Integrated Dementia Care Interventions for Alzheimer's and Dementia

Overseen By Diana Hernandez, BS

Age: 65+

Sex: Any

Trial Phase: Academic

Sponsor: NYU Langone Health

Disqualifiers: Under 66 years old

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

19200 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Community Paramedic-led Transitions Intervention (CPTI), Emergency Care Redesign (ECR), Nurse-led Telephonic Care (NLTC) for Alzheimer's and Dementia?

Research shows that integrated care strategies, which include community-based interventions and coordinated care, have been effective in reducing hospital transfers and improving care for people with dementia. These strategies emphasize care coordination, teamwork, and personalized care, which are key components of the treatments being studied. ^{1 2 3 4 5}

Is the Integrated Dementia Care Intervention safe for humans?

The available research suggests that interventions like the Community Paramedic-led Transitions Intervention (CPTI) and similar programs are designed to improve care transitions and reduce hospital admissions for people with dementia, which can enhance safety by preventing adverse outcomes associated with hospital stays. However, specific safety data for these interventions in humans is not detailed in the provided studies. ^{1 5 6 7 8}

How is the Community Paramedic-led Transitions Intervention (CPTI) treatment for dementia unique?

The Community Paramedic-led Transitions Intervention (CPTI) is unique because it focuses on reducing unnecessary hospital admissions by providing care in the community, which is particularly beneficial for dementia patients who often experience poor outcomes in hospital settings. This approach involves paramedics making more person-focused decisions and utilizing community resources to manage care effectively at home. ^{1 2 3 4 9}

What is the purpose of this trial?

The purpose of this study is to improve the care of persons living with dementia (PLWD) and their informal care partners by addressing emergency and post-emergency care through different combinations of three PLWD-care partner dyad focused interventions. The primary aims are to use coaching to help connect PLWD and their care partners with community support and services to improve transitional care, quality of care, care satisfaction and reduce future ED visits and hospitalizations.

Research Team

Joshua Chodosh, MD

Principal Investigator

NYU Langone Health

Eligibility Criteria

This trial is for people aged 66 and older diagnosed with Alzheimer's or related dementias, who have had multiple health visits for these conditions. Their care partners must be adults over 18. It's not open to patients under the age of 66.

Inclusion Criteria

I have been diagnosed with Alzheimer's or related dementia at least twice, once in an outpatient setting.

I am 66 years old or older.

Exclusion Criteria

I am younger than 66 years old.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive different combinations of interventions focused on improving emergency and post-emergency care for persons living with dementia and their care partners.

12 weeks

Follow-up

Participants are monitored for safety and effectiveness after interventions, focusing on transitional care, quality of care, and reduction in future ED visits and hospitalizations.

12 weeks

Treatment Details

Interventions

• Community Paramedic-led Transitions Intervention (CPTI)
• Emergency Care Redesign (ECR)
• Nurse-led Telephonic Care (NLTC)

Trial Overview The study tests three interventions: Nurse-led Telephonic Care (NLTC), Emergency Care Redesign (ECR), and Community Paramedic-led Transitions Intervention (CPTI) to improve post-emergency care for dementia patients.

Participant Groups

Group I: Two interventions: NLTC and CPTI Experimental Treatment 2 Interventions

Group II: Two interventions: ECR and CPTI Experimental Treatment 2 Interventions

Group III: Two intervention: ECR and NLTC Experimental Treatment 2 Interventions

Group IV: Single intervention: Nurse-led Telephonic Care (NLTC) Experimental Treatment 1 Intervention

Group V: Single intervention: Emergency Care Redesign (ECR) Experimental Treatment 1 Intervention

Group VI: Single intervention: Community Paramedic-led Transitions Intervention (CPTI) Experimental Treatment 1 Intervention

Group VII: All interventions: ECR, NLTC, and CPTI Experimental Treatment 3 Interventions

Group VIII: No intervention Active Control 1 Intervention

No intervention, serving as a usual care control group

Who Is Running the Clinical Trial?

NYU Langone Health

Lead Sponsor

Trials

1,431

Recruited

838,000+

National Institute on Aging (NIA)

Collaborator

Trials

1,841

Recruited

28,150,000+

Findings from Research

The ADMIT Me tool was developed to improve safe transitions of care for individuals with Alzheimer's and dementia, based on feedback from focus groups involving caregivers, emergency department nurses, and first responders.

Participants in the focus groups unanimously agreed that the ADMIT Me tool would enhance safety during care transitions by promoting clear communication and collaboration among healthcare providers, ultimately leading to more patient-centered care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Enhancing the ADMIT Me Tool for Care Transitions for Individuals With Alzheimer's Disease. Moore, JR., Sullivan, MM.[2018]

Community care coordination has shown promise in reducing the rate of nursing home admissions for older people with dementia, with a significant risk ratio of 0.66 based on data from 303 participants across two studies.

Other non-pharmacological interventions, such as psychoeducation and multifactorial approaches, did not demonstrate a significant effect on preventing hospital or nursing home admissions, suggesting that not all interventions are equally effective.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Non-pharmacological interventions to prevent hospital or nursing home admissions among community-dwelling older people with dementia: A systematic review and meta-analysis. Lee, DA., Tirlea, L., Haines, TP.[2021]

The DementiaNet program, which lasted for 2 years, significantly improved collaboration among 35 primary care networks and enhanced the quality of dementia care, with measurable increases in both areas during the program.

These improvements in collaboration and care quality were sustained even after the program ended, suggesting that DementiaNet successfully facilitated a lasting transition to integrated primary dementia care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

DementiaNet facilitates a sustainable transition toward integrated primary dementia care: A long-term evaluation. Oostra, DL., Nieuwboer, MS., Melis, RJF., et al.[2023]

References

1. England pubmed.ncbi.nlm.nih.gov

Home or hospital for people with dementia and one or more other multimorbidities: What is the potential to reduce avoidable emergency admissions? The HOMEWARD Project Protocol. [2021]

2. England pubmed.ncbi.nlm.nih.gov

Integrated care for adults with dementia and other cognitive disorders. [2019]

3. England pubmed.ncbi.nlm.nih.gov

Key components in models of community-based interventions coordinating care in dementia: a mixed studies systematic review protocol. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

Efficacy of a geriatrics team intervention for residents in dementia-specific assisted living facilities: effect on unanticipated transitions. [2008]

5. United States pubmed.ncbi.nlm.nih.gov

Impact of health service interventions on acute hospital use in community-dwelling persons with dementia: A systematic literature review and meta-analysis. [2020]

6. United States pubmed.ncbi.nlm.nih.gov

Enhancing the ADMIT Me Tool for Care Transitions for Individuals With Alzheimer's Disease. [2018]

7. England pubmed.ncbi.nlm.nih.gov

Non-pharmacological interventions to prevent hospital or nursing home admissions among community-dwelling older people with dementia: A systematic review and meta-analysis. [2021]

8. Australia pubmed.ncbi.nlm.nih.gov

Evaluation of a safe medication strategy intervention for people with dementia with an unplanned admission: Results from the Safe Medication Strategy Dementia Study. [2021]

9. United States pubmed.ncbi.nlm.nih.gov

DementiaNet facilitates a sustainable transition toward integrated primary dementia care: A long-term evaluation. [2023]