This project aimed to improve the care of Wisconsin residents living with dementia by increasing primary care provider and trainees’ knowledge and skills related to dementia diagnosis and management of the behavioral and psychological symptoms of dementia (BPSD). Alzheimer’s disease currently affects 110,000 Wisconsinites and the number is expected to increase to 130,000 by 2025. About 90 percent of individuals with dementia experience BPSD, which includes depression, physical aggression, wandering and sleep disturbance, among others. As a result, there is a need to train future and practicing primary care clinicians in the identification and management of BPSD to help caregivers manage these behaviors in the home setting, potentially preventing crisis escalation and unnecessary institutionalization.
The project successfully increased medical trainees’ and primary care providers’ knowledge and skills in dementia diagnosis and BPSD management. A web-based curriculum for third- and fourth-year medical students at the University of Wisconsin School of Medicine and Public Health improved students’ self-reported attitudes towards dementia care and informed the design of a new Dementia and Public Health elective that began in 2023. Additionally, academic detailing sessions for primary care providers at Richland Center Hospital and Milwaukee Health Services resulted in significant knowledge gains and improved confidence in managing BPSD. Lastly, the DICE Approach was used to train social workers, nurses, medical assistants and assisted living and nursing home frontline staff and led to increased knowledge, self-efficacy and comfort in managing BPSD.
The Challenge
Alzheimer’s disease (AD) currently affects 110,000 Wisconsinites, and the number is expected to increase to 130,000 by 2025. Despite the increasing prevalence of the disease, it is estimated that only 25 to 50 percent of those with dementia have been diagnosed, delaying treatment and important care interventions. Compared with non-Hispanic white adults, African American and Latino persons are at higher risk of a delay in AD diagnosis and have more advanced disease at the time of diagnosis. This delay has been attributed to a variety of factors including cultural beliefs about aging and cognitive decline, accuracy of screening tools in culturally diverse populations, disparities in access to diagnostic services and variations in treatment practices.
About 90 percent of individuals with dementia experience behavioral or psychological symptoms, such as depression, physical aggression, wandering and sleep disturbance, among others. These symptoms cause distress for patients, family members and other caregivers and can lead to higher rates of institutionalization. Many primary care providers feel poorly equipped to manage these behavioral and psychological symptoms of dementia (BPSD). As a result, there is a need to train future and practicing primary care clinicians in the identification and management of BPSD to help caregivers manage these behaviors in the home setting, potentially preventing crisis escalation and unnecessary institutionalization.
Project Goals
This project’s goal was to improve the care of Wisconsin residents living with dementia by increasing primary care provider and trainees’ knowledge and skills related to dementia diagnosis and management of BPSD. This goal was addressed by building upon the Wisconsin Alzheimer’s Institute’s established partnerships with clinicians from diverse communities to:
Increase the pipeline of health care providers capable of effectively diagnosing and caring for culturally-diverse patients with dementia.
Increase the knowledge, skills and attitudes of primary care providers in the culturally-tailored care of patients with BPSD.
Enhance communication between clinicians and those who care for persons with dementia.
Results
This project successfully achieved its goal of increasing medical trainee and primary care providers knowledge and skills surrounding dementia diagnosis and management of BPSD. Due to the pandemic, the plan to develop a comprehensive curriculum for medical students, residents and fellows to improve dementia care was modified to focus specifically on third- and fourth-year medical students at the University of Wisconsin School of Medicine and Public Health. A web-based curriculum was piloted by nine students from October 2021 to April 2022. Pre- and post-training surveys demonstrated improved self-reported attitudes toward the care of individuals with dementia. The positive outcomes from the pilot informed the design of a new Dementia and Public Health elective that began in 2023.
Academic detailing, an evidence-based educational technique to modify clinical practice, was implemented to enhance the knowledge, skills and attitudes of primary care providers in the culturally tailored care of patients with BPSD. The academic detailing sessions served clinicians at Richland Center Hospital and Milwaukee Health Services between August 2020 and February 2022. These sessions saw significant knowledge gains and improved confidence among participating clinicians. Project evaluation demonstrated that 74 percent of respondents attended multiple sessions and the knowledge gain from baseline to six months was largest. Additionally, the overall attitudes and confidence for managing persons with BPSD improved from 6 to 18 months of participation.
Lastly, an evidence-based training model focusing on behavioral, environmental and psychological strategies for dementia care, called the DICE Approach, was delivered virtually to social workers, nurses, medical assistants and assisted living and nursing home frontline staff. Twenty individuals from RIchland Center and two from Milwaukee Health Services completed the online DICE training and six monthly sessions focused on practicing and discussing challenging cases. Pre- and post-training evaluation indicated increased knowledge and self-efficacy in managing BPSD, improved comfort levels and high ratings for the DICE method’s ease of use and effectiveness.
Looking to the Future
The research team received an ICTR Clinical and Community Outcomes Research pilot grant that will be used to further understand the acceptability of this pilot program and how to best tailor delivery among primary care clinicians in Wisconsin.
