Enhancing Michigan Workforce Capacity for Behavioral Dementia Care Using the DICE Approach (MiDICE)
Investigators: Helen C. Kales, Frederic C. Blow, Mary C. Blazek, Laura May Struble, Donovan Maust, Kristen Jane Barry, Susan M. Maixner, Carey Sherman
Funding: Michigan Health Endowment Fund, 2017-2018 (R-1605-139821)
Dementia currently affects over 200,000 Michigan residents with over 500,000 Michigan family caregivers providing unpaid care. Contrary to popular belief, the memory part of dementia is just one symptom. Often far more troubling to family and other caregivers are non-cognitive behavioral and psychological symptoms of dementia (BPSD) that accompany the memory loss, which include agitation, depression, delusional beliefs, repetitive questioning, pacing, hallucinations, aggression, sleep problems, wandering, and a variety of socially inappropriate behaviors. BPSD occur in all types and stages of dementia and are among the most complex, stressful, and costly aspects of the illness, leading to frequent hospitalizations, nursing home placement, as well as caregiver stress and depression. Untreated BPSD are also associated with an accelerated trajectory to severe dementia and mortality. Antipsychotic medications are over-prescribed to treat these symptoms, despite minimal evidence of benefit and substantial risks, including mortality. While non-pharmacologic approaches (behavioral and environmental interventions) offer significant benefit for both patients and their caregivers and are recommended as first-line by multiple expert groups, they are infrequently used in community or long-term care settings. A major reason for this lack of uptake is lack of training among physicians and other first-line providers, who may not be comfortable addressing BPSD themselves, and are even less equipped to train caregivers. To address this need, the University of Michigan Program for Positive Aging convened a multidisciplinary national expert panel in 2011. The panel created an innovative, evidence-based, algorithmic approach called DICE (Describe, Investigate, Create and Evaluate) to address the assessment and management of behavioral symptoms so that caregivers and providers could integrate behavioral and environmental strategies into routine dementia care. DICE has since received considerable national and international acclaim and uptake. In this application, we propose to partner with the State of Michigan to offer two in-person DICE trainings for both formal and informal caregivers at distinct geographical sites in Michigan. Using information learned in the in-person trainings, we then propose to create an online DICE training program that will be sustainable, scalable and likely to achieve long-term impact for caregivers with measurable outcomes.