For the Love of Health

Reimagining Memory Care with Dr. Steven Huege

• ChristianaCare • Season 2 • Episode 18

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According to the Alzheimer's Association, nearly 7 million Americans are living with Alzheimer's. By 2050, that number is expected to grow to 13 million.As Delaware's aging population is expected to grow, the need for memory care is also increasing.

On this episode, Dr. Steven Huege endowed chair of ChristianaCare's Swank Center for Memory Care reveals how a multidisciplinary approach makes all the difference for patients and their families. You'll hear about the different conditions addressed by the Swank Center, their participation in the innovative GUIDE Program to assist caregivers, and what the future holds for memory care in terms of medications and cutting-edge treatments. If you're concerned about memory changes in yourself or a loved one, this is an episode not to be missed.

Steven Huege, M.D., MSEd is The Swank Foundation Endowed Chair in Memory Care and Geriatrics at ChristianaCare. He brings over two decades of experience to his clinical practice as a compassionate, dedicated board-certified geriatric psychiatrist. Dr. Huege sees older adults with behavioral and psychiatric symptoms related to neurocognitive disorders such as Alzheimer’s disease, Lewy Body Dementia, and FTD.


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Speaker 1:

The caregiver or family member becomes almost as much the patient as the patient themselves.

Speaker 2:

You're listening to For the Love of Health, a podcast about delivering care and creating health, brought to you by Christiana Care. And now here are your hosts.

Speaker 3:

Hello everyone, I'm Megan McGerman.

Speaker 2:

And I'm Jason Tokarski. Welcome to another episode of For the Love of Health brought to you by Christiana Care.

Speaker 3:

According to the Alzheimer's Association, nearly 7 million Americans are living with Alzheimer's. By 2050, that number is expected to grow to 13 million.

Speaker 2:

As Delaware's aging population is expected to grow, the need for memory care is also increasing. That's where today's guest comes in. Dr Stephen Hugie joins us today. He's the endowed chair of Christiana Care's Swank Center for Memory Care.

Speaker 3:

Steve, thank you so much for being here today.

Speaker 1:

Oh, thank you for having me.

Speaker 3:

Steve. The Alzheimer's Association reports 22,000 people 65 and older living with Alzheimer's in Delaware. Talk to us about that number. What does the memory care landscape look like in our region?

Speaker 1:

This is such an important issue because, if you look at that number, what that translates to is roughly 12% of Delawareans over the age of 65 who have Alzheimer's disease, so almost 1 in 10. The proportion of the population that is over 65, we're reaching an inflection point where that proportion that's over 65 is going to exceed the proportion that's under 18. And this is really unheard of in history. Really focusing on the care of older adults is going to become an increasingly important part of our society.

Speaker 2:

For people who are interested in the treatments that you offer. They're thinking memory care, they're probably thinking Alzheimer's and dementia and they may not know the difference between the two. So can you give us some detail about what conditions you're treating at Swank?

Speaker 1:

Absolutely so. That's often an important distinction. So dementia, the way we think about dementia is it's a broad category or syndrome of acquired cognitive impairment. So what that means is that a person was functioning at one level of cognitive performance and then, because of a medical illness, suddenly start to have problems with cognition. There's more than just memory to cognition. So the way I think about cognition is it's the way our brain takes in information from the external world, processes it and then allows us to interact with the world in meaningful and purposeful ways. So memory is one facet of that, but there are other things like visual, spatial abilities, what we call executive functioning, all these different facets of cognition. So dementia as a syndrome of acquired cognitive impairment.

Speaker 1:

Alzheimer's disease is one particular illness that causes dementia, and there are lots of other conditions that can cause dementia. For example, parkinson's disease can cause dementia. There's a similar related condition called Lewy body dementia. There's another condition called frontotemporal dementia, which tends to impact somewhat younger patients, so patients more in their late 50s, early 60s. We can see a lot of primary language and behavioral disturbances, whereas sort of classic kind of textbook Alzheimer's disease begins more as a disorder of short-term memory loss, begins more as a disorder of short-term memory loss, so problems recalling recent events, and then it eventually can spread to other. As it does spread to other parts of the brain, you can see deficits in other areas as well. So there's lots of conditions that can cause acquired memory loss, and so that's one of the things when patients come to Swank is we do a very thorough, comprehensive assessment to determine is this Alzheimer's disease or could this be some other condition?

Speaker 2:

Talk to us about the Swank Center for Memory Care here at Christiana Care and what makes it such a special and different program from what you might find in other healthcare systems around the country.

Speaker 1:

When I came here, the thing that really impressed me with our team and our program was just how cohesive and connected we all are.

Speaker 1:

The Swank Center is a multidisciplinary care team, so we have specialists in a variety of disciplines, including geriatric psychiatry, which is my personal background.

Speaker 1:

We have geriatricians, neurology, and we also have a number of other staff who are social work team or nursing staff who really work cohesively together.

Speaker 1:

And I think one of the things that patients who come to Swank maybe don't realize, because it's somewhat behind the scenes, is that you really have an entire team of professionals that are taking care of you and your family member, that are collaborating together, really sharing that expertise, because I'm a big believer that no one discipline has all the skill set necessary to take care of patients and their families. So it really is a team approach and I think that that's one of the things that really makes our program unique is that not only do we have a multidisciplinary team, there's also great communication, great coordination of care amongst our teams. Clinicians talk to each other frequently, we'll share cases, we are state-of-the-art, but we're also very focused and centered in our community. We have locations across the state. We're very committed to serving all of the state of Delaware and the surrounding communities. Part of our philosophy is really meeting patients and their families where they're at, understanding the unique needs of each community that we serve.

Speaker 3:

So you mentioned the need for multidisciplinary care and how important and a bit unique that is in your program. How does that show from a patient care perspective?

Speaker 1:

That shows in that you have a broad array of practitioners who are supporting you. If there are issues with falls or frailty, for example, our geriatricians have that expertise and really are equipped to handle those kinds of issues. If you have a patient, for example, our geriatricians have that expertise and really are equipped to handle those kinds of issues. If you have a patient, for example, who has more psychiatric or behavioral disturbances, we have the psychiatric expertise. If there's concerns, is there a possible co-occurring movement disorder or some other neurological condition, we have that expertise. All of these disciplines that can approach the patient together, but recognizing that different patients will have different care needs, different medical needs. And I think what sets us apart is that we're very intentional about this at Swank is that we don't want care that's siloed. So it's really all disciplines physicians, nurse practitioners, pas, social work, nursing all working together.

Speaker 2:

The Alzheimer's Association reports there's 31,000 family caregivers in Delaware bearing this burden of helping deal with the diseases of Alzheimer's and dementia. What is SWANC doing, and what should really all memory centers be doing, aside from ChristianaCare, to help those caregivers?

Speaker 1:

I think this is such an important part of really comprehensive memory care is focusing not just on the patient but also on their caregiver's unit. It can be adult children, it can be a spousal partner, it can be other friends. You know, again, we think of supportive caregivers as being very broad. There's different types of families for everybody, and so one of the things we're really excited about is that we are participating in the CMS Innovation Guide program. We're really excited to be rolling that out in our Wilmington location this summer.

Speaker 1:

Guide is a CMS innovation program that is centered on providing care, support and resources to caregivers of patients with living with dementia. And I think what Guide does is it allows us and health systems like Christiana to develop the infrastructure and the staff needed really to properly attend to the care needs of caregivers, because one of the things we find is that the caregiver or family member becomes almost as much of the patient as the patient themselves. And so what Guide does is it creates an infrastructure to help support the caregiver and meet them where they're at the focus. The center point of that is a care navigator, what we call memory support partner, so that is the point of contact for the caregiver and the patient, where that person then is their liaison to the rest of the SWANK guide team.

Speaker 1:

So what the memory support partner does and these are community health workers who have additional training and expertise in dementia care and dementia symptom management provide that initial point of contact, so somebody that the caregiver can reach out to and say you know, I'm having this problem or I'm worried about my family member getting lost or misplacing things. Our memory support partner is the initial point of contact. And then let's say it's an issue that maybe they need a social work question, then they can guide the caregiver to the social work, or maybe it's a nursing question or maybe it has to go up to our nurse practitioner or the physician level. But what you have is you have one person who is sort of the station master for your care. So we're so excited about this. I think that this for us, this really is the way that memory care should be provided and we're really excited to be part of a program that provides that infrastructure for support.

Speaker 2:

Tell us what you're looking forward to the most in terms of memory care, be it specifically for the SWANC program or, in general, for the field that you're in.

Speaker 1:

We have some new treatments that are coming on board and this is a new class of treatments that we're really excited about. For the past you know I graduated roughly almost 20 years ago now and from that time till very recently, there were two classes of medications that were purely symptomatic, so they didn't change the course of the illness. They gave some people some improvement. But now we have a new class of medications that was recently approved, within the past year or two, that changed the rate of illness. Now these medications are quite new and we're learning a lot about them. They're not for everybody, unfortunately. There's really strict monitoring and there's certain criteria that we have to look at and there's certain criteria that we have to look at. These medications, while holding great promise, they're also only indicated for people with very, very mild early disease. So again, really tremendous promise.

Speaker 1:

I sort of think about if you imagine where the field of cancer was maybe a generation or two ago. I'm very hopeful about the future that we're going to continue to develop even better treatments and treatments that are more preventative in nature. Expanding innovative programming like Guide those are some of the things that I'm really excited about. Also building the pipeline of folks to care for these patients. So I'm a geriatric psychiatrist. If you look nationwide, there's less than 50 geriatric psychiatrists trained annually, and not all geriatric psychiatrists focus exclusively on memory disorders. So one thing that I think has been a challenge for our field has been recruiting talented people into this field, and so we're developing some initiatives related to that. We have a PA nurse practitioner training program that we're developing that we're really excited about to help build this pipeline.

Speaker 3:

If someone is listening to this and isn't yet involved in your program, but is seeing signs in a family member that may be concerning, at what point should they call you? What are the warning signs?

Speaker 1:

I mean, certainly I think an important thing is making sure you have a good relationship with your primary care provider, but where I tell folks, where we start to become concerned are is there a change in this person's level of functioning. So it's one thing if you're somebody who you just never were good with names and you're not good with names, that's less worrisome than you know what. I used to never forget a face and now I can't remember who people are or if you're noticing difficulty functioning in your day-to-day environment. This is where sometimes folks who are still in the workforce may notice more subtle deficits because they're working there's more intellectual demand than maybe somebody whose lifestyle is much more pared down. So things that we worry about are is this person having difficulty in day-to-day functioning? Are they getting lost in familiar places? Are they misplacing things around the house? Often, are they missing bills, mismanaging medications? Sometimes we also see folks falling victim to scams and things like that. Again, that can happen, but is it happening frequently or repeatedly?

Speaker 1:

The other thing that we often also notice or that is when you start to see changes in personality or behavior and actually sometimes that's really the first indication that something might be happening, that sometimes it's's more, these behavioral psychiatric symptoms, so things like depression, severe anxiety, and even include psychotic symptoms, so like hallucinations, delusions, especially in somebody who has never had those kinds of symptoms before.

Speaker 1:

To me that would be a worrisome sign that you would want to get somebody assessed through a program like ours at Swank. I think an important take-home message is that you're not alone in this, that this can feel very isolating, and I know that you know a lot of our patients have also had other family members who may be their own parents or aunts or uncles or siblings, and it can feel very isolating. And what we hope is that through a comprehensive memory care program like Swank, that you have a team that's supporting you, that has the expertise and really knows how to be with you for this journey. These illnesses, unfortunately, can progress over years. If you look at the typical course of Alzheimer's disease, from initial onset of symptoms and diagnosis till end stage can be a decade. This is a long haul process and having the resources and expertise of a comprehensive program like SWANK can certainly facilitate or help ease some of the difficulties and burdens along that journey.

Speaker 3:

Steve, thank you so much for your time today and burdens along that journey.

Speaker 1:

Steve, thank you so much for your time today. Oh, thank you for having me and just the opportunity to share about what we're doing at Swank and how we're serving our community.

Speaker 2:

We'll have more information on Christiana Care's Swank Center for Memory Care in the show notes for this episode.

Speaker 3:

And don't forget, you can keep up with For the Love of Health on social media. Just search at Christiana Care on your favorite platform.

Speaker 2:

We'll be back in two weeks with another great conversation.

Speaker 3:

Until then, thanks for joining us for the Love of Health.

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Megan McGuriman

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