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A Person-Centered Approach to Alzheimer’s Disease Treatment: A Conversation with Geriatric Psychiatrist Dr. Gary Epstein-Lubow

We spoke with Dr. Epstein-Lubow about professional development, his vision for memory care treatment at HSL, and why person-centered care is the right approach to treat Alzheimer’s disease
Dr. Epstein-Lubow at Hebrew SeniorLife.

Tell us about your vision for the center of excellence for Alzheimer’s disease and memory care. Who will it serve and how?

The center will serve people with all types of memory concerns, and also family members and friends of those with memory issues. We’ll start with a comprehensive assessment for a person with a memory complaint. That assessment will provide answers about whether the complaint is due to a memory condition like Alzheimer’s, or something else such as depression. Once the assessment program is in place, treatments will focus on family support and care management, including a focus on person-centered goals to adjust to memory concerns and improve quality of life.

We’ll emphasize person-centered care and family-oriented treatments. Alzheimer’s and other dementias are the sixth leading cause of death, currently affecting more than 5 million Americans, and 1 in 3 seniors has symptoms of dementia at the time of death. Sadly, of the top 10 causes of death, Alzheimer’s is the only one that can’t be prevented or cured. However, research on family-oriented and person-centered treatments has advanced, and there is now great evidence about ways to cope with symptoms to maintain quality of life. The Center of Excellence will rely on these approaches.

What got you interested in Alzheimer’s and Dementia? Did you have an experience early in your career that led you down this path?

I studied cognitive science in college. At that time, in the late 80s, “cog sci” was just developing. My readings included psychology, brain science, philosophy, computer science, and anthropology with a focus on how language development relates to thinking. I loved it and thought a lot about doing graduate training in cognitive science or psychology, but I chose medicine…maybe because my father is a doctor; in fact, he’s a psychiatrist. When I went to medical school, I wasn’t focused on psychiatry; I thought about neurology or maybe family practice because I enjoy taking care of people’s basic health care needs. But then I did an elective rotation in public health psychiatry funded by the National Health Service Corps, and it turned out to be a great fit for my interests. 

It wasn’t until later in my psychiatry training that I first worked in-depth with people with Alzheimer’s and other types of dementia. Dementia combines my interest in working with patients who have unique symptoms and in working with family members to help them cope. In addition, I’m driven to work on the ‘big picture’ of health services and improving care delivery. And, finally, working with seniors is very satisfying because everyone’s life story is so interesting. 

I know in my own family how dementia can affect a person. My mother’s father had dementia and he lived in a nursing home. More recently, my wife’s mother developed symptoms in her 70s and lived her last years in an assisted living memory care unit. Having seen dementia up close in my own family has helped me understand what it’s like to manage these symptoms at home. Treatment is very complex and requires resources beyond a doctor’s office.

What is one piece of advice that you would offer to doctors and geriatricians who are treating patients with memory care issues?

The three big issues are:

  1. Making a diagnosis
  2. Providing care planning advice
  3. Providing or referring to supportive services for optimal care

In order to make a diagnosis, the doctor first does a short screening test of memory symptoms and then decides with the patient if more testing is needed; usually that testing leads to a diagnosis such as “mild cognitive impairment” or “dementia,” and it’s important to consider what is likely causing the symptoms. There are no lab tests that definitively say whether someone has Alzheimer’s disease or another type of dementia, but there are some tests - like a brain scan -  that can be combined with other genetics and memory tests, so the patient can be diagnosed.

Following diagnosis, the doctor should provide advice or refer the patient to a program such as the Alzheimer’s Association, for important discussions about “advance care planning” and linkage to services. Advance care planning includes considering the patient’s wishes about who will help with health care decisions, as well as planning for finances and housing arrangements. There are community agencies that can provide these services to support optimal care, and it’s important that the doctor make sure services like this get to the patient.

We see a lot of stories in the media lately about the increased number of seniors in America and the effects that our aging population will soon have on our health care system. Do you think the current health care system will be able to adequately serve our seniors as they continue to live longer? Is there any advice you would give to health care providers that can help them better serve this population?

You’re right that the U.S. health care system is under increasing strain, and I believe the reports that say the current workforce is too small to provide the same type of care that seniors have received in the past. But the systems are changing. I’m optimistic that we will see more results from the Center for Medicare and Medicaid Innovation. This program was started along with the Affordable Care Act and has been testing new models for delivering high-value care to large populations.

I would advise health care providers to participate in local accountable care organizations and other new care models, and to be early adopters of new procedures that are encouraged or mandated by the Centers for Medicare and Medicaid Services. For health care providers who are the most interested in this process as it relates to seniors at risk for a memory concern, there are opportunities here in Massachusetts to participate in health care system change to improve population health.

What most excites you about the challenge ahead?

Hebrew SeniorLife has the opportunity to help Massachusetts become a national model for delivering statewide high-quality memory care services. In my experience with the U.S. Department of Health and Human Service’s Advisory Council for Alzheimer’s Research, Care and Services, I saw few programs that have the track record in both senior health care and housing, combined with an international research leader like HSL’s Institute for Aging Research. I’m excited to see HSL’s and IFAR’s strengths combined in a public – private partnership with other regional leaders to establish Massachusetts as a national and international leader in improving the quality of life for persons living with a cognitive disorder, and their family members. 

About Hebrew SeniorLife Memory Care in Long-Term Chronic Care 
Highly trained Memory Care staff at Hebrew Rehabilitation Center deliver personalized care to memory care patients at each stage of their journey with us. Our staff is committed to learning values and preferences so that care plans include a balance of meaningful activities, medical services and other therapeutic interventions aimed at improving or maintaining each person’s functional level. Patients’ families are valuable partners in care giving and planning, working with our Memory Care team comprised of geriatricians, geriatric psychiatrists, nurse practitioners, licensed nurses, nursing assistants, rehabilitation therapists, social service professionals, dietitians, recreation therapists and activities staff to ensure that loved ones’ life-long interests and passions are represented in daily programming to reinforce a sense of identity and overall well-being.

More on HSL Memory Care here, or call 1-877-822-4722

Courtney Howe's picture

About the Blogger

Media Relations Specialist at Hebrew SeniorLife

As Media Relations Specialist at Hebrew SeniorLife, Courtney is responsible for communicating HSL’s unique stories to the world. Courtney comes to HSL with a background in marketing communications with previous work experience from The New England Center for Children, Neiman Marcus, and The Washington Post. Courtney earned an MBA with a marketing concentration from Bentley University (Waltham, MA) and a Bachelor’s Degree in Political Science from Trinity College (Hartford, CT).

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