A prestigious five-year grant from the National Institute on Aging is producing significant findings by researchers from the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai and the Division of Geriatrics at the University of California, San Francisco (UCSF) around factors that affect people with dementia and their caregivers.
“This work is allowing us to break new ground by studying co-existing medical, social, and health system components that affect people with dementia and their families,” says Melissa Aldridge, PhD, MBA, Professor and Vice Chair of Research in the Brookdale Department. “Our teams are leveraging powerful population data to answer high-priority questions regarding care, services, and support for persons with dementia and their care partners.”
Melissa Aldridge, PhD, MBA, Professor of Geriatrics and Palliative Medicine and Vice Chair for Research
One example is recent evidence that hospice care significantly improves the quality of life for older adults with dementia, and that Medicare costs for those who use hospice services are actually lower than for those who do not. Three recently published studies from the joint teams of researchers add to that growing body of evidence. They are:
Building on the Role of Paid Caregivers
Little is known about the caliber of care that older people with functional impairment living at home receive from paid caregivers, who include home health aides, personal care attendants, and other home care workers. In this nationally representative study, published in the Journal of General Internal Medicine in November 2023, researchers learned that those who received paid care were more functionally impaired, had more medically complex issues, or had greater health care utilization than those who did not receive paid assistance.
These results suggested to the research team that opportunities may exist for paid caregivers to support the health and well-being of people with co-existing functional impairment and dementia or other serious illnesses through enhanced collaboration with professional health care teams that also provide care. The goal: to explore if high-quality paid care could reduce unnecessary or unwanted health care utilization among people with functional disabilities.
Psychosocial Distress Among Spouses of Dementia Patients
This Mount Sinai-UCSF study, published in the Journal of the American Geriatrics Society in August 2024, provides the first look at the psychosocial well-being of spouses of people living with dementia in the years before and after their partner’s death.
Scientists learned that these devoted family caregivers had a substantially higher incidence of loneliness, depressive symptoms, and reduced life satisfaction than spouses married to individuals at the end of life with no cognitive impairment—and that they begin experiencing these disruptions in the years leading up to their partner’s death. This evidence highlighted for researchers that spouses of people with dementia have important psychosocial needs of their own that need to be carefully assessed and then addressed upstream through robust clinical and policy-level programs that begin in the years leading up to their partner’s terminal decline.
Health Care Use in Older Adults with Diabetes and Dementia
Prior research has confirmed that increased hospitalization is associated with patients who have both diabetes and dementia. This study in the Journal of the American Geriatrics Society, published in August 2024, sheds valuable light for the first time on patterns of health care use in older adults in the three years prior to and after a clinical diagnosis of dementia.
The results showed decreasing rates of outpatient specialty care but relatively stable rates of primary care use in older individuals with diabetes and dementia, underscoring the importance of primary care as an anchor for ongoing treatment.
Furthermore, the Mount Sinai-UCSF team found higher rates of acute and post-acute health care use up to three years prior to the development of dementia, and that those rates remained high up to three years post-incident dementia. In light of those findings, investigators underscored the need for additional research to identify how to best support older adults with dementia and chronic health conditions such as diabetes.