Benefits of home‐based dementia care on clinical and quality‐of‐life outcomes for persons living with dementia and their carers

Abstract

AbstractBackgroundScalable, home‐based approaches for the delivery of comprehensive dementia care that bridge medical, social, and supportive care services are needed to improve outcomes and care value for persons living with dementia (PWD) and family carers. We present results from a CMS‐funded Healthcare Innovations Award evaluating the 18‐month impact of a comprehensive home‐based dementia care coordination program, MIND at Home, on clinical and quality of life outcomes in a racially and socioeconomically diverse group of community‐living PWD and family carers.MethodsThis is a prospective, within‐subject, study to evaluate change (baseline to 9‐months, and baseline to 18‐months) in clinical and quality of life outcomes among 342 PWD in Maryland who received MIND at Home. Within‐group changes on dementia‐related unmet care needs (59 items total, 13 domains), neuropsychiatric behaviors (NPI), quality of life (QOL‐AD), carer burden (Zarit Burden Interview), carer depression (PHQ‐9) were assessed using longitudinal mixed effects models. We also tested whether change in outcomes over time was moderated by baseline cognition, living arrangement, or race (Caucasian vs. Non‐Caucasian) in post hoc analyses.ResultsIn adjusted linear mixed models, PWD and carers had significantly fewer total percent unmet dementia‐related needs (PWD: β=‐19.95, SE 0.7, p<0.001; CG: β =‐28.30 SE 0.9, p<0.001) and percent unmet in all need subdomains (all p<0.01), fewer behavioral symptoms (NPI) (β = ‐5.16, SE 1.4, p<0.001), reduced caregiver burden (ZBI short) (β = ‐1.69, SE 0.6, p=0.005), and reduced caregiver distress with behavioral symptoms (β = ‐1.63, SE 0.8), p=0.03) from baseline to 18 months. Carer depression trended towards improvement (PHQ‐9, β = ‐0.63, SE 0.37, p=0.086). No statistically significant change in QOL‐AD scores were observed. Most interaction effects were not significant, however non‐Caucasians tended to benefit more on several outcomes compared to Caucasians.ConclusionMIND is a scalable home‐based dementia model of care that promotes evidence‐based dementia care strategies addressing range of key medical, social, and environmental determinants of health. This quasi‐experimental analysis provides new evidence of effectiveness for improving outcomes for both PWD and their caregivers over time to and contributes important new longitudinal data to support the program’s value proposition to potential adopters.