Proactive Dementia Care: A Five-Year Experience in Dementia Caregiver Counseling (P07.156)

Abstract

Objective: To determine whether health educator (HE) and social worker (SW) counseling at time of diagnosis improves compliance with doctor advice related to dementia care. Background The contributions of HE and SW counseling to dementia care are underrecognized. Design/Methods: 1577 patients with a cognitive disorder were seen in a dementia clinic between January 2006 and December, 2010. All patients were referred to a HE and to a SW. We retrospectively determined how often a durable power of attorney for health care (DPOA) was present in the medical record and the enrollment level in our Gift to Life autopsy program (GTL). Results: Patients reflected the typical demographics of a dementia specialty clinic - 682 were men (43.24%), mean age 72.8 (SD 11.04), range 29 – 98 years, education 0 – 20 years, mean 14.25 (SD 2.9), Mini-Mental Status Exam (MMSE) or equivalent 0 – 30, mean 22.08 (SD 6.85). 1167 (74%) met with the health educator at least once, and 353 (22%) met with the social worker. We performed 4 separate logistic regression models with DPOA or GTL enrolment as outcomes, and SW visit (yes/no), or HE visit (yes/no) as predictor and controlled for gender and dichotomized for age, years of education, symptom years, and MMSE using cut off point 70, 12, 2, and 24 respectively. Exposure to either SW or HE was associated with DPOA documentation and enrollment in GTL.outcome Predictor Used observations OR (95% CI) pDPOA HE 1247 1.68 (1.29, 2.19) Conclusions: HE and/or SW counseling increases compliance with physician advice to complete a DPOA and to enroll in GTL. Prospective studies are needed to demonstrate that HE and SW improve quality of life and reduce costs. Supported by: Anonymous donor. A grant from The Center for Health Improvement. The Center for Alzheimer9s Care, Imaging, and Research at the University of Utah. Disclosure: Dr. Zamrini has nothing to disclose. Dr. Mandal has nothing to disclose. Dr. Andersen has nothing to disclose. Dr. Simpson has nothing to disclose. Dr. Wang has nothing to disclose. Dr. Greene has nothing to disclose. Dr. Ying has nothing to disclose. Dr. King has received research support from Alzheimer9s Association and the National Institute on Aging. Dr. Foster has received personal compensation for activities with GE Healthcare and Bristol-Myers Squibb Company. Dr. Foster received research support from Eli Lilly & Company, Janssen Alzheimer Immunotherapy, and Pfizer Inc.