ECHO-AGE: an innovative model of geriatric care for long-term care residents with dementia and behavioral issues

J Am Med Dir Assoc. 2014 Dec;15(12):938-42. doi: 10.1016/j.jamda.2014.08.014. Epub 2014 Oct 11.


Objectives: To design, implement, and assess the pilot phase of an innovative, remote case-based video-consultation program called ECHO-AGE that links experts in the management of behavior disorders in patients with dementia to nursing home care providers.

Design: Pilot study involving surveying of participating long-term care sites regarding utility of recommendations and resident outcomes.

Setting: Eleven long-term care sites in Massachusetts and Maine.

Participants: An interprofessional specialty team at a tertiary care center and staff from 11 long-term care sites.

Intervention: Long-term care sites presented challenging cases regarding residents with dementia and/or delirium related behavioral issues to specialists via video-conferencing.

Methods: Baseline resident characteristics and follow-up data regarding compliance with ECHO-AGE recommendations, resident improvement, hospitalization, and mortality were collected from the long-term care sites.

Results: Forty-seven residents, with a mean age of 82 years, were presented during the ECHO-AGE pilot period. Eighty-three percent of residents had a history of dementia and 44% were taking antipsychotic medications. The most common reasons for presentation were agitation, intrusiveness, and paranoia. Behavioral plans were recommended in 72.3% of patients. Suggestions for medication adjustments were also frequent. ECHO-AGE recommendations were completely or partially followed in 88.6% of residents. When recommendations were followed, sites were much more likely to report clinical improvement (74% vs 20%, P < .03). Hospitalization was also less common among residents for whom recommendations were followed.

Conclusions: The results suggest that a case-based video-consultation program can be successful in improving the care of elders with dementia and/or delirium related behavioral issues by linking specialists with long-term care providers.

Keywords: Long-term care; dementia; telemedicine.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Dementia / complications
  • Dementia / therapy*
  • Female
  • Humans
  • Long-Term Care
  • Maine
  • Male
  • Massachusetts
  • Mental Disorders / complications
  • Mental Disorders / therapy*
  • Middle Aged
  • Nursing Homes*
  • Patient Care Planning*
  • Pilot Projects
  • Program Development
  • Program Evaluation
  • Psychomotor Agitation
  • Remote Consultation*