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J Am Med Dir Assoc. 2014 Dec;15(12):938-42. doi: 10.1016/j.jamda.2014.08.014. Epub 2014 Oct 11.

ECHO-AGE: an innovative model of geriatric care for long-term care residents with dementia and behavioral issues.

Author information

1
Department of Medicine and Section of Geriatrics, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston TX. Electronic address: acatic@bcm.edu.
2
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA; Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: mmattison@bidmc.harvard.edu.
3
Lawrence General Hospital, Lawrence, MA; Greater Lawrence Family Health Center, Lawrence, MA; Elder Services Plan of the North Shore, Lynn, MA.
4
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
5
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA.
6
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA; Hebrew SeniorLife Institute for Aging Research, Boston, MA.

Abstract

OBJECTIVES:

To 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.

DESIGN:

Pilot study involving surveying of participating long-term care sites regarding utility of recommendations and resident outcomes.

SETTING:

Eleven long-term care sites in Massachusetts and Maine.

PARTICIPANTS:

An interprofessional specialty team at a tertiary care center and staff from 11 long-term care sites.

INTERVENTION:

Long-term care sites presented challenging cases regarding residents with dementia and/or delirium related behavioral issues to specialists via video-conferencing.

METHODS:

Baseline 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.

RESULTS:

Forty-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.

CONCLUSIONS:

The 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.

KEYWORDS:

Long-term care; dementia; telemedicine

Comment in

PMID:
25306294
DOI:
10.1016/j.jamda.2014.08.014
[Indexed for MEDLINE]

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