Patients with advanced dementia often need a BRO – VA News

Alzheimers. Dementia. These diagnoses tug at the strings of safety and certainty in patients, families and caregivers at an estimated rate of 6.5 million Americans age 65 and older in 2022 and approximately 168,600 VA patients in 2021. It’s a diagnosis expected to increase to 12.7 million Americans by 2050 and 217,400 VA patients over the next decade alone.

While a diagnosis is scary enough, so are the distressing behaviors that can be associated with the illness, such as verbal outbursts, inappropriate behavior, and even physical assaults. These often interfere with medical treatment and care which can harm the patient, carer or treatment team.

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As a young psychologist working at the Central Iowa Community Living Center, Dr. Kathleen Matthews saw these stressful behaviors firsthand and realized that these veterans could be better cared for through non-drug behavior plans rather than the traditional method of psychotropic medication.

Working with team members, he created the Behavioral Recovery Outreach (BRO) team to address the unmet needs of this highly vulnerable patient population.

BRO helps create a sense of connection and shared purpose to meet the needs of these veterans, Matthews said. By reducing distressing behaviors, especially given that Bro veterans tend to have very harsh behaviors, there is a sense of hope that these veterans can improve to the point where they can be discharged from the hospital environment even if it seems hopeless initially.

The engagement of the BRO teams makes the model of care work

The basic premise is to get to know the veteran as a person and use interventions such as redirection or offering alternatives to mitigate potential distress reactions. Sometimes it can be as simple as offering a different toothpaste to the veteran who refuses to brush his teeth, or it can be as complex as convincing the veteran that he’s already finished his work for the day if he’s fixating on his previous career.

While the highly individualized, holistic, veteran-focused approach is critical to addressing behavior care needs and developing effective behavior plans, it is the efforts of the interprofessional BRO teams that exist in approximately 15 VA facilities, including Minneapolis VA, the second VA site to establish a BRO team that makes this model of care work.

Behavioral neurologist Dr. Jamie Starks is the medical director of the VA BRO team in Minneapolis. His goal is to have all of the medical staff at his VA, including the medical residents and students he works with, build empathy for what these veterans are experiencing and provide a framework for why the behaviors occur.

Pictured above, Starks (right) and med student Amy Parkinson visit BRO veteran Richard Nick Knickerbocker.

Resident Physician assists BRO Veteran
Resident physician Leah Buda helps redirect veteran BRO Richard Jenkins.

In general, unmet needs or stress, such as no longer being able to communicate, lead to distressing behaviors, Starks said. Many behaviors are inadvertently caused by caregivers talking too fast, using too many words, and veterans not understanding why, for example, a stranger is helping them to the bathroom.

The feedback from healthcare professionals is extremely positive

As the BRO team learns about the veteran and finds behavioral interventions that work for that patient, the stressful behaviors often occur less frequently and may be less severe. This improves the quality of life of the veteran and his caregiver. When the veteran is ready to go home or be discharged to an assisted living or long-term care facility, the BRO team supports the veteran and caregivers by sharing the behavior plan and making visits for up to six months.

While BRO veterans often have longer lengths of stay, Starks says the results are worth it because they’re more stable when they leave the inpatient unit. He adds that the feedback from healthcare professionals is overwhelmingly positive. One of the biggest challenges is the stigma of dementia in the medical field as well.

Dementia isn’t considered a very glamorous field because we don’t have a pill or surgery that can cure things, she said.

But as her medical students and residents spend time with the BRO Veteransan an essential component in building the behavioral care plan, they see the humans behind the disease and find compassion as they provide care.

That’s the most important learning objective to me, Starks added, since these are people and not just problems.

VA salutes Dr. Jamie Starks, VA clinical educators, and the more than 1,400 educational institutions that partner with VA to train future health professionals.

These academic affiliations, some of which began more than 75 years ago, are coordinated by VA’s Office of Academic Affiliations (OAA). Learn more about VA’s academic mission by watching this video and visiting the Office of Academic Affiliations website.

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