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September 9, 2010 Volume VII, No. 10

HIN Communications Editor Jessica Papay

Dear Healthcare Intelligence Network Client,

This week we are focusing on dementia. Discover who is more at risk for memory problems and which activities can slow cognitive decline but may also speed up dementia. Also, learn how home visits can benefit dementia patients.

Your colleague in the business of healthcare,
Jessica Papay
Editor, Disease Management Update

This week's DM news:

Table of Contents

  1. Memory Problems & Men
  2. Dementia & Brain Exercises
  3. Redirecting Patients to Cost-Effective Care
  4. Home Visit Populations
  5. Points in Care for Patient Education
  6. Caregiver Education
  7. Dementia & Home Visits
  8. Telehealth in 2010

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Please send comments, questions and replies to jpapay@hin.com.

Publisher:
Melanie Matthews, mmatthews@hin.com

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Are Memory Problems More Common in Men?

A new study published in the September 7, 2010 issue of Neurology(R), the medical journal of the American Academy of Neurology, shows that mild cognitive impairment (MCI) may affect more men than women. MCI is a condition in which people have problems with memory or thinking beyond that explained by the normal rate of aging, and MCI often leads to Alzheimer’s disease. For the study, 2,050 people between the ages of 70 to 89 in Olmstead County, Minn. were interviewed about their memory and their medical history and tested on their memory and thinking skills.

The study found that MCI was 1.5 times higher in men compared to women. Nearly 14 percent of participants had MCI, about 10 percent had dementia and 76 percent of those tested had normal memory and thinking skills. A total of 19 percent of men had MCI, compared to 14 percent of women.

“This is the first study conducted among community-dwelling persons to find a higher prevalence of MCI in men,” said study author Ronald Petersen, M.D., Ph.D., with the Mayo Clinic in Rochester, Minn. “If these results are confirmed in other studies, it may suggest that factors related to gender play a role in the disease. For example, men may experience cognitive decline earlier in life but more gradually, whereas women may transition from normal memory directly to dementia at a later age but more quickly. Our results, showing combined rates of MCI and dementia at 22 percent, highlight the public health impact these conditions have and the importance of finding treatments for them.” People in the study who had a low level of education or were never married also had a higher rate of MCI.

To learn more about this research, please visit:
http://www.aan.com/press/index.cfm...

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Brain Exercises May Slow Cognitive Decline Initially, But Speed Up Dementia Later

Mentally stimulating activities such as crossword puzzles, reading and listening to the radio may, at first, slow the decline of thinking skills but speed up dementia later in old age, according to research from the Rush University Medical Center. For the study, researchers evaluated the mental activities of 1,157 people age 65 or older who did not have dementia at the start of the nearly 12-year study. People answered questions about how often they participated in mental activities such as listening to the radio, watching television, reading, playing games and going to a museum; for this five-point cognitive activity scale, the more points scored, the more often people participated in mentally stimulating exercises.

During the next six years, the study found that the rate of cognitive decline in people without cognitive impairment was reduced by 52 percent for each point on the cognitive activity scale. For people with Alzheimer’s disease, the average rate of decline per year increased by 42 percent for each point on the cognitive activity scale.

According to the researchers, mentally stimulating activities may somehow enhance the brain’s ability to function relatively normally despite the buildup of lesions in the brain associated with dementia. However, once they are diagnosed with dementia, people who have a more mentally active lifestyle are likely to have more brain changes related to dementia compared to those without a lot of mental activity. As a result, those with more mentally active lifestyles may experience a faster rate of decline once dementia begins. Mental activities compress the time period that a person spends with dementia, delaying its start and then speeding up its progress. “This reduces the overall amount of time that a person may suffer from dementia,” said study author Robert S. Wilson, Ph.D., neuropsychologist, Rush Alzheimer's Disease Center, Rush University Medical Center.

To learn more about this research, please visit:
http://www.rush.edu/webapps/MEDREL/servlet/...

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Redirecting Patients to Cost-Effective Care

Three key factors influence consumers' use of the hospital ER today, according to Dr. Barsam Kasravi, managing medical director for state-sponsored programs for WellPoint. In this podcast, Dr. Kasravi discusses how WellPoint is trying to close critical care gaps and encourage its members to utilize healthcare services more effectively.

To listen to this complimentary HIN podcast, please visit:
http://www.hin.com/podcasts/podcast.htm#126

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Targeted Populations for Home Visits

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Jessica Simo, program manager with Durham Community Health Network for the Duke Division of Community Health.

Question: Is there a particular diagnosis or patient profile that would benefit most from a home visit?

Response: As a general rule for the patient population that we are serving, the people who get the most home visits are middle-aged individuals with at least two chronic health conditions. These are not generally healthy individuals who had one adverse event that has brought them to our attention. These are people living day in and day out with chronic health problems that they struggle with managing. Those are the people that benefit the most from the amount of time that it takes to do a home visit.

For more information on home visits, please visit:
http://store.hin.com/product.asp?itemid=4095

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

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There are other free email newsletters available from HIN!

Medical Home Monitor tracks the construction of medical homes around the country and their impact on healthcare access, quality, utilization and cost. As providers and payors reframe care delivery, this twice monthly e-newsletter will cover the pilots, practice transformations, tools and technology that will guide healthcare organizations toward clinical excellence.

To sign up for our free email newsletters, please visit:
http://www.hin.com/freenews2.html

Points in Care for Patient Education

Healthcare organizations are learning that an investment in patient and member education is money well spent. We wanted to find out at which points in care patient education is conducted.





Click here to view the chart.

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Caregiver Education and Support Programs Provide Positive Impact

According to statistics by the Family Caregiver Alliance, approximately 52 million informal and family caregivers provide care to an adult that is ill or disabled in the United States. The majority of caregivers are 35 to 64 years old, and an estimated 60 percent are also working outside the home. A proactive approach to this growing dilemma through caregiver education and support programs allows employers to provide an invaluable benefit, while increasing employee loyalty and productivity.

To download this complimentary white paper, please visit:
http://www.hin.com/library/registercsp.html

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Visiting Dementia Patients at Home Improves DM

A home-based intervention for patients with dementia improves functional dependence for patients, most notably for such activities as using the telephone, shopping, preparing meals and doing housework, according to a study by Laura N. Gitlin, Ph.D., director of the Jefferson Center for Applied Research on Aging and Health (CARAH) at Thomas Jefferson University. A slight increase was also noted for self-care activities such as bathing, dressing and grooming. Caregivers who were undergoing Care of Persons with Dementia in their Environment (COPE) treatment reported improvement in well-being and confidence using activities after four months of intervention.

In the study, participants receive up to 10 sessions with an occupational therapist (OT) and two interactions with a nurse. The occupational therapist identifies the routines, roles, habits and interests of the patient and the caregiver's specific caregiving challenges and concerns. The OT also assesses the patient's strengths and deficiencies. With this information the OT develops an action plan outlining goals and strategies to engage the patient. The nurse provides health information to the caregiver, tells how to manage issues related to pain, constipation and dehydration, obtains blood and urine samples and evaluates patients for dehydration. Follow-up laboratory results are shared by phone. The study reports results of the COPE program, which aims to support patient capabilities by reducing environmental stress and to enhance caregiver skills.

At four months, 37 percent of patients in COPE had an underlying medical condition that was not previously treated and which may contribute to poor quality of life. Researchers note that one unanswered question is how frequently a person with dementia should undergo routine medical testing to catch these conditions and treat them in a timely manner. For example, a related question is that while it's known that pain is highly prevalent in dementia patients, physicians do not as yet have adequate approaches to detecting and managing pain. Also, after nine months, caregivers involved in COPE reported a great deal of improvement in their quality of life, including better understanding of the disease, more confidence in managing behaviors, improved caregiving and ability to keep the person with dementia at home.

"This study reinforces other recent findings that nonpharmacologic, biopsychosocial-environmental interventions may positively contribute to DM of patients with dementia who live at home and their caregivers," shares Dr. Gitlin. "It also highlights the important role of occupational therapists and nurses as part of the dementia care team. More research is needed to examine effects of underlying medical conditions, ways to boost treatment effects, cost-effectiveness and other issues, but this is a solid foundation for future study and an indication that nonpharmacologic approaches should be integrated into the standard of care of patients with dementia. This will require a new way of thinking about dementia care by physicians and practitioners."

To learn more about this research, please visit:
http://www.jefferson.edu/news/20100901_CARAH.cfm

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Telehealth in 2010

Powered by provisions in the Patient Protection and Affordability Act, healthcare delivery via telehealth and telemedicine is transforming wellness, disease management, medication management services and illness prevention while extending access to critical healthcare services. Complete HIN's second annual e-survey on Telehealth and Telemedicine by September 30 and receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

To participate in this survey and receive its results, please visit:
http://www.surveymonkey.com/s/telehealth2010

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