Community health workers and stronger primary care could help address behavioral symptoms in dementia

Efforts to improve dementia care in primary care settings may benefit from additional support for patients and caregivers, including the use of community health workers and earlier attention to behavioral symptoms.

A new program supported by Independence Blue Cross (IBX) and Jefferson Health aims to strengthen early detection and care planning for patients with cognitive impairment. Part of the model includes involving community health workers to help guide conversations with patients and families outside of the typical primary care visit.

Rodrigo Cerdá, M.D., M.P.H., senior vice president of health services and chief medical officer at IBX and a member of Managed Healthcare Executive’s editorial advisory board, said community health workers can play an important role in helping patients and caregivers clarify priorities and share that information with clinicians.

“I think, from what we understand, the plan is to have that community health worker have a phone call and conversation with the patient and their sort of family or caregiver on what those priorities are, do a bit of shared decision-making, understanding the preferences and being able to serve that up to the primary care doctor,” Cerdá said. “When you think about working at top of license, this is something that’s squarely possible for a community health worker to do.”

The goal is to take some of the communication and care planning work out of the time-limited primary care visit while still keeping the physician at the center of medical decision-making.

Behavioral symptoms of dementia are another area where stronger primary care engagement could make a difference, according to James Ellison, M.D., M.P.H., a geriatric psychiatrist at Jefferson Health.

“Some primary care healthcare providers are excellent at identifying and intervening with behavioral health problems that accompany cognitive impairment, but many of them are feeling at a loss because these symptoms don’t respond in the same way that individuals with primary mental health disorders respond,” Ellison said.

Ellison noted that apathy is the most common behavioral symptom in dementia and can often be mistaken for depression. Addressing these symptoms early, along with identifying triggers such as medical problems or environmental stressors, can help prevent more severe issues such as agitation or aggression.

When behavioral symptoms escalate, families may struggle to safely care for loved ones at home. Early recognition and support, Ellison said, can help stabilize patients and allow many families to continue home care longer, which is often less disruptive and more comfortable for patients.