{"id":19136,"date":"2023-07-18T14:30:00","date_gmt":"2023-07-18T14:30:00","guid":{"rendered":"https:\/\/adn.monetizemail.com\/?p=19136"},"modified":"2023-07-19T06:47:52","modified_gmt":"2023-07-19T06:47:52","slug":"advanced-dementia-patients-often-need-a-bro","status":"publish","type":"post","link":"https:\/\/adn.monetizemail.com\/?p=19136","title":{"rendered":"Advanced dementia patients often need a BRO"},"content":{"rendered":"

Alzheimer\u2019s. Dementia. These diagnoses rip the chord of safety and certainty in patients, families and caregivers at an estimated rate of 6.5 million Americans age 65 and older in 2022 and an estimated 168,600 VA patients in 2021. It\u2019s a diagnosis projected to increase to 12.7 million Americans by 2050 and 217,400 VA patients in the next decade alone.<\/p>\n

While a diagnosis is frightening enough, so too are distress behaviors that may be associated with the disease, like verbal outbursts, inappropriate behaviors, even physical aggression. These often interfere with medical treatment and caregiving that may harm the patient, the caregiver or the treatment team.<\/p>\n

As a young psychologist working at Central Iowa VA\u2019s<\/a> Community Living Center, Dr. Kathleen Matthews saw these distress behaviors first-hand and realized these Veterans could be better cared for through non-pharmacologic behavior plans rather than the traditional method of psychotropic medications.<\/p>\n

Working with team members, she created the Behavioral Recovery Outreach (BRO) team to meet this extremely vulnerable patient population\u2019s unmet needs.<\/p>\n

\u201cBRO helps build a sense of connection and shared purpose for meeting these Veterans\u2019 needs,\u201d Matthews said. \u201cBy reducing distress behaviors, especially given that BRO Veterans tend to have very severe behaviors, there is a sense of hope that these Veterans can get better to the point where they are able to be discharged from the inpatient setting even if initially it feels hopeless.\u201d<\/p>\n

Commitment of BRO teams make care model work<\/h2>\n

The basic premise is learning about the Veteran as a person and utilizing interventions such as redirecting or offering alternatives to mitigate potential distress reactions. Sometimes it may be as simple as offering a different toothpaste to the Veteran who refuses to brush his teeth, or it may be as complex as convincing the Veteran she has already finished her work for the day if she is fixating on her former career.<\/p>\n

While the highly individualized Veteran-centered holistic approach is central to addressing behavior care needs and developing effective behavior plans, it is the commitment of the interprofessional BRO teams that exist at approximately 15 VA facilities\u2014including Minneapolis VA<\/a>, the second VA site to establish a BRO team\u2014that make this care model work.<\/p>\n

Behavioral Neurologist Dr. Jamie Starks is the medical director for the Minneapolis VA BRO team. Her goal is to have all medical personnel at her VA, including the medical residents and students she works with, build empathy for what these Veterans are experiencing and provide a framework of why behaviors occur.<\/p>\n

Pictured above, Starks (right) and medical student Amy Parkinson visit with BRO Veteran Richard \u201cNick\u201d Knickerbocker.<\/p>\n

\n
<\/a>
Physician Resident Leah Buda helps redirect BRO Veteran Richard Jenkins.<\/figcaption><\/figure>\n<\/div>\n

\u201cGenerally, unmet needs or stress\u2014such as no longer being able to communicate\u2014causes distress behaviors,\u201d said Starks. \u201cLots of behaviors are inadvertently caused by caregivers\u2014speaking too fast, using too many words\u2014and Veterans not understanding why, for instance, a stranger is helping them go to the bathroom.\u201d<\/p>\n

Feedback from caregivers overwhelmingly positive<\/h2>\n

As the BRO team learns about the Veteran and finds behavioral interventions that work for that patient, distress behaviors often occur less frequently and may be less severe. This improves quality of life for the Veteran and their caregiver. When the Veteran is ready to return home or be discharged to assisted living or a long-term care facility, the BRO team supports the Veteran and the caregivers by sharing the behavior plan and making visits for up to six months.<\/p>\n

While BRO Veterans often have a longer length of stay, Starks says the outcomes are worth it because they are more stable when they leave the inpatient unit. She adds the feedback from caregivers is overwhelmingly positive. One of the greatest challenges is the stigma of dementia even within the medical field.<\/p>\n

\u201cDementia is not felt to be a very glamorous field because we don\u2019t have a pill or a surgery that can cure things,\u201d she said.<\/p>\n

But as her medical students and residents spend time with the BRO Veterans\u2014an essential component to building the behavioral care plan\u2014they see the human beings behind the disease and find compassion as they provide care.<\/p>\n

\u201cThat to me is the most important learning objective,\u201d Starks added, \u201cseeing that these are people and not just problems.\u201d<\/p>\n

VA salutes Dr. Jamie Starks, VA\u2019s clinical educators and the more than 1,400 educational institutions that partner with VA to train future health professionals.<\/p>\n

These academic affiliations, some of which began more than 75 years ago, are coordinated by VA\u2019s Office of Academic Affiliations (OAA). Find out more about VA\u2019s academic mission\u00a0by watching this video<\/a>\u00a0and visiting the\u00a0Office of Academic Affiliations website<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

Alzheimer\u2019s. Dementia. These diagnoses rip the chord of safety and certainty in patients, families and caregivers at an estimated rate of 6.5 million Americans age 65 and older in 2022 and an estimated 168,600 VA patients in 2021. It\u2019s a diagnosis projected to increase to 12.7 million Americans by 2050 and 217,400 VA patients in […]<\/p>\n","protected":false},"author":8,"featured_media":19138,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[542,5,64],"tags":[],"class_list":["post-19136","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-behavioral-recovery-outreach","category-health","category-inside-veterans-health"],"_links":{"self":[{"href":"https:\/\/adn.monetizemail.com\/index.php?rest_route=\/wp\/v2\/posts\/19136","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/adn.monetizemail.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/adn.monetizemail.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/adn.monetizemail.com\/index.php?rest_route=\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/adn.monetizemail.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=19136"}],"version-history":[{"count":3,"href":"https:\/\/adn.monetizemail.com\/index.php?rest_route=\/wp\/v2\/posts\/19136\/revisions"}],"predecessor-version":[{"id":19144,"href":"https:\/\/adn.monetizemail.com\/index.php?rest_route=\/wp\/v2\/posts\/19136\/revisions\/19144"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/adn.monetizemail.com\/index.php?rest_route=\/wp\/v2\/media\/19138"}],"wp:attachment":[{"href":"https:\/\/adn.monetizemail.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=19136"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/adn.monetizemail.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=19136"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/adn.monetizemail.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=19136"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}