Aging Brain Care Program - Brain Care Innovation - Eskenazi Health

After decades of research, the Eskenazi Health Aging Brain Care (ABC) program was developed to support primary care providers in the specialized diagnosis and management of patients with cognitive impairment caused by conditions such as Alzheimer’s disease, delirium and cognitive and emotional problems that may arise after critical illnesses. The ABC team also supports caregivers and includes family members in all care decisions.

“Dementia” refers to a range of symptoms associated with a decline in memory or other thinking skills that is severe enough to reduce a person’s ability to complete everyday activities. Dementia symptoms can vary greatly from person to person and can affect memory, language, mood, personality, judgment and behavior. Alzheimer’s disease is the most common form of dementia, accounting for an estimated 60 to 80 percent of all cases.

Approximately one out of every 10 people ages 65 and older has Alzheimer’s disease. Across the United States, more than 15 million people are caring for a family member or close friend suffering from memory problems. Although caring for a loved one can be very rewarding, it can create physical, emotional and financial pressures for caregivers.

Established in 2008, this one-of-a-kind center combines research and clinical care, resulting in the rapid translation of research discoveries into clinical practice. Working closely with the patient’s primary care provider, the multidisciplinary care team – consisting of physicians, nurses, psychologists, care coordinator assistants and social workers – develops a personal treatment plan for each patient that includes medications as well as non-drug treatments to improve the quality of life for patients and caregivers.

The ABC program functions under the Sandra Eskenazi Center for Brain Care Innovation at Eskenazi Health. The care team delivers state-of-the-art, evidence-based care in home, community and clinical settings. Care coordinator assistants are the cornerstone of the program, serving as the primary link between patients, their caregivers and the clinical team.

  • Diagnostic Evaluation

    Care begins with a complete diagnostic evaluation conducted in the ABC Center. This includes:

    • A clinical and neurological exam
    • Blood work
    • Brain imaging
    • Memory and mental status testing
    • Face-to-face family conference with the patient and family caregivers
  • Personalized Brain Care Plan

    A personal and specialized brain care plan will then be developed to include:

    • Home-based care management
    • Coordination with community resources
    • Tools to support patients and caregivers in managing dementia and navigating the health care system
  • Brain Care Management Services

    All patients and caregivers receive brain care management services that focus on improving self-management, problem solving and coping skills. Among them:

    • Patient and family education and counseling
    • Data collection via standardized tools to identify and address changes in brain health
    • Coordination of care transitions across multiple settings
    • Design and delivery of person-centered, non-pharmacological interventions to reduce physical and psychological burden for both patients and caregivers
    • Modifications to physical and social environments
    • Engagement of palliative and hospice care as appropriate
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