Integrated Care Models Promising for Dementia Patients

Merging primary and dementia care may help clinicians prescribe unnecessary medications, according to a poster presented at the Gerontological Society of America 2024 Annual Scientific Meeting in Seattle.

Researchers at the Integrated Memory Care Center (IMCC) at Emory University in Atlanta, Georgia, found that patients seen in their clinic had higher rates of being deprescribed potentially dangerous medications compared to patients who received care at standalone cognitive neurology or primary care clinics at Emory Healthcare.

The study findings “support the idea that having a coordinated, comprehensive approach to dementia care is beneficial,” said Laura Medders, LCSW, an author of the study and the program director at IMCC.

While IMCC functions largely as a primary care clinic, “we’re looking at all of their health conditions through the lens of their dementia diagnosis,” Medders said. The program offers cognitive assessments, psychiatric services, family support groups, and education to help caregivers better assist patients, Medders said.

The retrospective observational study consisted of 1508 patients aged ≥ 65 years with a dementia diagnosis between 2019 and 2021. All had been treated at Emory Healthcare: 509 at IMCC, 490 who received care at cognitive neurology and primary care clinics separately (CN), and 509 in primary care (PC) alone.

When compared to CN, IMCC patients had higher odds of being deprescribed high-dose antipsychotics (odds ratio [OR], 4.383; CI,1.405-13.677), benzodiazepines (OR, 3.338; CI, 1.541-7.231) and opiates (OR, 1.004; CI, 0.415-2.431).

Compared to PC alone, IMCC patients also had higher odds of being deprescribed high-dose antipsychotics (OR, 5.538; CI, 1.21-25.359), benzodiazepines (OR, 2.632; CI, 1.297-5.341), and opiates (OR, 1.424; CI, 0.571-3.55).

Patients in the CN arm were 66% more likely to be hospitalized as patients in the IMCC arm in adjusted models. Medders would not provide other comparison data.

Dementia patients are at a higher risk for potentially inappropriate prescribing, which is often associated with comorbid conditions and can lead to adverse health outcomes, such as increased all-cause mortality, osteoporosis, and falls.

Research shows that rates of potentially preventable hospitalizations among adults over 65 years with dementia are rising, which often leads to “unintended secondary consequences” where patients “often don’t leave the hospital the same way they entered,” Medders said. IMCC has an after-hours phone line for consultations for caregivers in an effort to reduce unnecessary hospital visits.

Medders said that patients who may not have needed hospital care can end up in subacute rehab centers instead of going home, disrupting care arrangements for families who are already experiencing the higher costs associated with hospitalization.

“Integrated care better addresses the complex nature of comorbid conditions,” said Kemi Reeves, associate director of UCLA Alzheimer’s and Dementia Care Program in Los Angeles. “Geriatric conditions do not live apart from the dementia diagnosis and they influence each other.”

Michal Schnaider Beeri, PhD, director of the Herbert and Jacqueline Krieger Klein Alzheimer’s Research Center in New Brunswick, New Jersey, said IMCC’s approach is a step in the right direction.

“IMC is a promising model with the potential to significantly improve outcomes and quality of life for both patients and their caregivers,” Beeri said. “However, widespread adoption would require changes in insurance coverage and healthcare delivery systems.”

The authors reported no disclosures or sources of funding.

Brittany Vargas is a medicine, mental health, and wellness journalist.