Tip sheet Annals of Internal Medicine, Nov. 21, 2006, issue

Caring for a family member with dementia can be extremely stressful, can contribute to psychiatric and physical illness and even increase risk for the caregiver's death. But two articles and an editorial in the Nov. 21, 2006, issue of Annals of Internal Medicine describe programs to improve the well-being of dementia patients and their caregivers.

1. SUPPORT PROGRAM FOR DEMENTIA CAREGIVERS IMPROVED THEIR LIVES

Researchers assigned 642 Hispanic, white and black caregivers to a group that received an intensive support or to a control group that received written educational materials (Article, p. 727).

After receiving help and counseling about how to manage stress, take care of their own health, improve social support network, and manage problem behaviors of their patients with dementia, the caregivers in the support group reported improved quality of life and had significantly less depression than those in the control group.

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Researchers assigned 408 pairs of people with dementia and their caregivers to one of two groups (Article, p. 713). In one group, case managers helped the caregivers get the needed services and care from various doctors and community agencies. In the other group, the caregivers and patients were responsible for coordinating their own doctor visits and social services.

Pairs in the coordinated system -- both caregivers and patients -- received more and higher-quality health and social services than those in the usual-care group. Sixty-four percent of patient care in the coordinated group met 23 dementia care guidelines vs. 33 percent in the usual-care group.

The studies above show the kind of interventions that improve quality of life for both caregivers and patients and improve patient care (Editorial, p. 780). If these interventions were drugs, they would be on the fast track for approval, the writers say. In fact, "the magnitude of benefit and quality of evidence supporting these interventions considerably exceed those of currently approved pharmacologic therapies for dementia."

Unfortunately, few clinicians will be able to implement the programs for their patients because 1) Medicare and other providers do not reimburse for most caregiver support services, despite that fact that caregivers save these systems millions of dollars by keeping patients out of hospitals and caring for them at home; and 2) Medicare does not pay for team-based case management service for elderly persons with dementia, even though "this approach clearly improves the quality of care."

Since dementia patients and their burdened caregivers are not likely to form the vocal lobby needed to work for these changes to Medicare law, the editorial writers call upon the medical profession "to advocate on their behalf."

ALSO IN THE NOV. 21, 2006, ISSUE OF ANNALS OF INTERNAL MEDICINE:

4. Changes in Career Decision of Internal Medicine Residents during Training," (Academia and Clinic, p. 774) with "Career Changes in Medicine: Part II" (Editorial, p. 782).

5. "Insurance Coverage and Care of Patients with Non-ST-Segment Elevation Acute Coronary Syndromes" (Article, p. 739).

NOTE: Annals of Internal Medicine is published by the American College of Physicians. These highlights are not intended to substitute for articles as sources of information.