-day rehospitalization rate was 11%. Only 5% of HABC patients received an order for neuroleptics and only 16% had simultaneous orders for both definite anticholinergic and anti-dementia drugs.

Conclusion: The tools of ‘implementation science’ can be utilized to translate a health care delivery model developed in the research laboratory to a practical, operational, health care delivery program.

Keywords:

• dementia care
• memory care practice
• implementation science
• complex adaptive system
• informal caregiver

Acknowledgments

Dr Boustani is supported by NIA Paul B. Beeson K23 Career Development Award no. 1-K23-AG026770-01 and R01AG029884-01. Dr Callahan is supported by NIA award nos K24-AG026770 and P30AG024967. Drs Sachs, Guerriero Austrom, Hake, Unverzagt, Farlow, and Matthews were supported partially by award no. NIH P30-AG010133.