Division of Geriatric Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
Department of Neurology and Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California.
J Am Geriatr Soc. 2021 Jan;69(1):210-215. doi: 10.1111/jgs.16835. Epub 2020 Sep 25.
BACKGROUND/OBJECTIVES: Cognitive and mobility impairments are common and underdiagnosed chronic conditions that afflict community-dwelling older adults. This study describes the organization, implementation, and evaluation of an intervention for underserved and ethnically diverse older patients with dementia and/or falls risk.
Observation, baseline and 1 year after intervention.
Community-based primary care county clinics in inland southern California.
A total of 272 persons, aged 70 years and older, who screened positive for falls and/or dementia and enrolled in the Cognition and Mobility Care Management program during the study period.
A nurse care manager performed a patient and caregiver evaluation and created and implemented a care plan with medical, behavioral, and psychosocial interventions in partnership with patients and their primary care providers.
Process outcomes included rates of positive screening for dementia and fall risk, referral, enrollment, and visit completion. Patient outcomes included fall history, mobility and cognitive assessments, and depression scales. Patients and/or caregivers completed questionnaires rating perceived benefits of enrollment after 1 year in the program.
Medical assistants screened 573 patients aged 70 years and older during the study period; 78% screened positive for dementia and/or fall risk. Of the patients who screened positive, 94% were referred; 91% of contacted patients elected to enroll, and 272 patients completed an intake visit (mean = 77 years; 65% female; 75% Latino; 10% African American). The patients and caregivers who completed satisfaction questionnaires 1 year after enrollment rated the program highly, and 92% would recommend the program to others.
A primary care-based screening and comanagement program to identify and manage dementia and falls risk in primarily Latino and African American older adult patients living in an underserved area was well received, with high satisfaction and perceived benefit from patients and caregivers.
背景/目的：认知和移动障碍是常见且未被充分诊断的慢性疾病，影响着社区居住的老年人群。本研究描述了一项针对服务不足和种族多样化的老年痴呆症和/或跌倒风险患者的干预措施的组织、实施和评估。
观察、干预前和干预后 1 年。
加利福尼亚州内陆社区基础护理县诊所。
共有 272 名年龄在 70 岁及以上的患者，他们在研究期间对跌倒和/或痴呆症进行了筛查，并且阳性结果提示存在风险，随后参加了认知和移动护理管理计划。
一名护士护理经理对患者和照护者进行评估，并与患者及其初级保健提供者合作，制定并实施包含医疗、行为和心理社会干预的护理计划。
过程结果包括痴呆症和跌倒风险的阳性筛查率、转诊率、入组率和就诊完成率。患者结果包括跌倒史、移动和认知评估以及抑郁量表。患者和/或照护者在参加计划 1 年后完成了对入组益处的感知的调查问卷。
在研究期间，医疗助理对 573 名 70 岁及以上的患者进行了筛查；78%的患者筛查出痴呆症和/或跌倒风险阳性。在筛查阳性的患者中，94%的患者被转诊；91%的联系患者选择入组，272 名患者完成了入组就诊（平均年龄=77 岁；65%为女性；75%为拉丁裔；10%为非裔美国人）。完成 1 年后入组满意度问卷的患者和照护者对该计划评价很高，92%的人会向他人推荐该计划。
在服务不足的地区，针对以拉丁裔和非裔美国老年患者为主的认知和跌倒风险管理的初级保健为基础的筛查和共同管理计划得到了很好的接受，患者和照护者对其满意度和受益感知很高。
