The debut of second generation memory care

Researchers and clinicians from the Indiana University School of Medicine and the Regenstrief Institute are blurring the distinction between lab and clinic as they debut the second generation of memory care.

Building upon a care model they developed and extensively tested over the past 7 years, the focus of second generation memory care is on two groups -- patients with cognitive disorders such as Alzheimer's disease and their caregivers. Results of the clinical trial of the IU-Regenstrief care model were published in the Journal of the American Medical Association in 2006.

The initial second generation memory center -- the Healthy Aging Brain Center opens at the IU Center for Senior Health at Wishard Health Services this month.

"When we make the lab from which we develop treatments and the clinic into one entity, we are constantly learning from our patients – what works for them and what does not. Our approach to memory care is on the fast track because by eliminating the distinction between the lab and the clinic, we compress the long timeline traditionally needed to go from discovery to treatment. For us and for those we treat, who are both those with memory problems and their caregivers, this means that they will be receiving the support and care they need now," said Malaz Boustani, M.D., M.P.H., an assistant professor of medicine at Indiana University School of Medicine, an Indiana University Center for Aging Research investigator and a Regenstrief Institute research scientist.

Dr. Boustani is also the chief research officer of the Indianapolis Discovery Network for Dementia, an expanding group of researchers, clinicians, caregivers and community advocates who are working to enhance dementia care in the nation's twelfth largest city. IDND is a national model for how members of the community, caregivers, clinicians and researchers can work together to improve the delivery of dementia care. Second generation memory care has benefited from IDND's panoramic approach to the issue.

Caregivers have not been a primary focus in first generation memory care in spite of the fact that caregivers are hospitalized at a very high rate and that they provide millions of unpaid care hours per year (180 million hours valued at $1.7 billion in 2005 in Indiana alone). "Passively handing out brochures and web links to caregivers isn't enough. We need to recognize that they have significant issues and address them," said Dr. Boustani.

"The new Healthy Aging Brain Center is putting cutting edge research into the hands of patients and caregivers as well as their primary care physicians, from whom most older adults receive their health care," said Greg Sachs, M.D., professor of medicine at IU School of Medicine, an IU Center for Aging Research investigator and a Regenstrief Institute research scientist. Dr. Sachs directs the medical school's Division of General Internal Medicine and Geriatrics.

He and Dr. Boustani, along with a team which includes social workers, psychologists, nurses and others will see patients and caregivers in the new outpatient facility.

Dementia is a growing burden for society, propelling patients and caregivers to increasingly use the health-care system. Dr. Boustani and Dr. Sachs, who are both geriatricians, say second generation memory care is key to decreasing overutilization of emergency rooms and inpatient services.

"Nationwide, the health-care system is not delivering good dementia care because we have not presented a comprehensive assessment of the biopsychosocial needs of a person with dementia and have not followed up with solutions that are sensitive to local community needs and resources," said Dr. Boustani, who has been instrumental in the development of IDND.

There are currently an estimated 5 million Americans with Alzheimer's disease. Eight out of 10 individuals with dementia living outside of nursing homes have significant behavioral and/or psychological symptoms that require medical and psychological care.