With all our technological capability to peer inside and manipulate the human brain, that approximately three pound organ continues to reveal complexities far deeper than any MRI can probe.

It follows, that a disease of the brain, and more specifically Alzheimer’s and related dementia, epitomize that same kind of complexity.

At the Home Instead Center for Successful Aging, in Omaha, a compassionate team with a unique approach in providing care for Alzheimer’s and related dementia patients hopes to tackle some of the difficulties of caring for Alzheimer’s while at the same time create significant savings.

Known as the Care Ecosystem study, the research is a partnership between the University of Nebraska Medical Center and the University of California-San Francisco, sponsored by a grant from the U.S. Department of Health and Human Services for Medicare and Medicaid. It focuses on the “care-giving” aspect of treating Alzheimer’s and the research team is searching for trial participants in the Fremont area and around rural Nebraska.

Dr. Steven Bonasera, associate professor, Internal Medicine Division of Geriatric Medicine at the University of Nebraska Medical Center in Omaha leads the trial in the Nebraska and Iowa area.

Although Alzheimer’s Disease has been a major focus of research in the national institutes of health, tallying vast amounts of money into research and development of new pharmaceutical treatments and cures, “currently, we don’t really have a good understanding as to what causes Alzheimer’s disease,” said Dr. Steven Bonasera, associate professor, Internal Medicine Division of Geriatric Medicine at the University of Nebraska Medical Center in Omaha.

“The treatments that we have developed have proven to be not nearly as effective as we thought they would be when they first came out,” Bonasera added.

In America today, Alzheimer’s disease and related dementia illnesses represent potent killers. They serve as the sixth leading cause of death among both men and women in the United States. What is more, because the association between growing older and acquiring Alzheimer’s proves so strongly correlated, and the aging baby-boom generation is expected to dramatically increase over the next 15 to 20 years, the prevalence of Alzheimer’s is projected to dramatically increase in numbers of affected, and in dollars.

“The RAND Corporation has estimated that we will spend more than $50 trillion per year on care-giving for Alzheimer’s disease within the next 15 years,” said Dr. Stephen Bonasera. “Who has $50 trillion dollars right now?”

“Medicare is looking in the future, and they’re seeing this tremendous future increase in spending that’s going to be inevitable if current trends continue without any change,” Bonasera underscored.

The Care Ecosystem employs a distinctive approach in the treatment of Alzheimer’s that hopes to significantly improve care while at the same time lowering the cost, he explains. This approach is different from treatments that focus mainly on specifically designed pharmaceuticals, such as anti-amyloid therapies.

Instead of using medications, or other invasive treatments, Care Ecosystem focuses on the “care-giving” aspect of treating Alzheimer’s. Through a variety of methods, this approach works to provide supportive care to the patient; and also to the family members who frequently experience emotional and other medical-related ailments due to the stress of 24/7 care-giving for a loved one.

Bonasera stressed that care-giving is a very powerful process.

“To put it simply, care-giving isn’t sexy,” Bonasera plainly state. In other words, care-giving doesn’t draw money like new medications, new surgical techniques and other research into fancy new technologies.

He continued with emphasis:

“Yet (care) is vital, it totally improves peoples’ quality of life, it is actually as good, if not better, than any of the drugs we currently have for the disease,” he said. “But it gets neglected because care-giving isn’t high-tech, care-giving requires a lot of person-to-person interaction … care-giving is a very time honored and venerable task that people do … and it really makes a difference. But right now it doesn’t get a lot of headlines and doesn’t receive a lot of money.”

With the Care Ecosystem trial Bonasera and his team look to change the relevance of care-giving for Alzheimer’s treatment by using various methods, all powered by compassionate, and skillfully trained people.

Those methods involve four main components: a care team navigator; a medication review; assistance with making important patient and family decisions; and finally, functional monitoring. Not every patient or family receives all four components; it depends on the severity of the illness and is determined on a case-by-case basis.

The care team navigator serves as the heart and compassion of the Care Ecosystem trial. These individuals undergo several weeks of training, and by the end of it they are experts, possessing a deep knowledge of dementia. They serve as a resource that family members can call when a loved one with Alzheimer’s begins displaying difficult behaviors. Their specialized training allows them to assist the family and the patient to work through periods of increased anxiety or other Alzheimer’s related symptoms.

The medication review involves coordinating the sometimes long list of medications prescribed by the patient’s various medical providers.

The care navigator also assists the family with important decisions related to advanced directives, financial and other aspects of daily life that may be overwhelming for the patient and family.

Finally, some patients receive what is called functional monitoring. Through the use of smart devices such as smartphones and smartwatches the care providers can observe and detect various behavioral components that facilitate the prediction of problems both medical and emotional that may be developing in the patient.

One of the hopes for Dr. Bonasera and his team is that, within the next year, evidence will begin to emerge showing that the Care Ecosystem approach to Alzheimer’s treatment saves money. Bonasera hopes that if his team can show insurance providers specific data that reveals a savings in patient expenses, then those insurance providers may start to offer the program’s interventions as extensions of current healthcare benefits.

“I will be the first one to be delighted when a cure for Alzheimer’s disease is discovered … Until then we need to have something we can offer families, to make their lives easier and improve care of the patient with Alzheimer’s. And at the same time be able to ration healthcare dollars so that we spend the most wisely,” Bonasera said.

Bonasera’s team is still looking for participants. For information on participation call 402-552-7200 or 1-855-315-1777 or send email to care.eco@unmc.edu.


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