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Long-term Care

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Patients with Alzheimer's disease and their caregivers need a comprehensive care program that addresses problem behaviors

A newly developed, multicomponent care management intervention program may help Alzheimer's disease patients and their families obtain the comprehensive care and support services they need. The program, which is coordinated by a geriatric nurse practitioner, provides protocols to manage the behavioral problems often exhibited by Alzheimer's patients. It also provides caregiver education and support. The program was developed by researchers at Indiana University and the Indiana Alzheimer Disease Center. Although it is too early to gauge the success of the program, it has been well received by patients, caregivers, and primary care physicians, according to the researchers.

In a study supported by the Agency for Healthcare Research and Quality (HS10884), Mary G. Austrom, Ph.D., and colleagues implemented the program at a university-affiliated primary care practice serving predominantly poor and black patients. The clinical team included a geriatric nurse practitioner, social psychologist, geriatrician, and geriatric psychiatrist who made patient-specific treatment recommendations (including medications) once a patient's diagnostic workup was completed.

Based on caregiver responses to questionnaires about the patient's behavior, the team recommended specific behavioral protocols accompanied by user-friendly handouts. The nurse practitioners regularly contacted the family to track progress and address any new or continuing concerns. They also encouraged patients and caregivers to attend monthly support meetings.

The goal of the behavioral protocols is to minimize behaviors that typically cause tremendous distress for patients and caregivers. For example, to reduce aggression or agitation, caregivers should identify potential triggers of emotional outbursts and try to prevent them; establish a calm environment and gentle approach; avoid arguing, confronting, or trying to reason with the patient; and redirect the patient's attention. Other behavioral protocols include ways to distract or redirect patients from delusions or hallucinations, reduce anxiety or depression, maintain independence in personal care, avoid wandering and falls, and reduce sleep disturbances.

For more information, see "Development and implementation of nonpharmacologic protocols for the management of patients with Alzheimer's disease and their families in a multiracial primary care setting," by Dr. Austrom, Teresa M. Damush, Ph.D., Cora West Hartwell, A.N.P., and others, in the August 2004 Gerontologist 44(4), pp. 548-553.

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