ECHO-AGE: An Innovative Model of Geriatric Care for Long-Term Care Residents With Dementia and Behavioral Issues |
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| Affiliation: | 1. Department of Medicine and Section of Geriatrics, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston TX;2. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA;3. Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA;4. Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA;5. Lawrence General Hospital, Lawrence, MA;6. Greater Lawrence Family Health Center, Lawrence, MA;7. Elder Services Plan of the North Shore, Lynn, MA;8. Hebrew SeniorLife Institute for Aging Research, Boston, MA;1. Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA;2. Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA;3. University of Pittsburgh Medical Center, Pittsburgh, PA;4. Department of Medicine, University of Pittsburgh Medical Center—Medical Education, Pittsburgh, PA;5. Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA;6. Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA;7. Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA;1. Beth Israel Deaconess Medical Center, Boston, Mass;2. Harvard Medical School, Boston, Mass;3. Hebrew SeniorLife Institute for Aging Research, Boston, Mass;4. Massachusetts General Hospital, Boston;1. Wolfson Centre for Age-Related Diseases, King''s College London, London, UK;2. Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK;1. Grupo Ballesol, Universidad Católica de Valencia, Valencia, Spain;2. Centro de Atención Primaria Vall de Uixó, Castellón; Universidad Católica de Valencia, Spain;3. Hospital Pare Jofré, Valencia, Spain; Universidad Católica de Valencia, Spain;4. Grupo Ballesol, Madrid, Spain;5. Servicio de Geriatría, Hospital Universitario Ramón y Cajal, Madrid, Spain; Universidad Europea de Madrid, Spain;1. Centre d''excellence sur le vieillissement de Québec, CHU de Québec, Québec, Canada;2. Faculté de Pharmacie, Université Laval, Québec, Canada;3. Donald Berman Maimonides Geriatric Centre, Montreal, Quebec, Canada;4. Division of Geriatric Medicine, McGill University, Montreal, Quebec, Canada;5. Faculté des Sciences Infirmiéres, Université Laval, Québec;6. Département de médecine, Faculté de médecine, Université Laval, Québec, Canada;7. Institut universitaire de gériatrie de Montréal, Montréal, Quebec, Canada;8. Département de Médecine Familiale, Faculté de Médecine, Université Laval, Québec, Canada;9. Département de Médecine Sociale et Préventive, Faculté de médecine, Université Laval, Québec (Québec), Canada;10. Centre de recherche sur le vieillissement, Université de Sherbrooke, Sherbrooke, Quebec, Canada |
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| Abstract: | ObjectivesTo design, implement, and assess the pilot phase of an innovative, remote case-based video-consultation program called ECHO-AGE that links experts in the management of behavior disorders in patients with dementia to nursing home care providers.DesignPilot study involving surveying of participating long-term care sites regarding utility of recommendations and resident outcomes.SettingEleven long-term care sites in Massachusetts and Maine.ParticipantsAn interprofessional specialty team at a tertiary care center and staff from 11 long-term care sites.InterventionLong-term care sites presented challenging cases regarding residents with dementia and/or delirium related behavioral issues to specialists via video-conferencing.MethodsBaseline resident characteristics and follow-up data regarding compliance with ECHO-AGE recommendations, resident improvement, hospitalization, and mortality were collected from the long-term care sites.ResultsForty-seven residents, with a mean age of 82 years, were presented during the ECHO-AGE pilot period. Eighty-three percent of residents had a history of dementia and 44% were taking antipsychotic medications. The most common reasons for presentation were agitation, intrusiveness, and paranoia. Behavioral plans were recommended in 72.3% of patients. Suggestions for medication adjustments were also frequent. ECHO-AGE recommendations were completely or partially followed in 88.6% of residents. When recommendations were followed, sites were much more likely to report clinical improvement (74% vs 20%, P < .03). Hospitalization was also less common among residents for whom recommendations were followed.ConclusionsThe results suggest that a case-based video-consultation program can be successful in improving the care of elders with dementia and/or delirium related behavioral issues by linking specialists with long-term care providers. |
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| Keywords: | Long-term care dementia telemedicine |
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