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September 28, 2020
As Americans age and the incidence of dementia increases, McLean Hospital is embarking on a path to provide more specialized care for a subset of patients with the behavioral problems that accompany the advanced stages of the illness.
According to the World Health Organization, mental health and neurological disorders among older adults account for 6.6% of the total disability for those aged 60 or above, and approximately 15% of adults aged 60 and over live with a mental health disorder.
Dementia is a specific collection of symptoms that severely affects memory and thoughts in a way that interferes with daily functions. Alzheimer’s disease, a form of dementia, is often accompanied by memory impairments, changes in personality, and an inability to reason.
McLean’s Center of Excellence in Geriatric Psychiatry has two 18-bed geriatric inpatient programs. One is the Older Adult Program, serving people ages 50 and older with various psychiatric issues, including depression, bipolar disorder, and anxiety. In 2019, the Cognitive Neuropsychiatry Program’s 18 beds were subdivided into a 12-bed service that mirrors the care of the Older Adult Program and a six-bed service focusing on individuals with advanced dementia and associated behavioral symptoms and care needs.
“The needs and requirements of the advanced dementia population are very different,” explained Brent P. Forester, MD, MSc, chief of the Center of Excellence in Geriatric Psychiatry and director of the Geriatric Psychiatry Research Program. “They’re often complicated with significant medical issues and functional challenges. Many of them need assistance with the activities of daily living.”
“The restructuring allowed us to really focus on the environment for people with more advanced dementia,” added James M. Wilkins, MD, DPhil, medical director of the Cognitive Neuropsychiatry Program, who is joined by Alexis Freedberg, MD, Moinuddin Muttakin, MD, and Jane Crone, MSN, RN, as leaders of the care team.
The smaller program results in improved patient-staff interaction, according to Crone.
“The staff does a great job of getting to know the individual,” she said. “This allows them to identify what might trigger a patient, or what the patient may respond to in a positive way, allowing the staff to provide more quality care.”
Forester said the program’s attention is not solely focused on patients, given the stresses inherent in caring for people with dementia.
“Caregivers suffer from very high rates of depression and other psychiatric illnesses,” he said. “They often suffer from mortality rates that are high, and they often wind up having a risk of dying early because of the stress of caregiving, which is tremendous. The behavioral symptoms overwhelm the capacity of the caregiver to care.”
One thing unchanged is the focus on the program’s teaching and research efforts that help generate “objective information that allows us to more thoroughly track changes in symptoms and day-to-day functioning while someone is here. It gives a more objective account of how people are doing,” said Forester.
“Our research team can now work with clinical staff to collect this information, put it into a database, and produce reports that can be used by the clinicians in real time.”
All of the work ultimately reflects the reality that dementia will be a growing problem as the nation’s population ages.
“We know that about half of the 5.8 million Americans with Alzheimer’s disease do not have a diagnosis. And the half that are diagnosed are not even recognized as having dementia until they are already in the moderate stages of the disease, when they can no longer drive or pay their bills,” he said.
The longer-term goal is to make the Cognitive Neuropsychiatry Program an important cog in how Mass General Brigham addresses what Forester labeled the “epidemic of our times.”
“The demand for specialty dementia care and support for caregivers, frankly, is only going to grow,” he said.
After discovering that a cannabis gummy alleviated the distress of a beloved family member suffering from Alzheimer’s, a local family foundation funded an innovative ten-week study at McLean that will look at the effects of a cannabis-derived solution on patients with Alzheimer’s who struggle with anxiety and agitation.
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