Dr. Helen C. Kales, Professor of Psychiatry and Director for the Program for Positive Aging, has been selected to take part in an update of the international expert Lancet commission on Dementia Prevention, Intervention and Care in October 2018 in London. In addition, Dr. Amanda Leggett, Research Assistant Professor of Psychiatry, has been selected to take part in the commission as a promising future researcher in dementia. Amanda currently has a K-award from NIH examining a variety of caregiver well-being and stress measures towards creating profiles of “caregiver styles” (akin to parenting styles). Dr. Kales is her primary mentor. Congratulations Dr. Kales and Dr. Leggett!

 

Lancet commission on Dementia Prevention, Intervention and Care: http://www.ucl.ac.uk/psychiatry/research/olderpeople/lancet-dementia-commission

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(As featured by Michigan Medical’s Institute for healthcare Policy & Innovation at http://ihpi.umich.edu/news/caring-caregiver-novel-web-based-approach)

 

Air travelers well know the instruction to “please put on your own oxygen mask before assisting others” in the event of an emergency.

This is, as it turns out, good advice in general for dealing with many of life’s stressful situations: we need to take care of ourselves to more effectively help others. And for the 15 million family members caring for the 5 million people with dementia in the United States, self-care is an absolute necessity – the daily demands placed on these caregivers create distress that can seriously erode their ability to look after their loved ones’ wellbeing.

As the older U.S. population grows, dementia is projected to affect 16 million Americans by 2050, with 98 percent of them impacted by symptoms such as depression, anxiety, delusions, wandering, aggression and sleep problems.

Michigan Medicine’s Helen C. Kales, M.D., U-M professor of psychiatry, and her Program for Positive Aging (PPA) team have been at the forefront of innovation for dementia caregivers, providing reliable and well-evaluated information and training, creating support tools and studying how to enhance self-care.

Helen Kales
Helen Kales

One web-based caregiver support tool called the WeCareAdvisor, developed by Kales and the PPA with collaborators at John Hopkins University, has been shown to measurably reduce caregiver distress, according to an evaluation recently published in BMC Geriatrics. Future research will identify whether using WeCareAdvisor for longer periods can impact other caregiver and behavioral outcomes; the caregivers in the study used it for one month; future trials plan to evaluate three months of using WeCareAdvisor.

WeCareAdvisor is designed to lead the family caregiver through the assessment, management and monitoring needed to accomplish the following:

  • Identify and address the underlying causes of behavioral symptoms (e.g. pain, urinary tract infection, communication issues, environmental overstimulation, etc.)
  • Reduce behaviors
  • Reduce caregiver distress
  • Enhance confidence in managing behaviors by teaching the user new and transferrable problem-solving skills such as enhanced verbal and nonverbal communication.

Kales will discuss WeCareAdvisor and other PPA-developed products to benefit individuals with dementia and their caregivers at the Precision Medicine World Conference in Ann Arbor, June 6-7.

The bedrock of the WeCareAdvisor tool is the “DICE” approach to dementia behaviors that was developed from a U.S. national multidisciplinary expert consensus panel led by Kales and the PPA in 2011. DICE™ comprises four steps:

  • DESCRIBE the behavior from the caregiver’s perspective to derive an accurate characterization and the context in which it occurs;
  • INVESTIGATE: having the healthcare provider examine, exclude and identify possible underlying causes of the behavior;
  • CREATE and implement a treatment plan for the behavior as a partnership between the caregiver and the provider; and
  • EVALUATE which parts of the treatment plan were attempted and effective. Within the DICE approach, behavioral triggers from the caregiver (unrealistic expectations, caregiver stress/depression, etc.), person with dementia (medical conditions, functional status, etc.); and environment (overstimulation, lack of routines, etc.) are evaluated and addressed by the provider and caregiver.

The approach promoted by DICE and the WeCareAdvisor, putting behavioral and environmental strategies ahead of drugs in the management of dementia behaviors is consistent with the stance of multiple medical organizations and expert groups as the preferred first-line treatment approach.

 

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Dr. Helen Kales has a new research collaboration with University College London. She and members of the PPA team will be training family caregivers in London on the DICE method as part of UCL’s “New Interventions for Independence in Dementia” grant.

 

 

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The PPA team trained nearly 100 nurses and social workers May 15 in Lansing on its DICE (Describe, Investigate, Create and Evaluate) training program for caregivers of Alzheimer’s and dementia patients. The training was part of the Michigan Mental Health & Aging Conference at the Kellogg Center. Led by Helen Kales, the PPA team of Mary Blazek, MD, MEHP; Lynn Etters, DNP, GNP-BC, ANP-C, and Laura M. Struble, PhD, GNP-BC provided the training at an all-day session. PPA team members Molly Turnwald, Barb Stanislawski and Bri Broderick coordinated the event.

 

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The Best About Positive Aging

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Two faculty from the Program for Positive Aging will be presenting at next week’s Issues in Aging conference held at Schoolcraft College in Livonia on April 23rd and 24th.

Lynne Etters, DNP,GNP-BC,ANP-C and Gerontological Nursing Leadership Academy Fellow, U-M will present The DICE Approach: We’re on a Roll during the Current Research & Practices for Alzheimer’s Disease & Dementia program. The DICE approach is a nationally and internationally-acclaimed educational and training strategy developed by PPA’s Director Dr. Helen Kales to better assess, identify and resolve behavioral expressions in patients and support caregivers in family and institutional environments.

Donovan Maust, MD, MS, Asst. Prof of Psychiatry, U-M Research Scientist, VA, Ann Arbor Healthcare System will present Understand & Simplify: Psychotropic Prescribing in Older Adults as part of the New Enhancements in Frailty Care program.

The conference is sponsored by Michigan Medical’s Michigan Alzheimer’s Disease Center, the Greater Michigan Chapter Alzheimer’s Association and Wayne State University’s institute of Gerontology.

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Tranquilizers, antidepressants, opioids and anti-psychotic medications carry special risks for older people, alone or in combination.

Dr. Donovan Maust, M.D., M.S., assistant professor of psychiatry, brought his research findings and expertise on that subject to the Michigan Psychiatric Society’s Annual Spring Frontiers in Psychiatry event Friday, April 13 at Michigan State’s Kellogg Center.

His presentation will assist fellow psychiatrists and physicians better understand:

Trends in psychotropic prescribing among older adults, both of single agents and combination use.

Understand how the risk-to-benefit calculation for psychotropic prescribing may shift as patients age.

Review evidence from policies that try to reduce specific types of psychotropic prescribing.

Frontiers in Psychiatry is jointly provided by the American Psychiatric Association and the Michigan Psychiatric Society.

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Dr. Lauren Gerlach has been chosen from a wide field of applicants to participate in the Cornell University 2018 Career Institute in Mental Health of Aging Summer Research Institute. The Summer Research Institute (SRI) is an effort by the field of geriatric psychiatry to increase the number of talented investigators in the research career pipeline and to broaden the base of geriatric psychiatry research by attracting new investigators.

“It’s an honor to participate in such a meaningful program that aims to mentor and support junior investigators, providing them with the tools needed to succeed in a research career.”

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Lauren Gerlach, MD  Kara Zivin, PhD

Program for Positive Aging faculty Lauren Gerlach DO, Helen C. Kales MD, Kara Zivin PhD, and their colleagues co-authored an article that was recently published in The American Journal of Geriatric Psychiatry! The article examines the response after the FDA issued safety warnings regarding the prescription of high doses of citalopram.

You can read the article here.

Good work team!

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Lauren Gerlach, MD Drs. Lauren Gerlach and Helen Kales have co-authored an article published in Psychiatric Clinics of North America on managing the stressful behavioral and psychological symptoms of dementia (BPSD). This paper gives a great overview of what BPSD are, the factors that may influence BPSD and how caregivers and providers can better manage the symptoms.

You can read the article at this link!

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Congratulations to Dr. Mary Blazek who received the Nancy CA Roeske, MD Certificate of Excellence in Medical Student Education from the American Psychiatric Association. This certificate is awarded annually to APA members who have made outstanding and sustaining contributions to medical student education.

Keep up the great work Dr. Blazek!

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Drs. Helen Kales and Amanda Leggett recently wrapped up a project looking into how we can improve dementia care throughout our medical system. They spoke with patients and staff throughout the emergency departments, inpatient units and outpatient services to find the strengths and challenges of Michigan Medicine’s dementia care. The project was funded by MCubed and a video highlighting the project was featured at the MCubed Symposium earlier this week! You can see the video below:

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Donovan Maust, MD, MS

Congratulations to Dr. Donovan Maust for winning the 2018 Barry Lebowitz Early Career Scientist Award from the American Association for Geriatric Psychiatry!

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We are excited to announce that the Program for Positive Aging has demonstrated a strong national impact with three articles in the October issue of the American Journal of Geriatric Psychiatry (AJGP).

The headline special article on the development of geriatric mental health learning objectives for medical students represents ongoing efforts by Dr. Mary Blazek, who leads a multi-institutional workgroup to provide medical educational resources to combat the critical U.S. shortage of geriatric psychiatrists.
This article can be read here.

Dr. Donovan Maust authored an article on the relationship between dementia caregiver distress and healthcare utilization and costs, with contributions by Drs. Helen Kales, Fred Blow and Amanda Leggett.
This article can be read here.

Drs. Courtney Polenick, Amanda Leggett and Helen Kales described the implications of medical care activities on spousal caregivers for older adults with functional impairment.
This article can be read here. 

Congratulations to all!

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Last week, Dr. Kales did an interview with BYUradio, discussing dementia care, risk factors, and what we can do to help caregivers.

Listen here: http://www.byuradio.org/episode/0e1ba3d3-80fc-4567-a235-c05b4cfcbe40?playhead=1061&autoplay=true

 

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Amanda Leggett, PhD Congratulations to our faculty researcher Amanda Leggett, PhD, who has received a Research Scientist Development K01 award from the National Institute on Aging. Her project, “Style and Substance: Characterizing Dementia Caregiving Styles and Associated Biopsychosocial and Health Services Outcomes” will capture information about and associated with dementia caregiving styles. We are very excited for Amanda to have this opportunity.

Congratulations!

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Last year, Dr. Kales participated in an international panel to discuss the burden associated with Alzheimer’s Disease. The report from The Lancet Commission on Dementia Care has been released and the groups findings were presented at the Alzheimer’s Association International Conference in London.

Dr. Kales discussed the importance of this report for a blog post that you can read here. 

The full Lancet report can be found here. 

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On May 8th and 9th, Dr. Kales co-chaired the NIMH/NIA Workshop “Novel Approaches to Understanding the Mechanisms of the Neuropsychiatric Symptoms of Dementia in Alzheimer’s and Advancing Treatment Development”. This workshop brought together approximately 30 clinical, behavioral science and neuroscience researchers to discuss information gaps and best steps to 1) improve understanding of mechanisms of NPS and 2) further develop better behavioral and psychopharmacologic treatment approaches.

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We are excited to announce the Program for Positive Aging has been selected for the upcoming S-Citalopram for Agitation in Dementia (S-CitAD) trial. The S-CitaD trial is funded by the National Institute on Aging at the National Institutes for Health (NIA/NIH). It will evaluate escitalopram plus structured psychosocial intervention against a placebo plus structured psychosocial intervention for the treatment of agitation in patients with dementia. The S-CitAD Trial will be initiated in summer 2017.

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