Enhancing Workforce Capacity for Behavioral Dementia Care Using the DICE Approach
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.1 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.1 Untreated BPSD are also associated with an accelerated trajectory to severe dementia and mortality.2 In terms of treatment, antipsychotic medications are over-prescribed to treat these symptoms, despite lack of FDA approval, minimal evidence of benefit3 and substantial risks,4 including mortality.5 While non-pharmacologic approaches (behavioral and environmental interventions) offer significant benefit for both patients and their caregivers6 and are recommended as first-line by multiple expert groups,7,8 they are infrequently used in community or long-term care settings.1 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.
Centers for Medicare and Medicaid Services
(subcontract: MA No. 20180230-00 / Project # E20182781-00)
Funding Period: 10/1/2017 to 9/30/2018