PRIOR MIND AT HOME RESEARCH PROJECTS


MIND at Home Phase II was a pilot randomized controlled trial (RCT) (Samus et al., 2014).  The aim of this study was to determine whether an 18-month dementia care coordination intervention could delay time to transition from home and reduce unmet needs in community-residing elders with memory disorders.  It included 303 community-residing elders age 70 or older who lived in 28 postal code areas of Baltimore, MD.  The MIND at home intervention was used to systematically identify and address dementia-related care needs through individualized care planning, referral and linkages to services, provision of dementia education and skill-building strategies for caregivers, and care monitoring by an interdisciplinary team. 

All participants, including those with dementia (87%) and those with mild cognitive impairment (13%), received the needs assessment based on the JHDCNA tool.  A written report outlining any identified unmet needs and recommendations for addressing those needs were given to the person with dementia and their caregiver, and copy of the report was sent to their primary care provider with the patient’s permission.  At baseline, the most common unmet needs of those with dementia were in the areas of personal and home safety (91%), general health and medical care (63%), meaningful activities (53%), legal and advance care planning (48%) and evaluation and diagnosis of dementia (32%) (Black et al., 2013).  Caregivers had high rates of unmet needs for resource referrals (89%) and caregiver education (85%).



Approximately one-third (n=110) of participants received the 18-month MIND intervention, and their outcomes were compared to those of the remaining participants (n=193) who received usual care that was augmented by receiving results of the MIND needs assessment and recommendations for how to address those needs.

This study demonstrated that participants who received the MIND intervention had significant delays in the time to transition from their home.  Over an extended follow-up period (median time of 26 months), those in the MIND intervention group continued to remain in their homes significantly longer (median of 288 days) than those in the augmented usual care group.  Unmet needs in both groups declined during the initial 18-month period.  This was likely due to both groups receiving the needs assessment and recommendations for addressing those needs.  However, the MIND intervention group had significantly greater declines in unmet needs related to issues of safety and advance care planning.  Participants who received the intervention also had a significant improvement in self-rated quality of life when compared to the control participants.  Caregivers in the intervention group had a significant reduction in the amount of time they spent with the person with dementia (Tanner et al., 2014).  This outcome may have been due to the emphasis placed on promoting caregiver respite opportunities in the MIND model of care coordination.

 



Enabling persons with dementia to remain in their homes longer and delay costly long term care placement, suggests that the MIND at Home care coordination model may help to reduce societal costs of caring for the growing population of elders who have Alzheimer disease and other types of dementia.

Days in Home

Figure 2 of KM survival curves from Samus et al 2014

Figure 2 of KM survival curves from Samus et al 2014

Figure 1 of Percentage of persons with dementia with any unmet needs from Black et al 2013