title: ECHO-AGE: an innovative model of geriatric care for long-term care residents with dementia and behavioral issues.
abstract: OBJECTIVE
  To design, implement, and assess the pilot phase of an innovative, remote case-based video-consultation program called ECHO-AGE that links experts in the management of behavior disorders in patients with dementia to nursing home care providers.
  
  
  METHODS
  Pilot study involving surveying of participating long-term care sites regarding utility of recommendations and resident outcomes.
  
  
  METHODS
  Eleven long-term care sites in Massachusetts and Maine.
  
  
  METHODS
  An interprofessional specialty team at a tertiary care center and staff from 11 long-term care sites.
  
  
  METHODS
  Long-term care sites presented challenging cases regarding residents with dementia and/or delirium related behavioral issues to specialists via video-conferencing.
  
  
  METHODS
  Baseline resident characteristics and follow-up data regarding compliance with ECHO-AGE recommendations, resident improvement, hospitalization, and mortality were collected from the long-term care sites.
  
  
  RESULTS
  Forty-seven residents, with a mean age of 82 years, were presented during the ECHO-AGE pilot period. Eighty-three percent of residents had a history of dementia and 44% were taking antipsychotic medications. The most common reasons for presentation were agitation, intrusiveness, and paranoia. Behavioral plans were recommended in 72.3% of patients. Suggestions for medication adjustments were also frequent. ECHO-AGE recommendations were completely or partially followed in 88.6% of residents. When recommendations were followed, sites were much more likely to report clinical improvement (74% vs 20%, P < .03). Hospitalization was also less common among residents for whom recommendations were followed.
  
  
  CONCLUSIONS
  The results suggest that a case-based video-consultation program can be successful in improving the care of elders with dementia and/or delirium related behavioral issues by linking specialists with long-term care providers.
authors.affiliation: Department of Medicine and Section of Geriatrics, Baylor College of Medicine and the Michael E. DeBakey VA Medical Center, Houston TX. Electronic address: acatic@bcm.edu.
authors.forename: Angela G
authors.initials: AG
authors.lastname: Catic
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA; Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: mmattison@bidmc.harvard.edu.
authors.forename: Melissa L P
authors.initials: ML
authors.lastname: Mattison
authors.affiliation: Lawrence General Hospital, Lawrence, MA; Greater Lawrence Family Health Center, Lawrence, MA; Elder Services Plan of the North Shore, Lynn, MA.
authors.forename: Innokentiy
authors.initials: I
authors.lastname: Bakaev
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Marisa
authors.initials: M
authors.lastname: Morgan
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Monti
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA; Hebrew SeniorLife Institute for Aging Research, Boston, MA.
authors.forename: Lewis
authors.initials: L
authors.lastname: Lipsitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008281:Maine; D008297:Male; D008404:Massachusetts; D001523:Mental Disorders / Q000150:complications / Q000628:therapy*; D008875:Middle Aged; D009735:Nursing Homes; D010347:Patient Care Planning; D010865:Pilot Projects; D016730:Program Development; D015397:Program Evaluation; D011595:Psychomotor Agitation; D019114:Remote Consultation
keywords: Long-term care; dementia; telemedicine