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Page: << Prev | 1 | 2 | 3 | Next >> The effectiveness of these recommendations had not yet been tested, Callahan said. "We decided to put it all together and see what happened if you did apply these the way the experts suggest," he said.
So, 153 older adults with mild to moderate Alzheimer's and their caregivers were randomly picked to receive either collaborative-care management or "augmented usual care" at primary-care practices.
The collaborative-care approach involved one year of care from an interdisciplinary team headed by an advanced practice nurse who was located at a primary-care practice.
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"The care manager is the quarterback for the management of the patient with Alzheimer's and the caregiver," Callahan explained. "She's acting as an ombudsman, not only for facilitating the knowledge that she has, but also facilitating access to the rest of the health-care system. The primary-care doctor is still quarterbacking everything else."
Caregivers and patients in the augmented usual-care group received counseling from a geriatric nurse practitioner and were also given information about local community resources.
Eighty percent of patients in the collaborative care arm and 55 percent of patients in the control group received cholinesterase inhibitors, an FDA-approved drug treatment for Alzheimer's; and 45 percent in the collaborative arm took antidepressants, compared with 27.5 percent in the control group.
Patients receiving collaborative care had significantly fewer behavioral and psychological symptoms of dementia at one year and at 18 months after the study began. Caregivers also reported improvements in their levels of stress at 12 months and in depression at 18 months.
"The intervention worked even though we were comparing this intervention to another intervention," Callahan said. "It worked on the symptoms that older adults and their families find the most distressing, these behavioral factors."
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