title: A multidimensional home-based care coordination intervention for elders with memory disorders: the maximizing independence at home (MIND) pilot randomized trial.
abstract: OBJECTIVE
  To assess whether a dementia care coordination intervention delays time to transition from home and reduces unmet needs in elders with memory disorders.
  
  
  METHODS
  18-month randomized controlled trial of 303 community-living elders.
  
  
  METHODS
  28 postal code areas of Baltimore, MD.
  
  
  METHODS
  Age 70+ years, with a cognitive disorder, community-living, English-speaking, and having a study partner available.
  
  
  METHODS
  18-month care coordination intervention to systematically identify and address dementia-related care needs through individualized care planning; referral and linkage to services; provision of dementia education and skill-building strategies; and care monitoring by an interdisciplinary team.
  
  
  METHODS
  Primary outcomes were time to transfer from home and total percent of unmet care needs at 18 months.
  
  
  RESULTS
  Intervention participants had a significant delay in time to all-cause transition from home and the adjusted hazard of leaving the home was decreased by 37% (Hazard ratio: 0.63, 95% Confidence Interval: 0.42-0.94) compared with control participants. Although there was no significant group difference in reduction of total percent of unmet needs from baseline to 18 months, the intervention group had significant reductions in the proportion of unmet needs in safety and legal/advance care domains relative to controls. Intervention participants had a significant improvement in self-reported quality of life (QOL) relative to control participants. No group differences were found in proxy-rated QOL, neuropsychiatric symptoms, or depression.
  
  
  CONCLUSIONS
  A home-based dementia care coordination intervention delivered by non-clinical community workers trained and overseen by geriatric clinicians led to delays in transition from home, reduced unmet needs, and improved self-reported QOL.
authors: Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD. Electronic address: qmiles@jhmi.edu.
authors: Quincy M
authors: QM
authors: Samus
authors: Department of Psychiatry and Behavioral Sciences, School of Medicine, The Johns Hopkins University, Baltimore, MD.
authors: Deirdre
authors: D
authors: Johnston
authors: Department of Psychiatry and Behavioral Sciences, School of Medicine, The Johns Hopkins University, Baltimore, MD.
authors: Betty S
authors: BS
authors: Black
authors: Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD.
authors: Edward
authors: E
authors: Hess
authors: Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD.
authors: Christopher
authors: C
authors: Lyman
authors: Department of Epidemiology, Columbia University, New York, NY.
authors: Amrita
authors: A
authors: Vavilikolanu
authors: Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD.
authors: Jane
authors: J
authors: Pollutra
authors: Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD.
authors: Jeannie-Marie
authors: JM
authors: Leoutsakos
authors: Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD; Department of Community Public Health Nursing, School of Nursing, The Johns Hopkins University, Baltimore, MD.
authors: Laura N
authors: LN
authors: Gitlin
authors: Department of Psychiatry and Behavioral Sciences, School of Medicine, The Johns Hopkins University, Baltimore, MD.
authors: Peter V
authors: PV
authors: Rabins
authors: Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, School of Medicine, The Johns Hopkins University, Baltimore, MD.
authors: Constantine G
authors: CG
authors: Lyketsos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000628:therapy*; D005260:Female; D006699:Home Care Services; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D057187:Independent Living; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D008569:Memory Disorders / Q000628:therapy*; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010346:Patient Care Management / Q000379:methods*; D010865:Pilot Projects; D016016:Proportional Hazards Models; D016037:Single-Blind Method; D013997:Time Factors
keywords: Dementia; care coordination; care management; community; intervention; memory disorders