Indiana University School of Medicine
The Aging Brain Care Virtual Program
Health Care Systems
Indiana University Health
Dr. Torke is a professor of medicine and section chief of Palliative Medicine at Indiana University School of Medicine and practicing outpatient palliative care physician at IU Health Methodist Hospital. Dr. Torke is a research scientist with the Indiana University Center for Aging Research, Regenstrief Institute and director of the Evans Center for Religious and Spiritual Values in Healthcare. Her research focuses on ethical, communication, and spiritual aspects of medical decision-making for older adults and on surrogate decision-making for older people living with dementia and other forms of cognitive impairment. She has received funding from the NIH, the Greenwall Foundation and other foundation sources. Dr. Torke received her medical degree from Indiana University and her Master of Science degree from University of Chicago where she also completed a fellowship in primary care health services research and ethics.
Dr. Fowler is an associate professor of medicine at Indiana University School of Medicine. She is also director of research for the Division of General Internal Medicine and Geriatrics at IU, the associate director of the Indiana University Center for Aging Research at the Regenstrief Institute, and a scientist in the IU Center for Health Innovation and Implementation Science. Dr. Fowler is an applied health services researcher in the areas of non-pharmacologic approaches in dementia care, family caregiving, and medical decision-making for older adults with cognitive impairment. Her research focuses on the development, testing, implementation, and comparison of evidence-based and patient-centered interventions that improve the detection of dementia for at-risk individuals and the quality of care for older adults and their family caregivers. Her research has been funded by multiple foundations, NIH, and the Department of Defense.
RATIONALE: Family care partners are critical to the wellbeing and quality of life of people living with dementia (PLWD), but often lack experience in how to manage behavioral and psychological symptoms of dementia as well as the common comorbidities that PLWD frequently have. There is a tremendous demand for primary care-based interventions that address these crucial needs, are pragmatic, able to be scaled across urban, rural, and suburban settings and focused on improving care and outcomes for PLWD and their family care partners.
OBJECTIVE: To conduct a statewide pragmatic cluster randomized trial to test the effectiveness of a virtual dementia collaborative care program to PLWD and their care partners to reduce emergency department (ED) visits.
SETTING: 24 Indiana University Health primary care clinics located across the state of Indiana.
POPULATION: Patient participants will be 860 community-dwelling patients aged 65 or older, living with dementia (PLWD) (430 intervention, 430 control) and 430 care partners of intervention participants. Up to 30 clinicians and care partners will be interviewed about their experience with the Aging Brain Virtual Care program.
INTERVENTION: The intervention consists of a dementia care manager who will provide a needs assessment of the dyad, develop a care plan, and implement protocols over a 12-month period that will help the care partner manage the symptoms of dementia and other acute and chronic illnesses that the PLWD may have. Some components of the intervention will be tailored to the needs of each PLWD and care partner.
OUTCOMES: The primary clinical outcome is all cause utilization of emergency department over the 12 months of the intervention. The secondary clinical outcomes are appropriate medication use, in particular anticholinergic medicines, benzodiazepines, and antipsychotics over 12 months. Implementation of the intervention will be assessed through surveys and interviews with clinicians and care partners. Implementation endpoints include measures of acceptance, feasibility and appropriateness measured by the Acceptability of Intervention Measure (AIM). Feasibility of Intervention Measure (FIM), and Intervention Appropriateness Measure (IA)M. Qualitative interviews with stakeholders will assess the process and outcomes of the Aging Brain Care Virtual program.
IMPACT: Embedding a scalable primary care-based intervention that addresses the crucial needs of PLWD and their care partners has the potential to improve the quality of dementia care across the country, especially where PLWD do not have access to highly specialized research centers.