Home is where the future is: The BrightFocus Foundation consensus panel on dementia care.

INTRODUCTION: A national consensus panel was convened to develop recommendations on future directions for home-based dementia care (HBDC). METHODS: The panel summarized advantages and challenges of shifting to HBDC as the nexus of care and developed consensus-based recommendations. RESULTS: The panel developed five core recommendations: (1) HBDC should be considered the nexus of new dementia models, from diagnosis to end of life in dementia; (2) new payment models are needed to support HBDC and reward integration of care; (3) a diverse new workforce that spans the care continuum should be prepared urgently; (4) new technologies to promote communication, monitoring/safety, and symptoms management must be tested, integrated, and deployed; and (5) targeted dissemination efforts for HBDC must be employed. DISCUSSION: HBDC represents a promising paradigm shift to improve care for those living with dementia and their family caregivers: these recommendations provide a framework to chart a course forward for HBDC.

Suicidality in older African Americans: findings from the EPOCH study.

The authors examined the current frequency of suicidality and associated characteristics in a sample of 835 African-American older adult residents of six urban public housing developments who consented to participate in an intervention trial of mobile outreach. The frequency of passive and active suicidal ideation was 2.5% and 1.4%, respectively. Characteristics of individuals with both active and passive suicidality included elevated anxiety, social dysfunction, somatic symptoms, low social support, lack of a confidant, and low religiosity. Characteristics of those with passive, but not active, ideation also included older age, lower levels of education, elevated depressive symptoms, poorer cognitive functioning, and having recently discussed emotional problems with a healthcare provider. The characteristics of those reporting active, but not passive, ideation included having a history of mental health treatment and reporting no instrumental support. Multivariate analyses indicated that depression and religiosity were uniquely associated with passive suicidal ideation, and life satisfaction and religiosity were uniquely associated with active suicidal ideation. The authors discuss implications of these findings and offer suggestions for research and clinical practice.

Identifying dementia in high-risk community samples: the memory and medical care study.

The Memory and Medical Care Study (MMCS) is a community-based, longitudinal study of elders at risk for dementia. This paper describes the study methods for identifying subjects with dementia or mild cognitive impairment (MCI) and the validation of these methods. The MMCS cohort was established by identifying subjects at risk for dementia in three previous studies of randomly ascertained samples. Neuropsychologic test score criteria were established to identify MMCS subjects with dementia or MCI. These criteria were validated using a fourth community-based sample of at-risk elders in which dementia was identified by a clinical adjudication panel. Of the 498 MMCS subjects, 70% had dementia and 27% had MCI by the MMCS criteria. In the validation sample, the MMCS dementia classification method was in agreement with the clinical adjudication panel for 81% of cases (kappa = 0.62, 95% confidence interval = 0.45-0.78). The methods used in the MMCS are efficient and reasonably valid for establishing a cohort of subjects to investigate how dementia is assessed, diagnosed, and treated in the community.