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Dr Martin Levine Explains the Growing Need for Caregiver Support in Alzheimer Disease


Martin Levine, MD, MBA, chief medical officer at the PolyClinic at Optum Washington, describes why caregivers need more resources to adequately manage patients with Alzheimer disease and what clinics can do to ensure access to those resources.

Caregivers need more resources to adequately care for patients with Alzheimer disease, according to Martin Levine, MD, MBA, chief medical officer at the PolyClinic at Optum Washington.


What has been Optum Washington’s approach to helping patients with Alzheimer disease and reduce memory loss?

So, about 10% of all people over the age of 65 have what we call as dementia, and dementia means trouble with your thinking and memory that interferes with your ability to keep yourself independent at your house. And the most common dementia is really unexplained and comes with getting older, and that's called Alzheimer disease. So, the term Alzheimer disease has nothing to do with severity, it's just a term to describe the most common kind. The other kinds of dementia could be caused by strokes—there are other versions of it, but the treatment’s sort of all the same. There are some medical therapies, but a lot of what's really necessary is to help families learn to understand the condition and to plan for it. There's a lot you can do if you work with people and families, but it's not a great thing if you don't invest time in planning.

So, I think your first question to me was really, what are we doing about that at Optum Washington. We recognize that, although it's 10% of people over age 65, nationally, the diagnosis is often not addressed by doctors and families until it's either middle stage or severe. And so what we've done is we've built a system across 28 clinics, serving about 30,000 people who are 65 and up, where we build a system where we've taught the doctors how to be more comfortable diagnosing early, and then how to talk to families so that we can provide them with services earlier in the course and make things more manageable for them.

Why is it important to ensure adequate support for caregivers of patients with Alzheimer disease and what initiatives has Optum Washington implemented to provide that support?

So, dementia should really be thought of as a chronic condition, like diabetes is a chronic condition. There's not a cure, but it's something that families and the people who have it have to manage every day. So, when people have chronic medical problems, they might go to the doctor several times a year, but they have to do things, they have to have a set of knowledge, skill, and attitudes so that they can better manage it at home.

So, what we've done at Optum Washington is we've built a system whereby we diagnose the condition earlier. And then, we've hired a team of social workers who take referrals from primary care doctors or specialists—really any doctor could refer to us. And then, they work with families over time to help them understand the condition, to stage it, to plan for the future, to talk about driving, to explore management of challenging problems common with families, to connect them to community resources, and to be basically an advisor and a helper to them on this journey in perpetuity.

So, in the same way somebody might get a primary care doctor and that's their go-to doctor, we give a go-to social worker to families dealing with a loved one who has Alzheimer disease or any other kind of dementia.

What more needs to be done on a national level to ensure that caregivers have access to sufficient resources and support to better provide care for patients with Alzheimer disease?

Well, there are really lots of things we could do. Everyone already knows that we have an aging society. So, the baby boomer generation is getting older. And we'll have increasing numbers of people with this condition. And so, it really needs to be a multilevel approach, where we provide support within the medical services realm, which is where the basis of the work that we're doing is, but it's also strengthening the services that are in the community for every stage of the condition, whether people are just at a mild stage and live at home with help from family members or if they have more complex needs, maybe need some kind of long-term care services.

So, a lot of medical care or thoughts about health are organized around individual patients. But when you think about Alzheimer disease and other kinds of dementia, we have to think about the family unit, not just the individuals, and we have to think about how do we organize services for the family unit so that they can better manage things for themselves because they're the ones doing it every day.

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