Alzheimer’s: Effective Non-Drug Interventions

While new drugs to treat Alzheimer’s disease tend to receive the most public attention, many well-researched ways to care for people with dementia don’t involve medication. 

A new evaluation compared the cost-effectiveness of four non-drug interventions to the usual care received by people with dementia and found that the interventions not only resulted in a better quality of life, but also saved money.

In a study published April 6 in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, researchers used a computer simulation model to show that the four dementia-care interventions saved between $2,800 and $13,000 in societal costs, depending on the type of intervention, and all reduced nursing home admissions and improved quality of life compared to usual care.

Alzheimer’s drugs hold great promise, but they still need additional research and improvement, said lead study author Eric Jutkowitz, an associate professor at Brown University’s School of Public Health. In the meantime, he said, a number of non-drug interventions have been shown to be effective in clinical trials in improving quality of life for people with dementia and helping them stay safely at home longer.

The four interventions studied included the following: Maximizing Independence at Home, an at-home, care coordination intervention that consists of care planning, skill-building, referrals to services and care monitoring; New York University Caregiver, which is implemented in an outpatient clinic and provides caregivers with six counseling sessions over four months plus lifetime ad-hoc support and access to weekly support groups; Alzheimer’s and Dementia Care, in which a health care system provides people living with dementia and their caregivers a needs assessment, individual care plans and round-the-clock access to a care manager; and Adult Day Service Plus, which augments adult day care services with staff providing face-to-face caregiver support, disease education, care management, skill-building and resource referrals.

Nonpharmacological interventions like these provide family caregivers with knowledge, skills and support tailored to their care challenges. 

They have been shown to improve quality of life for the caregiver and the person living with dementia, as well as to reduce nursing home admissions, and they are not associated with adverse events such as hospitalizations and mortality. 

For these reasons, nonpharmacological interventions are recommended as first-line therapies for the management of Alzheimer’s and dementia.

To conduct the study, the researchers used a computer simulation to model the likelihood of nursing home admission for four evidence-based Alzheimer’s and dementia non-pharmacological interventions compared to usual care. 

In addition to finding that the interventions were cost-effective from a societal perspective, the researchers also found that from a healthcare payer perspective, the interventions involved little to no additional cost, compared to usual care, while increasing patient quality of life.

Based on the study findings, the authors concluded that health insurance policies should find ways to incentivize providers and health systems to implement nonpharmacological interventions.

The importance of understanding the cost-effectiveness of non-drug Alzheimer’s and dementia interventions is further highlighted by changes in Medicare payment models and emerging Alzheimer’s therapeutics, the researchers noted. The Centers for Medicare and Medicaid Services is in the process of determining coverage for new Alzheimer’s and related dementia drugs.

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Sources:

Eric Jutkowitz, Laura T. Pizzi, Peter Shewmaker, Fernando Alarid‐Escudero, Gary Epstein‐Lubow, Katherine M. Prioli, Joseph E. Gaugler, Laura N. Gitlin. Cost effectiveness of non‐drug interventions that reduce nursing home admissions for people living with dementia. Alzheimer’s & Dementia, 2023; DOI: 10.1002/alz.12964

Brown University. (2023, April 6). Non-drug interventions for patients with Alzheimer’s are both effective and cost-effective, study shows. ScienceDaily. Retrieved April 6, 2023 from www.sciencedaily.com/releases/2023/04/230406075657.htm

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