Integrated Dementia Care Interventions for Alzheimer's and Dementia

Overseen By Julia Levine, MPA

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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to improve care for people living with dementia and their caregivers by testing different support strategies. Researchers are examining three main interventions: Emergency Care Redesign (ECR), Nurse-led Telephonic Care (NLTC), and Community Paramedic-led Transitions Intervention (CPTI). These interventions aim to connect participants with community services, enhance the quality of care, and reduce hospital visits. Suitable candidates for this trial are individuals aged 66 or older who have been diagnosed with Alzheimer's or a related dementia and have recently visited the emergency department. As an unphased trial, this study allows participants to contribute to innovative care strategies that could enhance support for dementia patients and their caregivers.

Will I have to stop taking my current medications?

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

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that the treatments in this study aim to assist people with dementia and their caregivers. These treatments are designed to smooth the transition from emergency care to home care and enhance the overall care experience.

The Community Paramedic-led Transitions Intervention (CPTI) has undergone previous testing. It focuses on reducing unnecessary hospital visits by providing care at home, easing and securing the shift from hospital to home.

The Emergency Care Redesign (ECR) targets individuals with dementia. It has been implemented in several emergency departments to enhance care delivery. The goal is to better meet the needs of dementia patients, and early results suggest it is well-received.

The Nurse-led Telephonic Care (NLTC) involves regular phone calls from nurses to support patients and caregivers. Previous studies have shown that this approach can improve quality of life and reduce stress.

All three treatments are designed to be safe and supportive for people with dementia. They aim to provide better care without adding stress or causing harm. While specific safety data for these interventions are not detailed, their focus on improving care rather than introducing new medical treatments suggests a lower risk of side effects. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these interventions for Alzheimer's and dementia because they offer fresh approaches to patient care. Unlike traditional treatments that mainly focus on medication, these interventions emphasize innovative care methods. The Community Paramedic-led Transitions Intervention (CPTI) aims to smooth the transition from hospital to home, potentially reducing readmissions. Emergency Care Redesign (ECR) seeks to improve how emergency care is delivered, making it more efficient and tailored to dementia patients' needs. Lastly, Nurse-led Telephonic Care (NLTC) provides ongoing support through phone calls, enhancing patient monitoring and caregiver support. These methods are designed to improve overall care quality and patient outcomes in ways that current standard treatments may not fully address.

What evidence suggests that this trial's treatments could be effective for dementia care?

Research shows that the Community Paramedic-led Transitions Intervention (CPTI), one of the interventions in this trial, helps people with dementia transition from the emergency room to home more smoothly. This program offers personalized help from paramedics, which has improved care and reduced future hospital visits. Another intervention, Emergency Care Redesign (ECR), aims to change emergency room services to better serve dementia patients, and studies suggest this can decrease the likelihood of returning to the emergency room. Nurse-led Telephonic Care (NLTC), also tested in this trial, provides phone support, effectively helping caregivers manage dementia symptoms and easing their caregiving responsibilities. Together, these programs focus on improving the quality of care and satisfaction for both patients and their caregivers. ^{1 2 4 6 7}

Who Is on the Research Team?

Joshua Chodosh, MD

Principal Investigator

NYU Langone Health

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

Citations

1. reporter.nih.gov reporter.nih.gov/project-details/10709340

Community Paramedicine In this study, we will test our hypothesis that the CPTI will improve the ED-to-home transition and utilization outcomes for PLWD, both alone and when combined ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT06079203

Study Details | NCT06079203 | ED-LEAD: Emergency ... 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- ...

3. emed.wisc.edu emed.wisc.edu/news/emergency-departments-transforming-alzheimers-and-dementia-care-research-grant/

Emergency departments seek to transform Alzheimer's and ... In the CPTI, persons with dementia and their care partners receive individualized coaching from a trained community paramedic during one home ...

4. reporter.nih.gov reporter.nih.gov/search/-YORzSfMKUmNeq29WzKwFA/project-details/10929991

RePORT RePORTER - National Institutes of Health (NIH) | In this study, we will test our hypothesis that the CPTI will improve the ED-to-home transition and utilization outcomes for PLWD, both alone and when combined ...

5. database.clin-star.org database.clin-star.org/display/project-5U19AG07810502

Community Paramedicine In this study, we will test our hypothesis that the CPTI will improve the ED-to-home transition and utilization outcomes for PLWD, both alone and when combined ...

6. withpower.com withpower.com/trial/phase-dementia-2024-90812

Integrated Dementia Care Interventions for Alzheimer's and ... The Community Paramedic-led Transitions Intervention (CPTI) is unique because it focuses on reducing unnecessary hospital admissions by providing care in the ...

7. nationalacademies.org nationalacademies.org/event/docs/D9E034C15E2CED9B0E89D0B2AD2C3B377C1CF65588E7?noSaveAs=1

The Emergency Medical Services System: Prevention: Community Paramedic Transitions Intervention. – Based on Coleman's Care Transitions Intervention. – Delivered to older ED patients being ...