Q&A with Dr. Paul Mikulecky, CareMore Health Chief Medical Officer

Is Alzheimer’s Disease increasing as the population ages?

As medical care has improved, people are living longer.  Whether due to multi-infarct dementia (multiple small strokes), Alzheimer’s or other types of dementia, we are seeing an increased incidence as we help people live longer lives.

As a primary care doctor, what advice do you give to caregivers?

CareMore maintains a member-centric approach.  Part of this is working with the patient and their caregiver to build a shared understanding of the goals of care and what we as clinicians are doing to help the patient live their best life.  As clinicians, we focus not only on managing chronic disease states, but also on maximizing quality of life.  As our patients lose some of their independence due to dementia, we pivot with them by focusing on what matters to them most.

Our Aspire Health palliative program can be helpful to patients with dementia, including Alzheimer’s disease. The goal of palliative care is to relieve symptoms and address the emotional and social stress that comes with Alzheimer's Disease. There’s a misconception that palliative care is only for end of life. However, whether it is Alzheimer’s Disease or other serious and advanced illnesses, palliative care may be appropriate at any stage. Patients can receive palliative care while their physician provides curative or supportive treatment.

Think of Aspire palliative care as providing an additional layer of support on top of a patient’s existing primary care clinician and specialists.  The Aspire team manages the patient’s symptoms, providing support and education while focusing on quality of life. We involve family and loved ones in care planning, which helps ensure that treatment meets the patient’s personal needs and goals.

What are realistic goals when treating an Alzheimer’s patient?

We approach the patient holistically, addressing physical needs, mental challenges, safety and social determinants of health. We focus on the patient, their quality of life and what is important to them. Unfortunately, with progression of Alzheimer’s disease, patients may become unsafe to live alone, losing their independence. If this prompts a change in environment or lifestyle, the patient may feel stress.

We work with the caregiver and patient to manage their physical health, including medication side effects. We also explore how dementia affects their mental well-being.  Is the patient anxious or depressed due to a change in environment?  How can we help the patient and caregiver cope with changes they are experiencing?

We also consider impact on finances.  Increased support can put a significant strain on a patient and their loved ones.

Helping connect the patient and family to support services while bringing in the multi-disciplinary care team improves our effectiveness in helping patients and their families.

How does a caregiver determine if their Alzheimer’s patient needs a different type of intervention?

The caregiver knows the patient best. It is not unusual for a caregiver to feel overwhelmed.  The best advice is to listen to your gut, ask questions and don’t be afraid to ask for help.

Patients often have trouble communicating effectively, so we rely on changes in behavior.  Caregivers are most sensitive to these changes, so it is important as clinicians to be curious and look for unusual presentations of a disease state. If the patient withdraws from normal activities, it may be because of a physical condition such as a urinary tract infection. Or they may feel anxiety over inability to process stimulation (lights, sounds, etc.).

From the caregiver perspective, it requires communication, support and coordination of resources. We want to set up our caregivers for success through education and empowerment.

What preventive steps are recommended to keep Alzheimer's patients safe at home?

Simplifying the home environment often leads to better results.  This includes minimizing the side effects of medication, keeping patients engaged in activities, and closely monitoring to ensure they remain safe. Consistent support and cadence to the day builds a sense of security while creating a stable environment. 

Are there therapies, technologies or drugs for Alzheimer's that are promising?

There are some great new medications coming out.  However, we need to be vigilant as most medications have side effects. We need to make sure that the cure isn’t worse than the problem it is treating. CareMore has a shared goal with caregivers: Maintain the patient’s independence and autonomy. So with all new drugs and therapies, caregivers are advised to do their research and consult with their clinician.