July 25, 2016

Continuous medical care is crucial for people with dementia


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Dr. Larson discusses how continuity of care for dementia patients may lower costs, emergency visits, and hospital stays.

by Eric B. Larson, MD, MPH, executive director of Group Health Research Institute and vice president for research at Group Health

People with memory failure can no longer recall symptoms or tell health care providers about them. But with help from an informed caregiver, a provider can still gather information to understand what is happening with the patient—especially if the patient and provider have had a continuous, long-term healing relationship, ideally dating from before memory failed.

Patients, families, and policymakers value continuity of care, which is a fundamental tenet of effective primary care. I believe continuity of care isn’t achieved often enough and may be the single most valuable aspect of the care that we can offer to people with dementia. I have seen it do much more good than the aggressively marketed medications that are supposed to reduce the rate of decline in people with Alzheimer’s disease but have generally disappointed.

Knowing a patient and providing ongoing care and observation—and encouraging regular walking and fall prevention—can help prevent emergency visits and hospital stays, which are typically horrendous experiences for dementia patients and their families. As we reform and redesign health insurance payment to encourage high-value care, we should ensure incentives to promote continuity of care.

In a new analysis of a large database of Medicare fee-for-service claims, Dr. Halima Amjad of Johns Hopkins University School of Medicine and her colleagues linked continuity of care with lower costs—and fewer emergency visits and hospital stays, the main source of increased costs. I wrote an invited commentary about their findings for JAMA Internal Medicine called “Medical Care When Memory Fails.”