Study Examines Caregiver Satisfaction with VA Dementia Care
BACKGROUND:
Overall, the prevalence of dementia among Veterans is just over 7%, with Alzheimer's disease being the most common diagnosis. Dementia is a very expensive disease, in part because of the wide range of care needs of patients and caregivers. The vital role of caregivers is highlighted by the fact that they provide an estimated 17 billion hours per year of unpaid care, valued at $202 billion in the United States. Thus, comprehensive care necessitates meeting the needs of persons with dementia, as well as their caregivers. Greater satisfaction with care has been shown to be an important predictor of effective healthcare decision-making, and higher adherence with medical regimens and clinical outcomes. This study examined caregiver-rated satisfaction with dementia care received through the VA healthcare system, focusing on 457 Veterans enrolled in Partners in Dementia Care (PDC) — a telephone-based intervention for Veterans with dementia. Administered from 2007-2009 through partnerships between five VAMCs and four local chapters of the Alzheimer's Association, the PDC intervention was designed to address unmet care needs and provide care coordination and support services for Veterans with dementia and their family caregivers. Measures included: demographics, cognitive impairment (e.g., Veteran's ability to remember information or follow instructions), problem behaviors (e.g., confusion, wandering), and personal care dependency. VAMC site and total unmet needs also were included to examine potential relationships with dependent variables (satisfaction with physician and VAMC care). Only caregiver ratings were assessed.
FINDINGS:
- Overall, at the start of the PDC intervention, satisfaction with physician and VA care was quite good; however, caregivers reported that many unmet dementia care needs remained. On average, caregivers reported about 17 unmet care needs, indicating that they needed more information about or help with approximately one-third of the care needs used in the study analyses.
- Total unmet need was the only significant predictor of satisfaction with physician care, indicating that as the number of unmet needs increase, satisfaction with physician care suffers. Similarly, total unmet need was the strongest predictor of satisfaction with VA care, indicating that as the number of unmet needs increase, satisfaction with VA healthcare also suffers.
- Behavior problems and VA site were additionally predictive of satisfaction with VA care.
LIMITATIONS:
- This study focused on baseline data only, precluding evaluation of directionality of effects.
IMPACT:
- This study also may inform goals for patient-aligned care teams, which emphasize comprehensive care and meeting a wide range of patient needs, including those of both patient and caregiver.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D (IIR 04-238). Drs. Wilson and Kunik are part of HSR&D's Houston Center for Quality of Care & Utilization Studies.
Gallagher K, Bass D, Judge K, Snow AL, Wilson N, Morgan R, Walder A, and Kunik M. Satisfaction with Dementia Care. Federal Practitioner April 2012;29(4):33-40.
