Q&A: Non-drug interventions for AD, dementia lower nursing home admissions, save money

Key takeaways:

• Non-pharmacologic interventions for Alzheimer’s and dementia reduced the risk for nursing home admission and saved on care costs.
• Work is needed to help health care systems implement these interventions.

Non-drug interventions for people with Alzheimer’s disease and related dementias effectively lowered the risk for nursing home admission while being cost-effective, according to findings published in Alzheimer’s & Dementia.

To assess the cost-effectiveness of existing evidence-based non-pharmacologic interventions, researchers created a person-level microsimulation model. The models compared differences in the risk for nursing home admission, societal costs, quality-adjusted life years and incremental cost-effectiveness ratios between these interventions and usual care.

Models indicated that all non-drug interventions assessed lowered the risk for being admitted to a nursing home and saved money compared with usual care.

“Now that we can show that these effective interventions can also save money, it just makes sense to find ways to make them available to more families,” Eric Jutkowitz, PhD, an associate professor at Brown University in Providence, Rhode Island, and lead study author, said in a press release from Brown. “These interventions can be used to help people with dementia starting today.”

Healio spoke with Jutkowitz to learn more about the interventions and future steps.

Healio: What prompted this study?

Jutkowitz: A number of studies have shown that providing family caregivers with support (such as education, skills, care plans and coaching or clinical support) improves outcomes not only for caregivers, but also for people with dementia. For example, research has shown that providing support for family caregivers can reduce the chances that a person with dementia will need to move to a nursing home. So, we know that they’re effective in terms of treatment, but it’s less understood how effective they are from an economic perspective. We wanted to understand how cost-effective these programs are, in the hope of helping decision-makers develop policies that can advance care for people with dementia.

Healio: What specific interventions did you evaluate?

Jutkowitz: We evaluated four non-drug interventions, each of which was shown in at least one prior study to reduce the risk of a person with dementia moving to a nursing home. The interventions include the following:

• Maximizing Independence at Home, which consists of interdisciplinary care coordination, linkage to services and skill-building;
• New York University Caregiver Intervention, which consists of counseling and support for caregivers and support groups;
• Alzheimer’s and Dementia Care, which consists of a physician and nurse practitioner comanaging patients, performing needs assessments and creating individualized care plans; and
• Adult Day Service Plus, which is delivered out of adult day centers and consists of identifying caregiver concerns or needs, developing and implementing care plans, skills training, and referral and linkage to services.

Healio: What is the take-home message?

Eric Jutkowitz

Jutkowitz: Non-drug dementia care interventions that support family caregivers and reduce the risk for nursing home admission reduce costs for families and for society overall. We need payment models or policies that can support health systems in implementing these types of programs.

Healio: What are the clinical implications of your findings?

Jutkowitz: The interventions we evaluated have been shown in studies to improve outcomes that matter to families and people with dementia, including reduced stress and improved quality of life. Our study contributes to the literature by providing data on the economic impact of these interventions.

Healio: What work needs to be done to implement non-pharmacologic interventions in Alzheimer’s and dementia care?

Jutkowitz: Payment. Specifically, we need reimbursement models that support providers in delivering these modes of care. We need to find a way to incorporate these modes of care into the current health care system. The current system doesn’t make it easy to deliver them to people. It’s also important to inform the workforce about these effective, affordable non-pharma interventions — that can start with patients or patient families asking about them.

Healio: Is there anything else you would like to add?

Jutkowitz: The media has been covering pharmacological treatments for dementia, and you can even read articles about how these types of medications may or may not be covered under insurance. CMS is actively considering ways to make different types of dementia medication available to people who would benefit from them. But people would benefit from these evidence-based programs, as well. We would like non-drug treatments to be part of the conversation, and part of what CMS is considering and evaluating. As CMS thinks about payment models for new dementia drugs, we think they should also recognize the value of non-pharmacologic interventions and offer a reimbursement structure for these evidence-based programs, too.

References:

• Jutkowitz E, et al. Alzheimers Dement. 2023;doi:10.1002/alz.12964.
• Non-drug interventions for patients with Alzheimer’s are both effective and cost-effective, study shows. https://www.brown.edu/news/2023-04-06/alzheimers-interventions. Published April 6, 2023. Accessed May 3, 2023.