The New England Journal of MedicineToward Gerineuropalliative Care for Patients with Dementia

Gerineuropalliative Dementia Care: A Comprehensive Approach for a Growing Crisis

In a landscape where more than 6.7 million Americans over the age of 65 live with dementia and are partially cared for by 11 million unpaid caregivers, a new integrated approach to dementia care, termed “gerineuropalliative care,” offers hope. By blending principles from geriatric, palliative, and dementia care, this approach aims to address the full scope of needs for patients and their families, attempting to rectify a fragmented healthcare system.

HCN Medical Memo
The proposed gerineuropalliative approach presents a blueprint for tackling the multifaceted challenges in dementia care. Your role is no longer just diagnosing and managing the disease but also involves navigating a complex emotional and social landscape. With emerging new payment models and the integration of palliative, geriatric, and dementia-specific care, there’s an opportunity to holistically support patients and their families, addressing both medical and psychosocial needs.

Key Points:

• A proposed gerineuropalliative approach would amalgamate geriatric, palliative, and dementia care principles.
• Physicians report alignment between palliative care needs and their core practices but face barriers like lack of training and difficulty in having challenging conversations.
• Gerineuropalliative care would also adapt to emerging research about different trajectories of decline and responsiveness to treatments in various dementia types.
• In July 2023, the Center for Medicare and Medicaid Innovation (CMMI) announced an 8-year test for a new alternative payment model, Guiding an Improved Dementia Experience (GUIDE), aiming to bolster home and community-based dementia care.

Just as advances in cancer treatments (e.g., immunotherapy) have increased the salience of geriatrics and palliative care for treating the whole person, the advent of disease-modifying treatments for dementia makes gerineuropalliative dementia care more pressing, given potentially burdensome treatment protocols and side effects, prognostic uncertainty, and the need to navigate discoordinated health care.

Additional Points:

• The US may have more than 13 million people living with dementia by 2060.
• Medical and nursing fellowships could incorporate training specific to gerineuropalliative dementia care.
• Barriers include limited visit time for primary care providers and the absence of robust, competent workforces trained in interdisciplinary dementia care.
• New payment models are essential for the success of this comprehensive approach, advocating for interdisciplinary teams including chaplains, home health aides, and therapists.

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