Last May, geriatrician Sakina Ouedraogo Tall, MD, a specialist in dementia care at NYU Langone Health, launched the Telemedicine Cognitive Geriatric Program at NYC Health + Hospitals/Bellevue, a public safety-net hospital serving patients from diverse ethnic and racial backgrounds. The program aims to address the growing need in diagnosing and caring for patients living with dementia and also helping their caregivers.
Here, Dr. Tall shares insights into the holistic program, its early successes, and its dual focus on supporting both patients and caregivers—many of whom are adult children needing support as much as those in their care.
Physician Focus: Tell us about your Telemedicine Cognitive Geriatric Program.
Dr. Tall: The program aims to detect mild cognitive impairment and dementia and provide holistic care to patients and support to caregivers. Holistic dementia care is individualized to address what matters most to the patient and caregiver. It addresses cognitive health (which includes emotional health), physical health, medications, nutrition, and social and environmental factors, as those factors can all impact cognition and wellbeing.
Physician Focus: What are the core components of the program?
Dr. Tall: The program has three main goals and objectives. The first goal is to provide consultative cognitive assessment and management for older adults via telehealth. The assessment aligns with the 2015 Dementia Measurement Set Update and includes several key components: disclosure of dementia diagnosis, caregivers’ education and support, assessing the level of function, screening and management of behavioral symptoms, screening for safety concerns, conducting pain assessments, and managing dementia pharmacologically, when appropriate. Advance care planning is also a key part of this process.
“The program’s social worker has been providing assistance to almost 90 percent of the caregivers in the program, and a survey of our caregiver population revealed that 61 percent are adult children.”
Sakina Ouedraogo Tall, MD
The second goal is to provide social worker–led caregiver support and counseling. And finally, we aim to foster close collaboration with primary care physicians on dementia diagnosis and management.
Physician Focus: What measurable outcomes or feedback have you observed from patients and their caregivers?
Dr. Tall: We’ll soon collect one-year data, allowing for more comprehensive analyses. The program currently cares for more than 100 patients and their caregivers. About two-thirds of those patients are living with dementia.
So far, some of the most compelling insights relate to the needs of caregivers and how programs like ours can help ease the significant burdens of caregiving.
The program’s social worker has been providing assistance to almost 90 percent of the caregivers in the program, and a survey of our caregiver population revealed that 61 percent are adult children. Prior to launching the program, we partnered with community resources, but soon realized that the needs of caregivers went beyond support groups. In addition to referring many to community programs, the social worker assisted 44 percent in obtaining increased home care services. This included helping 17 percent get durable medical equipment and connecting 12 percent to transportation resources.
Physician Focus: Can you share a specific patient case that highlights the program’s impact?
Dr. Tall: A 74-year-old woman was referred to the program after a recent diagnosis of mild to moderate cognitive decline and a recommendation for home support. The initial evaluation, a video visit with the patient and three adult children, concluded that she had a mild dementia syndrome and probable Alzheimer’s disease. We had an extensive discussion on the diagnosis. We discussed the management of her other medical comorbidities, as well as the importance of nonpharmacological management for brain health, including exercise, social and cognitive engagement, and a Mediterranean diet.
I answered all their questions and planned to meet again to discuss pharmacological management. They were grateful about the diagnosis clarity, which allowed them to make a care plan. I also referred the children to the social worker.
At that meeting, the family expressed relief and greater understanding of the diagnosis. The social worker facilitated several phone conferences with all three siblings for emotional support and planning, and referred them to home health services. Two months later, the patient had 25 hours a week of home care. This case highlights the impacts of collaborative care and the importance of a proper diagnosis and holistic approach.
Physician Focus: What are your plans for expanding or refining the program, and what advice would you offer to clinicians looking to implement similar initiatives?
Dr. Tall: I’m proud of what the program has achieved so far. The dedicated team is looking forward to continuing its care and support. My goal is to expand this program to other NYC Health + Hospitals facilities. Telehealth allows us to connect with patients throughout New York.
My advice to others is to make sure they are passionate about caring for patients living with dementia and their caregivers. It is a journey. Caregivers should have access to connect with the clinician or the support team when needed. An initial discussion on the diagnosis, etiology, symptoms, and disease course, including the unpredictability of progression, is often very helpful. Clinicians should be patient, flexible, and persistent, particularly during the initial telehealth discussion.
