Alzheimer Disease Center, Departments of Neurology, Psychiatry and Population Health, New York University Langone Medical Center, New York, NY, USA.
Clinical Psychology Program, University of Missouri - St Louis, MO, USA.
Clin Interv Aging. 2014 Apr 10;9:621-30. doi: 10.2147/CIA.S60838. eCollection 2014.
In a collaborative effort between the Missouri Department of Health, Area Agencies on Aging (AAA), Alzheimer Association, and academic researchers, we tested whether early dementia detection and comprehensive care consultations would improve health outcomes in care receivers (CRs) and their family caregivers (FCGs), therefore addressing an important public health concern.
A total of 244 community-dwelling older adults screened for early-stage dementia by the AAA field staff were referred to the Alzheimer Association and participated in Project Learn MORE (Missouri Outreach and Referral Expanded) (PLM) - a 2-year, nonrandomized multisite intervention consisting of comprehensive care consultations to improve coping skills. PLM participants were compared against 96 controls receiving the Alzheimer Association's "usual services" between January 2011 and December 2012. We examined CR and FCG outcomes, including burden, care confidence, and mood, as effects of PLM, on delaying transitions in level of care.
CRs showed improved knowledge (P=0.002) and reduced depression (P=0.007), while FCGs demonstrated improved knowledge (P=0.003) and ability to identify sources of support for the CR (P=0.032) and for themselves (P=0.043). However, FCGs were more burdened after PLM (P=0.02), due to increased awareness of Alzheimer's disease. PLM delayed transitions in care (odds ratio [OR] 3.32, 95% confidence level [CI]: 1.25-8.83) with the number needed to treat =6.82.
PLM was successful in improving detection of incident cases of dementia in the community and in connecting patients and their families with needed services. Our findings support the use of state agencies and community service partners to detect dementia. Early implementation of psychosocial interventions could have significant impact in improving patient- and family-centered outcomes, potentially providing a cost-efficient alternative to pharmacotherapy.
在密苏里州卫生部、地区老龄化机构（AAA）、阿尔茨海默病协会和学术研究人员的合作下，我们测试了早期痴呆检测和综合护理咨询是否会改善护理接受者（CR）及其家庭照顾者（FCG）的健康结果，从而解决了一个重要的公共卫生问题。
共有 244 名通过 AAA 现场工作人员筛查出早期痴呆的社区居住老年人被转介到阿尔茨海默病协会，并参与了 Project Learn MORE（密苏里州拓展外联和转诊）（PLM）-一项为期 2 年的非随机多地点干预措施，包括改善应对技能的综合护理咨询。PLM 参与者与 2011 年 1 月至 2012 年 12 月期间接受阿尔茨海默病协会“常规服务”的 96 名对照进行了比较。我们检查了 CR 和 FCG 的结果，包括负担、护理信心和情绪，作为 PLM 的影响，以延迟护理水平的转变。
CR 表现出知识的提高（P=0.002）和抑郁的减少（P=0.007），而 FCG 表现出知识的提高（P=0.003）和识别 CR 及其自身支持来源的能力的提高（P=0.032 和 P=0.043）。然而，PLM 后 FCG 的负担增加（P=0.02），这是由于对阿尔茨海默病的认识增加。PLM 延迟了护理的转变（优势比 [OR] 3.32，95%置信区间 [CI]：1.25-8.83），需要治疗的人数为 6.82。
PLM 成功地提高了社区中痴呆症新发病例的检出率，并将患者及其家属与所需服务联系起来。我们的发现支持使用州机构和社区服务伙伴来检测痴呆症。早期实施心理社会干预可能会对改善以患者和家庭为中心的结果产生重大影响，可能为药物治疗提供一种具有成本效益的替代方案。
