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Many people still lack access to high-quality care and are not living as well as they might. Racial and ethnic minorities and other disadvantaged groups continue to experience deep and persistent inequities, such as lower-quality care in nursing homes and greater use of feeding tubes.1,2 The COVID-19 pandemic has further exacerbated the social isolation, risk of abuse of older persons, and other challenges encountered by many persons living with dementia and their care partners and caregivers.
While the term caregiver is well known, the committee also uses the term care partner, which is preferred by some because it acknowledges the reciprocal contributions of and partnership between individuals.
(T)he committee concluded that the evidence is sufficient to justify implementation of 2 types of interventions: collaborative care models and REACH (Resources for Enhancing Alzheimer Caregiver Health) II and its adaptations.
Collaborative care models use multidisciplinary teams that integrate medical and psychosocial approaches to care. The AHRQ review found low-strength evidence that such models benefit quality of life, quality indicators, and reduce emergency department visits. REACH II, a multicomponent intervention that supports family care partners and caregivers through a combination of strategies, includes problem solving, skills training, stress management, support groups, and education. These interventions incorporate many of the core components of care, services, and supports.
Collaborative care models and REACH II and its adaptations are already being implemented in a variety of settings with promising results. Notably, REACH II has been studied in and adapted for diverse populations to a greater extent than is the case for most dementia care interventions. These interventions are ready for more widespread adoption in and adaptation to the variety of settings where people seek care, with evaluation to continue to expand the evidence base. The committee recommends actions for organizations in a position to advance implementation and evaluation of these interventions, including the US Department of Health and Human Services through the Administration for Community Living, AHRQ, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, National Institute on Aging, and the Office of the Assistant Secretary for Planning and Evaluation. The committee also recommends actions for the Department of Veterans Affairs, state Medicaid programs, and health care systems working with local home-based community services and support agencies.